OPP Exam #3 Flashcards
(153 cards)
1
Q
if there is a renal lithiasis (kidney stone), it may cause the psoas to become hypertonic and you would have a positive
A
Thomas test
2
Q
if there is appendicitis, it may cause the psoas to become hypertonic and you would have a positive
A
Thomas test
3
Q
Goal of Counterstrain is to decrease
A
gamma gain
4
Q
Spencer techniques utilize
A
muscle energy, articular, lymphatic/myofascial techniques
5
Q
Lumbar spine will side-bend towards the…and rotate towards the..
A
long leg.. short leg
6
Q
Most commonly used form of contraction in muscle energy is
A
isometric contraction
7
Q
Take a history prior to physical examination
A
physical examination
8
Q
the first part of the physical examination
A
Observation/observing the patient move
9
Q
Isometric contraction used in muscle energy tenses the… causing….
A
Golgi Tendon organs
a reflex inhibition of the muscle allowing an increase in muscle length
10
Q
Translation to the right=
translation to the left=
A
left
right side-bending
11
Q
Pancreas chapman point and cause
A
- (think of Amylase/Lipase/Blood glucose)
- Anterior Chapman point: 7th intercostal space near sternum on right side
12
Q
Tight piriformis muscle would lead to
A
reduced hip internal rotation
13
Q
Coracoid process location
A
1” inferiorly from the most distal articulation of the clavicle
14
Q
Terrible triad consists of
A
- anterior cruciate ligament
- medial collateral ligament
- medial meniscus
15
Q
Transition zones are more susceptible to somatic dysfunction and where
A
OA, C7-T1, T12-L1, L5-S1
16
Q
A heel lift for a leg length difference may help prevent
A
osteoarthritis in a patient
17
Q
Posterior talus problem
A
decreased plantar flexion
18
Q
Anterior talus problem
A
decreased dorsiflexion
19
Q
If a muscle is torn, do not
A
stretch it
20
Q
T.A.R.T.
A
T: Tissue Texture Changes
A: Asymmetry
R: Restriction of motion
T: Tenderness
21
Q
somatosomatic reflex
A
localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures. For example, rib somatic dysfunction from an innominate dysfunction.
22
Q
somatovisceral reflex
A
localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures. For example, triggering an asthmatic attack when working on thoracic spine.
23
Q
viscerosomatic reflex
A
localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures. For example gallbladder disease affecting musculature.
24
Q
viscerovisceral reflex
A
localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures. For example, pancreatitis and vomiting.
25
5 Osteopathic Models
```
Biomechanical (structural, postural)
Neurological
Respiratory/circulatory
Metabolic/Nutritional
Behavioral (psychobehavioral)
```
26
Acute vs chronic
-Local increase in muscle tone, contraction, spasm, increased muscle spindle firing
Normal or sluggish ROM
May be minimal or no somatovisceral effects
-Decreased muscle tone, contracted muscles, sometimes flaccid
Restricted ROM
Somatovisceral effects more often present
27
Orientation of Superior Facets
BUM
BUL
BM
28
Orientation of Inferior Facets
AIL
AIM
AL
29
Anterior Lumbar Counterstrain Points
```
AL1 Medial to ASIS
AL2 Medial to AIIS
AL3 Lateral to AIIS
AL4 Inferior to AIIS
AL5 Anterior, superior aspect of pubic ramus, lateral to symphysis pubis
```
30
Psoas inserts on the
lessor trochanter of femur
31
The key somatic dysfunction initiating or perpetuating psoas syndrome is believed to be a
type II (non-neutral) somatic dysfunction (F Rx Sx) usually occurring in the L1 or L2 vertebral unit, where “x” is the side of side-bending of the somatic dysfunction
32
Psoas Syndrome
- The key, nonneutral (type II) somatic dysfunction at L1 and/or L2
- Sacral somatic dysfunction on an oblique axis, usually to the side of lumbar side-bending
- Pelvic shift to the opposite side of the greatest psoas spasm
- Hypertonicity of the piriformis muscle contralateral to the side of greatest psoas spasm
- Sciatic nerve irritation on the side of the piriformis spasm
- Gluteal muscular and posterior thigh pain that does not go past the knee, on the side of the piriformis muscle spasm
33
ME is
direct/active
34
HVLA is
direct/active
35
Counterstrain is
Indirect/Passive
36
Balanced ligamentous technique is
Indirect/Passive
37
Facilitated Positional Release is
Indirect/Passive
38
Examples of Indirect Techniques
Counterstrain
Facilitated Positional Release (FPR)
Balanced Ligamentous Tension Technique (BLT)
Functional Technique
Myofascial Release (may also be direct)
Cranial (may also be direct)
Still Technique (combined indirect and direct)
39
Examples of Direct Techniques
```
Soft tissue
Articulatory
Muscle Energy
High velocity, low amplitude (HVLA)
Springing
Myofascial Release (may also be indirect)
Cranial (may also be indirect)
Still Technique (combined indirect and direct)
```
40
Effleurage
Gentle stroking of congested tissue used to encourage lymphatic flow
41
Petrissage
Involves pinching or tweaking one layer and lifting it or twisting it away from deeper areas
42
Tapotement
striking the belly of a muscle with the hypothenar edge of the open hand in rapid succession in order to increase it’s tone and arterial perfusion. A hammering, chopping percussion of tissues to break adhesions and/or encourage bronchial secretions
43
Counterstrain interacts with
-Muscle spindle
Muscle length
rate of change of length
In parallel
44
Muscle Energy interacts with
```
-Golgi tendon
Muscle tension
Rate of change of muscle tension
In series
-Nociceptors
```
45
Postisometric Relaxation
- The physician isometrically resists contraction, then takes up the slack inaffected muscles during the relaxed refractory period.
- There may also be increased tension on Golgi organ proprioceptors in tendons with muscle contraction, which inhibits active muscle contraction.
- Physician Repositions Patient to Feather Edge of New Barrier
- Goal: muscle relaxation
- all three planes
46
Reciprocal Inhibition
- Relax and lengthen muscles in acute spasm.
- Patient is Instructed to GENTLY Push TOWARD the Barrier
- all three planes
47
Counterstrain: Steps of Treatment
- Maintain finger contact at all times (NOT PRESSING FIRM constantly, only monitoring!)(***continuous monitoring)
- Hold it for 90 seconds (that’s the time for ALL counterstrain points, including ribs)
- Return patient to neutral position SLOWLY!!
48
Facilitated Positional Release (FPR)
Body part in NEUTRAL position
COMPRESSION applied to shorten muscle/muscle fibers (some cases may have TRACTION instead)
Place area into EASE of motion (INDIRECT) for 3-5 seconds
Return body part to neutral
THIS TECHNIQUE IS INDIRECT!!!!
49
Still Technique
Tissue/joint placed in EASE of motion position (augments the somatic dysfunction)
Compression (or traction) vector force added
Tissue/joint moved through restriction (into and through the restrictive barrier) while maintaining compression (or traction) and force vector
THIS TECHNIQUE GOES FROM INDIRECT TO DIRECT!!!!
50
Epicondylitis lateral
Tennis elbow
51
Medial epicondylitis
Golfer’s elbow
52
Upper Extremity Counterstrain Points Subscapularis
Extension, internal rotation, and slight abduction of the humerus
53
Upper Extremity Counterstrain Points Levator Scapulae
internally rotation of arm/shoulder with traction and slight abduction
54
Upper Extremity Counterstrain Points Supraspinatus
Flex arm/shoulder 45 degrees
Abduct arm/shoulder 45 degrees
Externally rotate arm/shoulder
55
Upper Extremity Counterstrain Points Infraspinatus
Flex arm/shoulder 150 degrees
Internally rotate arm/shoulder
Abducts arm/shoulder
56
During pronation (radius and ulna)
Distal radius crosses over ulna and moves anteromedially
| Proximal radial head glides (moves) posterior
57
During supination (radius and ulna)
Distal radius moves posterolaterally
| Proximal radial head glides (moves) anterior
58
most common radius/ulna disfunction and what does it inhibit
Posterior radial head is the most common dysfunction, leading to loss of forearm supination
59
Falling forward on an outstretched hand leads to a.... and can inhibit
- Falling forward on an outstretched hand leads to a posterior radial head
- Forearm resists supination
60
Falling backward on an outstretched hand leads to ... and can inhibit
- Falling backward on an outstretched hand leads to an anterior radial head
- Forearm resists pronation
61
Short-lever Evaluation & Diagnosis of Radius
- Palpate radial head
- With distal hand induce pronation & supination at the wrist proximal to the carpal bones
- A/P glide & rotation should be palpable, esp. at extremes of supination & pronation
62
radius during pronation and supination
```
Pronation = posterior
Supination = anterior
```
63
long lever Evaluation & Diagnosis—Radius
- With elbows at the side and bent to 90º, grasp both wrists proximal to carpal bones and induce supination & pronation at the extremes of motion
- Isolates motion of radius, ulna & interosseous membrane at end-point of supination & pronation
64
Radial Head, Pronation DysfunctionStill Technique (treatment)
- The patient is seated on the table, and the physician stands in front of the patient.
- The physician holds the patient's hand on the dysfunctional arm as if shaking hands with the patient.
- The physician places the index finger pad and thumb of the other hand so that the thumb is anterior and the index finger pad is posterior to the radial head (Fig. 13.58).
- The physician rotates the hand into the indirect pronation position and pushes the radial head posteriorly with the thumb until the ease barrier is engaged (Fig. 13.59).
- Finally, the physician, with a moderate acceleration through an arclike path of least resistance, supinates the forearm toward the restrictive bind barrier (Fig. 13.60) and adds an anterior directed counterforce (arrow, Fig. 13.61) with the index finger pad.
- The release may occur before the barrier is met. If not, the radial head must not be carried more than a few degrees beyond.
- The physician reevaluates the dysfunctional (TART) components.
65
Radial Head, Pronation DysfunctionStill Technique (diagnosis)
- Symptoms: Elbow discomfort with inability to fully supinate the forearm
- Motion: Restricted supination of the forearmPalpation: Tenderness at the radial head with posterior prominence of the radial head
66
Radial Head, Supination Dysfunction Still Technique (Diagnosis)
- Symptoms: Elbow discomfort with inability to fully pronate the forearm
- Motion: Restricted pronation of the forearmPalpation: Tenderness at the radial head with anterior (ventral) prominence of the radial head
67
Radial Head, Supination Dysfunction Still Technique (treatment)
- The patient is seated on the table, and the physician stands in front of the patient.
- The physician holds the patient's hand on the dysfunctional arm as if shaking hands with the patient.
- The physician places the index finger pad and thumb of the other hand so that the thumb is anterior and the index finger pad is posterior to the radial head (Fig. 13.62).
- The physician rotates the hand into the indirect supination position (Fig. 13.63) and pushes the radial head anteriorly (arrow, Fig. 13.64) with the index finger pad until the ease barrier is engaged.
- Finally, the physician, with moderate acceleration through an arclike path of least resistance, pronates the forearm toward the restrictive bind barrier and adds a posterior directed counterforce (arrow, Fig. 13.65) with the thumb.
- The release may occur before the barrier is met. If not, the radial head must not be carried more than a few degrees beyond.
- The physician reevaluates the dysfunctional (TART) components.
68
Somatic Dysfunction of the Elbow Joint (Abducted Ulna
| )
Named for freedom of motion
Olecranon process has a medial glide
Distal Ulna Abducts (moves laterally)
69
Somatic Dysfunction of the Elbow Joint (Adducted Ulna
| )
Named for freedom of motion
Olecranon process has a lateral glide
Distal Ulna Adducts (moves medially)
70
Upper Extremity Sympathetics (nerves and disfunction)
-T2 – T8
-Dysfunction of the upper thoracic spine and ribs may increase sympathetic tone to the upper extremity
Increased sensitivity to pain, decreased blood flow and lymphatic return
71
Branchial plexus Nerve roots pass between
pass between the anterior and middle scalenes
72
Branchial plexus Nerve trunks pass between
From the scalene triangle to the clavicle
73
Branchial plexus Nerve divisions pass between
posterior clavicle to axilla
74
Branchial plexus Nerve cords pass
axilla
75
Branchial plexus nerves
C5-8, T1
76
Branchial plexus Neurovascular bundle contents
Subclavian artery and vein
Brachial plexus
Sympathetic nerve plexus
77
Neurological Exam of UE C4
Sensation: shoulder
Motor:
reflex:
78
Neurological Exam of UE C5
Sensation: lateral elbow
Motor: bicep
reflex: bicep
79
Neurological Exam of UE C6
Sensation: thumb, index finger
Motor: wrist extensors
reflex: brachialradialis
80
Neurological Exam of UE C7
Sensation: mid finger
Motor: tricep
reflex: tricep
81
Neurological Exam of UE C8
Sensation: ring finger, pinky
Motor: wrist flexor
reflex:
82
Neurological Exam of UE T1
Sensation: medial elbow
Motor: interossi
reflex:
83
Thoracic Outlet Syndrome (TOS) Entrapment Sites
```
-Scalene triangle
Anterior and middle scalenes
Brachial plexus, subclavian artery
-Costoclavicular space
1st rib and clavicle
-Brachial plexus, subclavian artery and vein
Subcoracoid space
Overlying ribs under pectoralis minor attachment at coracoid process
```
84
TOS Diagnosis (Adson’s test)
- Neck extended turned toward affected side
- Narrows the interscalene space
- Modified version (Reverse Adson’s) - turn head to opposite side
- For cervical rib
85
TOS Diagnosis (Costoclavicular (Halsted) maneuver)
- Exaggerated military posture
- scapula retracted and depressed
- chest protruding
- Narrows the costoclavicular space
86
TOS Diagnosis (Wright’s (Hyperabduction) maneuver)
- shoulder external rotation
- abduction beyond 90°
- Compression below the pectoralis minor insertion
87
TOS Diagnosis (EAST test (Roo’s test))
- shoulders externally rotated and abducted to 90°; elbows flexed to 90 °
- open and close hands repeatedly for up to three minutes
88
Rotator Cuff muscles and actions
Supraspinatus – Abduction
Infraspinatus - External rotation
Teres Minor – External rotation
Subscapularis – Internal rotation
89
Most commonly torn rotator cuff muscle is
supraspinatus
90
Rotator cuff tear leads to weakness of the shoulder and difficulty with
overhead activity
91
Shoulder Abduction Movement sequence
Supraspinatus
Deltoid 0-90
Trapezius 90-150
Erector Spinae 150-180
92
Glenohumeral Motion
The scapula must upwardly rotate to allow overhead activity.
1st 30-45o of humeral abduction is GH with little motion of scapula.
Then, for every 15o of abduction there is 10o at GH joint and 5o at the scapulothoracic joint.
Therefore, ROM ratio glenohumeral to scapulothoracic is 2:1
93
Humeral dislocation usually occurs
anteriorly and inferiorly
94
Mid-shaft fracture of the humerus would most likely impair
extension at the wrist
95
Neer's test (how and what does it check)
- stabilize scapula
- pronate arm
- maximum flexion of arm (arm straight above head)
- pain resulting from subacromial impingement
96
Carpal Tunnel Contents
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
Median nerve
97
Carpal Tunnel Syndrome
- Median nerve compression within tunnel (entrapment neuropathy)
- Pain, paresthesia, weakness (Palmar surface of the thumb, index, middle and ½ of ring finger)
- May lead to thenar atrophy
98
Phalen and prayer test for carpel tunnel
- Wrist flexion to maximum for 60 seconds
| - opposite
99
Provocation Test
Compress and hold over transverse carpal ligament
100
DeQuervain (or stenosing) tenosynovitis
This condition is a stenosing tenosynovitis of the thumb
-Extensor pollicis brevis
-Abductor pollicis longus
Repetitive movements of the thumb cause inflammation within tendon sheath
-Swelling around anatomic snuffbox
101
Finkelstein test indicative and how
DeQuervain (or stenosing) tenosynovitis
| -put thumb in fist and ulnar deviation
102
Apley’s Scratch Test
Active Shoulder Range-of-Motion
103
Apprehension Test
Anterior Shoulder Instability/Integrity of Glenohumeral Joint Capsule
104
Cozen Test
Tests for Lateral Epicondylitis
With the patient’s wrist immobilized, the pain is reproduced when patient extends their wrist against resistance.
105
Drop Arm Test
Supraspinatus Muscle Tear
106
Spurling Test
Radicular Symptoms/Nerve root compression/Neural foraminal narrowing
107
Empty Can Test
Supraspinatus Muscle Tear
108
Yergason Test
Tear of Transverse Humeral Ligament
| Dislocation of Biceps Tendon in Bicipital Groove
109
Allen Test
Radial and ulnar artery patency
110
Hip Drop Test
Thoracolumbar/Lumbar Side-Bending Abnormality
111
Straight Leg Raising (SLR) Test and Contralateral Straight Leg Raising test for
Herniated Lumbar Disc (L1-L5, S1)
112
Bragard Test
Herniated Lumbar Disc (L1-L5, S1)
| -dorsiflex and drop leg
113
Thomas Test
Hip Flexion Contracture (Psoas Muscle Hypertonicity)
114
Babinski Reflex
Upper Motor Neuron Pathology
115
Hoover Test
Malingerer
116
Q (quadriceps) angle
- is the angle formed by intersection of the functional longitudinal axis of the femur and the tibial longitudinal axis
- Lower extremity alignment influences function
117
normal Q (quadriceps) angle
Normally measures between 10-12 degrees
118
Lateral collateral ligament restricts
Limits lateral glide
119
Medial collateral ligament restricts and attachment
-Limits medial glide
| Attaches to meniscus
120
Anterior cruciate ligament restricts and attachment
Limits excessive anterior glide
| Anterior tibial attachment
121
Posterior cruciate ligament restricts and attachment
Limits excessive posterior glide
| Posterior tibial attachment
122
Lateral collateral ligament (LCL) test
```
varus stress (foot in)
-Be sure to hold ABOVE the knee
```
123
Medial collateral ligament test
valgus stress (foot out)
124
Lachman’s Test
Apply an anterior force on the tibia while stabilizing the thigh. Positive if laxity
BEST TEST FOR ACL INTEGRITY.
125
posterior cruciate ligament (PCL)
Sag test and post. drawer test
126
The medial meniscus IS attached to the
MCL
127
The lateral meniscus IS NOT attached to the
LCL
128
Patellar Grind Test
Assessment of posterior patellar articulatory surface
Pt supine with knee extended
Dr applies posterior pressure onto patella
Dr may articulate patella or ask pt to actively extend knee
Considered positive with elicited pain or apprehension
129
Patellofemoral tracking syndrome (Chondromalacia) would give a positive
This would have a positive patellofemoral grind test
130
pronation Effect on Distal Fibula
Causes posteromedial movement
131
pronation of foot =
Dorsiflexion
Abduction
Eversion
132
Supination of foot =
Plantar Flexion
Adduction
Inversion
133
supination Effect on Distal Fibula
Causes anterolateral movement
134
Medial longitudinal arch includes
talus, navicular, cuneiforms, 1st – 3rd metatarsals
135
Lateral longitudinal arch includes
calcaneus, cuboid, 4th and 5th metatarsals
136
Transverse arch includes
navicular, cuneiforms, cuboid, proximal metatarsal ends
137
Fallen Arch causes
Talus anteriorly rotates
Navicular glides inferomedially
Cuboid glide inferolaterally
Cuneiforms glide inferiorly
138
Tenderness to palpation of the lateral foot distal to the calcaneous caused by
laterally rotated cuboid
139
Tenderness to palpation of the medial foot distal to the talus caused by
medially rotated navicular
140
Somatic Dysfunction Transverse Arch
- Cuboid (lateral) tends to move laterally around an AP axis (eversion)
- Edge is prominent midline on the plantar surface
- Navicular (Medial) tends to move medially around an AP axis (inversion)
- Edge is prominent midline on the plantar surface
- Cuneiform (inferior)-glides directly in plantar direction
141
Ankle Sprains 1st Degree
Ligament integrity
Conservative care
ATF
142
Ankle Sprains 2nd Degree
Partial tearing (slight laxity)
Usually no need for surgery
ATF and CF
143
Ankle Sprains 3rd Degree
Complete rupture
Immobilization
Surgery rarely indicated
ATF, CF, and PTF
144
MOST COMMONLY INJURED LIGAMENT IN AN INVERSION ANKLE SPRAIN IS THE
ANTERIOR TALOFIBULAR (ATF)
145
Treatments of the FootMedial Ankle Counterstrain Point
- Location: Anterior Tibialis m.
1. Patient lies lateral recumbent. Place a pillow under the medial aspect of the distal tibia to create a fulcrum.
2. Apply an inversion force to the foot and ankle with slight internal rotation of foot until the tenderness reduced.
3. Re-assess
146
Treatments of the FootLateral Ankle Counterstrain Point
- Location: Fibularis Longus, Brevis, or Tertius m.
1. Patient lies in lateral recumbent position. Physician places a pillow under the lateral aspect of the distal tibia to create a fulcrum.
2. Physician applies an eversion force to the foot and ankle with slight external rotation of the foot until the tenderness is reduced.
3. Reassess
147
Posterior Fibular Head HVLA
1. Patient lies prone with dysfunctional knee flexed at 90 degrees.
2. Physician stands at the side of the table opposite the side of the dysfunction.
3. Physician places cephalad hand behind dysfunctional fibular head.
4. Physician’s caudad hand grasps ankle on dysfunctional side and flexes knee to restrictive barrier.
5. Patients foot and ankle are externally rotated to carry fibular head back against physician’s cephalad hand.
6. Physician’s caudad hand delivers a thrust toward patient’s buttocks, which then causes fibular head to move anteriorly.
* **An anterior thrust is applied at the fibular head
148
Posterior Fibular Head HVLA
1. Patient lies supine with dysfunctional knee flexed at 90 degrees.
2. Physician stands on the same side of the table as the dysfunction.
3. Physician places cephalad hand behind dysfunctional fibular head.
4. Physician’s caudad hand grasps ankle and/or tibia on dysfunctional side.
5. Physician either dorsiflexes, everts, and externally rotates the ankle or externally rotates the tibia into the restrictive barrier.
6. Physician delivers short HVLA thrust with caudad hand to approximate calcaneus to ischial tuberosity, and the cephalad hand acts as a fulcrum.
* **An anterior thrust is applied at the fibular head
149
Anterior Fibular Head HVLA
1. Patient lies supine.
2. Physician’s caudad hand plantar flexes, inverts, and internally rotates patient’s ankle to bring distal fibular more anterior.
3. Physician places cephalad hand over the anterior surface of proximal fibula.
4. A thrust is delivered through the fibular head straight back toward the table.
* **A posterior thrust is applied at the fibular head
150
Tennis Elbow and Related Injuries: Ligamentous Articular Strain Technique
- flex wrist and pronate arm
- grasp olecranon between index finger and thumb
- compress forearm between two hands until at balance point
- extend elbow keeping pressure
151
Inversion ankle sprain will cause
anterolateral distal fibular head
post. fibular head
externally rotated tibia
152
right inversion ankle sprain will cause what to the sacrum
right sacral rotation
lumbar left
thoracic right
cervical left
153
DeQuervain (or stenosing) tenosynovitis muscles affected and symptoms
Extensor pollicis brevis
Abductor pollicis longus
Swelling around anatomic snuffbox
