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Flashcards in OS Exam 2 Deck (230):
1

How many cervical vertebra do we have

7

2

The atlas lacks what vertebral structure

Has no vertebral body

3

What is the atypical feature of C2

Dens (odontoid process)

4

Articular facets in the cervical spine are oriented in what direction

Superior: upward toward eye
Inferior: point toward opposite shoulder

5

C2-c7 follow what type of mechanics

type II

6

From a lateral view. We can check alignment along what imaginary lines

Anterior vertebral line
Posterior vertebral line
Spinolaminar line
Posterior spinous line

7

What view must you use for x ray of the dens

AP (anteroposterior view) with an open mouth

8

What do we think is the cause of cervical spine somatic dysfunction

Compensatory after for dysfunction of lower parts of spine

9

Rotational testing in the. Cervical spine. Requires us to contact lateral mass (lateral to spinous process) and rotate them in what plane

Transverse plane

10

If you induce a force in the transverse plane on the left lateral mass what motion are we inducing in cervical vertebra

Rotate right

11

Translation of cervical vertebra (lateral segment movement: left to right or right to left) induces motion in which plane

Coronal plane

12

If we move a cervical vertebra in the coronal plane: translation from left to right what do we document this motion as

Sidebent left

13

If there is more restricted motion in the cervical vertebra while the neck is flexed how would we name it

Extension dysfunction

14

Which part of the chart should include documentation of somatic dysfunction

Objective portion (of SOAP note)

15

Normal flexion of the neck

45-90

16

Normal extension of the neck

45-90

17

Normal side bending of the neck

45

18

Where do we palpate while checking cervical ROM actively and passively

At the C7-T1 junction

19

Normal rotation of the neck

70-90

20

What are the major motions of OA joint

Flexion and extension (Sagittal plane motion)

21

What type of mechanics are displayed at the OA joint

Flex/extend but SB/Rot to opposite directions ALWAYS making it modified type I

22

To assess restriction of motion at the OA joint contact posterior occipital with middle finger and lateral aspect with index finger. Assess rotation right by lifting anterior on which side?

Left

23

To assess restriction of motion at the OA joint contact posterior occipital with middle finger and lateral aspect with index finger. Assess side bending left by inducting what motion?

Translation

24

antlantoaxial joint (AA) has what primary motion

Rotation (atlas rotates around dens)

25

To assess restriction of motion at the AA joint contact posterior occiput and place fingers on AA joint. Fully flex the head and neck to take out inferior segments. In this position we can check what motions for restriction?

Rotate right and left

26

We must assess OA and AA joint restriction of motion in what positions?

Neutral, flexed, and extended

27

We can also translate left or right in the sagittal plane at C3-7 by placing our fingertips where before inducing lateral motion

Tip of transverse process

28

Floor of thoracic cavity

Diaphragm

29

3 parts of sternum

Manubrium, body, xiphoid

30

The xiphoid remains cartilaginous until when

40. Years

31

The head of rib 6 articulates with what structure on vertebra?

Inferior costal facet of T5 AND Superior costal facet T6

32

The transverse costal facets on transverse processes of vertebra articulate with what

Rib tubercle of the same numbered rib

33

Ligament holding head of rib into costal facets of adjacent vertebra

Radiate ligament

34

Rib tubercle held in place by what ligaments

Superior, lateral, Intertransverse and costotransverse ligament

35

Thoracic and lumbar vertebra follow Fryette's laws of what type

Both type I (N, group of vertebra) and type II (F or E, one segment)

36

Main motion of thoracic spine

Rotation (because of ribs we can't do much else)

37

Where in the spine can we do the most rotation? Second most?

Most- AA joint
Second most- thoracic vertebra

38

Why can we flex more than extend in thoracic spine

Because of the natural kyphotic curve

39

Where do we find sympathetic ganglion

Paravertebral ganglia of sympathetic trunks

40

Visceral distrubance often causes increased musculoskeletal tension in somatic structures innervated from the same spinal level. How can we reduce somatic afferent input thus reducing somatosympathetic activity to the organ

OMT treatment! treat at the transverse process that is tense

41

Which spinal segments correspond to sympathetics that supply the head and neck

T1-4

42

Which spinal segments correspond to sympathetics that supply the heart

T1-5

43

Which spinal segments correspond to sympathetics that supply the lungs

T2-7

44

Which spinal segments correspond to sympathetics that supply the upper abdominal viscera (stomach, liver, gallbladder, spleen, pancreas, duodenum)

T5-9

45

Which spinal segment corresponds to spine of scapula? Inferior angle of scapula?

T3 for spine
T7 for inferior angle

46

Which spinal segments correspond to sympathetics that supply the lower abdominal viscera (Pancreas, duodenum, jejunum, ilium, proximal and 2/3 of transverse colon)

T10-11

47

Which spinal segments correspond to sympathetics that supply the remainder of lower abdomen (distal 1/3 transverse colon, descending colon, sigmoid colon, rectum)

T12-L2

48

Which rib articulates posteriorly with cephalon border of scapula

Rib 1

49

Which rib anteriorly articulates with manubriosternal junction

Rib 2

50

Which rib attaches posteriorly at the level of the scapular spine

Rib 3

51

Which rib anteriorly attaches to xiphoid thermal junction and posteriorly at inferior angle of scapula

Rib 7

52

Which rib has cartilage at lowest part of thoracic cage at midclavicular line

Rib 10

53

Which are the true ribs (attach to sternum via own costal cartilage)

1-7

54

Which are false ribs (cartilage connected to those above before connecting to sternum)

8-10

55

Which ribs are floating (no eternal attachment

11-12

56

Which ribs are "typical" (with head neck tubercle and body)

3-9

57

What makes rib 1 atypical?

Single facet on head since it articulates with only T1, groove for subclavian artery and vein, scalene tubercle for anterior scalene attachment

58

What makes rib 2 atypical?

Tuberosity for serratus anterior

59

What makes rib 10-12 atypical?

Single facet on head because they articulate with ONLY ONE vertebra

60

What makes rib 11-12 atypical?

No neck or tubercle

61

What is the motion of ribs that is analogous to flexion / extension (rib 1-6 moves anteriorly)

Pump handle motion

62

What is the motion of ribs that is analogous to abduction/ adduction (rib 1 and 7-10 moves laterally)

Bucket handle motion

63

What is the motion of ribs that is analogous to internal/ external rotation (rib 11-12 pivoting because they have no anterior attachment)

Caliper motion

64

How would you characterize a dysfunction of ribs where the anterior ribs lift during inhalation and then remain there during exhalation

Inhalation Pump handle dysfunction (causes narrowing of intercostal space. Above dysfunction)

65

How would you characterize a dysfunction of ribs where the ribs don't lift laterally during inhalation

Exhalation bucket handle function

66

If a rib has an inhalation dysfunction, which rib is the key rib to treat in this dysfunction

Lowest rib in dysfunction

67

If a rib has an exhalation dysfunction, which rib is the key rib to treat in this dysfunction

Uppermost rib in dysfunction

68

What is the number 2 reason for patient to go to doctor

Lower back pain

69

Majority of back pain does not require surgical intervention. Most of this pain is due to what?

Mechanical dysfunction

70

What can be some mechanical and non mechanical causes of low back pain

Mech: arthritis, spondylosis, spondylolisthesis, degenerative disc disease, somatic dysfunction
Non-mech: renal colic, endometriosis, abdominal aortic aneurysm

71

What motion do lumbar vertebra most easily do

Flexion and extension (because of the orientation of superior and inferior facets)

72

What is sacralisation of L5

Fusion of L5 to sacrum

73

What is lumbrasation of S1

Looseness of S1 from sacrum causes it to act like a lumbar vertebra

74

Flexion occurs in what plane

Sagittal

75

Rotation occurs in what plane

Transverse plane

76

In what plane does side bending occur

Frontal plane

77

When you flex lumbar spine what happens at sacral spine

Extension (they are moving in opposite directions)

78

How do we remember the directionality of type I mechanics

TONGO (type one neutral group opposite) side bending and rotation occur in opposite directions

79

What is a scotty dog fracture? (We know it occurred because our scotty dog has a collar)

Pars interarticularis fracture or separation- spondylolysis (if this is present bilaterally then sponlylolysthesis aka slippage anteriorly is more likely)

80

Which muscles maintain type II mechanics in lumbar spine

Short restrictors (multifidus, rotators, interspinales, intertransversaris)

81

What happens when you herniate a disc in the vertebra

Nucleus pulposus leaks through annulus fibrosus and can compress the spinal cord

82

Type one mechanics of spine are maintained by what muscles

Long restrictors (iliocostalis, longissimus, spinalis)

83

Dermatome covering anteromedial thighs and knee

L4

84

Dermatome converting posterolateral thigh and lateral leg

L5

85

Dermatome covering posterior thigh, leg, and plantar foot

S1

86

Knee jerk tests what spinal segment reflex

L4

87

Ankle jerk (achilles reflex) tests what spinal segment reflex

S1

88

what are the cauda equina symptoms that serve as red flags for lower back pain

Saddle anesthesia, new onset of bladder or bowel dysfunction, neurological symptoms that are severe or progressive

89

Red flags for low back pain

Over 50 or under 20, history of cancer, past trauma, cauda equina symptoms, constitutional symptoms

90

What are constitutional symptoms that serve as red flags in low back pain

Fever, chills, unexplained weight loss, recent bacterial infection, IV drug abuse, immunosuppression, nighttime pain severe

91

Failure of lamina to fuse causes what condition

Spina bifida (usually because of neural tube defects)

92

What do we give moms to prevent spina bifida in their kiddos

Folate

93

Which form of spina bifida causes tuft of hair near l5-s1 and is asymptomatic

Occulta

94

What type of spina bifida forces meninges of spinal cord out into vertebral spaces

Meningocele

95

What type of spina bifida forces meninges and spinal cord of spinal cord out into vertebral spaces

Myelomeningocele

96

Spinal cord terminates where

L1-L2

97

What conditions can compromise spinal canal via stenosis

Posterior longitudinal ligament hypertrophy, ligamentum flavin thickens, osteoarthritis, osteophytes, tumors, disc rupture

98

What are tender points that act as clues for visceral dysfunction (palpable small smooth, firm nodule)

Chapman reflexes

99

Chapman checks what anterior points for the little nodules

Periumbilical area (adrenal, kidney, bladder)
5th intercostal (stomach liver)
6th (stomach, liver, gallbladder)
7th (spleen, pancreas)

100

Chapman checks what posterior points for the little nodules

Kidney, bladder, urethra, uterus, colon, pelvic organs

101

What is something we need to be careful and aware of with LBP management?

Drug addiction is real- Try not to get your patients addicted to the good good (narcotics)

102

According to the rule of 3's where can you find spinous process for T1-T3

At the same level of the corresponding transverse process

103

According to the rule of 3's where can you find spinous process for T4-T6

Located 1/2 segment below corresponding transverse process

104

According to the rule of 3's where can you find spinous process for T7-T9

Located 1 spinal segment below the corresponding transverse processes

105

According to the rule of 3's where can you find spinous process for T10

Located 1 spinal segment below the corresponding transverse processes

106

According to the rule of 3's where can you find spinous process for T11

Located 1/2 spinal segment below the corresponding transverse processes

107

According to the rule of 3's where can you find spinous process for T12

Located at the same level as the corresponding transverse processes

108

T5-9 transverse processes correspond to the sympathetics that innervate what visceral structures

Stomach, liver, gallbladder, spleen, part of pancreas and duodenum

109

T10-11 transverse processes correspond to the sympathetics that innervate what visceral structures

Part of. Pancreas and duodenum, jejunum, Ilium, ascending. Proximal and 2/3 of. Transverse. Colon

110

T12-L2 transverse processes correspond to the sympathetics that innervate what visceral structures

Distal 1/3 transverse colon, descending and sigmoid colon, rectum

111

Intercostal spaces are named according to the rib forming which of their borders

Superior (so 4th intercostal space is between ribs 4-5)

112

What is the name of the space and nerve running inferior to T12

Subcostal

113

Which muscles help during inhalation

External intercostals, diaphragm

114

What muscles help us exhale

Rectus abdominus, internal and external obliques, transverse abdominis

115

Accessory muscles of inhalation and exhalation

Inh: SCM, scalene
Exh: passive recoil

116

Dysfunction of the thoracic wall can increase risk of atelectasis. What is atelectasis?

Complete or partial lung collapse

117

Why can rib fractures cause. Increased risk of atelectasis and infection??

Rib fracture causes pain with inhalation so patients stop taking deep breaths and this can cause alveoli to collapse

118

Pinpoint tenderness at Costochondral junction can indicate costodhondritis which we treat how?

NSAIDS, OMM (rib, thoracic spine, sternum, lymph treatment)

119

Latrogenic affects are those brought on by medical procedures. What procedures can cause rib dysfunction?

Thoracotomy
Lobectomy
Sternotomy (done in conjunction with CABG)

120

Sympathetic innervation that supplies the thyroid comes from which spinal segments

C6-t1

121

Sympathetic innervation that supplies the bronchus comes from which spinal segments

T2-3

122

Sympathetic innervation that supplies the lung comes from which spinal segments

T1-6

123

Sympathetic innervation that supplies the pleura comes from which spinal segments

T1-11

124

Sympathetic innervation that supplies the heart comes from which spinal segments

T1-5

125

Sympathetic innervation that supplies the myocardial septa comes from which spinal segments

T2

126

Sympathetic innervation that supplies the myocardial anterior wall comes from which spinal segments

T3-4

127

Sympathetic innervation that supplies the myocardial posterior wall comes from which spinal segments

T4-5

128

Sympathetic innervation that supplies the myocardial arrhythmia comes from which spinal segments

T2

129

Sympathetic innervation that supplies the chronic cardiac disease comes from which spinal segments

C5-7

130

Sympathetic innervation that supplies the stomach comes from which spinal segments

T5-9 (left)

131

Sympathetic innervation that supplies the duodenum comes from which spinal segments

T10 (right)

132

Sympathetic innervation that supplies the gallbladder comes from which spinal segments

T9 right

133

Sympathetic innervation that supplies the liver comes from which spinal segments

T5-9. Right

134

Sympathetic innervation that supplies the pancreas comes from which spinal segments

T6-9

135

Sympathetic innervation that supplies the kidney and ureters comes from which spinal segments

T10-l1

136

Sympathetic innervation that supplies the ovaries/ testes comes from which spinal segments

T10-l1

137

Sympathetic innervation that supplies the adrenals comes from which spinal segments

T10-l1

138

Sympathetic innervation that supplies the appendix comes from which spinal segments

T11-l2 right

139

Sympathetic innervation that supplies the uterus comes from which spinal segments

T10-L2

140

Sympathetic innervation that supplies the urinary bladder/ prostate comes from which spinal segments

L1-2

141

Sympathetic innervation that supplies the colon comes from which spinal segments

T8-L2

142

Sympathetic innervation that supplies the rectum/ anus comes from which spinal segments

L1-2

143

Parasympathetic innervation that supplies the viscera from pharynx to descending colon comes from where

Vagus nerve

144

Parasympathetic innervation that supplies the viscera from descending colon to pelvic organs comes from where

Sacral plexus (S2-4)

145

TART indicates somatic dysfunction. what does TART stand for?

Tissue texture changes
Asymmetry
Restriction of Motion
Tenderness

146

what are acute vs chronic Tissue Texture findings?

acute: warm, moist, red, inflamed, boggy muscle, increased muscle tone/ spasm

chronic: cool, pale, increased sympathetic tone, ropy muscle, faccid muscle

147

whats the term describing: abnormal shortening of muscle due to fibrosis

contracture

148

what are acute vs chronic Restriction of Motion findings?

acute: sluggish (guarding)

chronic: limited, painless ROM

149

what kind of abnormal end feel is associated with protective spasm after injury

early muscle spasm

150

what kind of abnormal end feel is associated with chronic muscle spasm

late muscle spasm

151

what kind of abnormal end feel is associated with frozen shoulder

hard capsular

152

what kind of abnormal end feel is associated with synovitis (such as knee swelling after injury)

soft capsular

153

what are acute vs chronic tenderness findings?

acute: sharp, severe

chronic: dull, ache, paresthesias

154

expected PROM for hip flexion

90

155

expected PROM for hip extension

15-30

156

which portion of the chart would include somatic dysfunction

objective portion (note the side of laterality)

157

expected PROM for hip external rotation

40-60

158

expected PROM for hip internal rotation

30-40

159

expected PROM for hip abduction

45-50

160

expected PROM for hip adduction

20-30

161

expected PROM for knee internal rotation

10

162

expected PROM for knee external rotation

10

163

what type of force do you apply when accessing abduction of the knee joint

varus

164

what type of force do you apply when accessing adduction of the knee joint

valgus

165

what do we do to access proximal fibula at the knee joint

with thumb and index finger, apply anterior and posterior force to assess for gliding motion of fibular head

166

what motions do we need to check for glenohumoral stability

shoulder flexion (180), extension(60), abduction(180), adduction(40-50), internal and external rotation(both 90)

167

how can one assess the rotational ability of the acromioclavicular joint

while the pt is in 60 degree of both coronal and horizontal abduction, internally and externally rotate the glenohumeral joint

168

what motion occurs in the sternoclavicular joint when the patient is lying supine, shoulders flexed to 90 and then they reach toward the ceiling

proximal clavicle moves posteriorly (horizontal flexion)

(horizontal extension of sternoclavicular joint occurs when shoulders return to neutral- proximal clavicle moves anterior)

169

most common dysfunction of sternoclavicular joint

horizontal extension dysfunction (restriction to horizontal flexion )

170

how can you assess abduction of the clavicle

place index fingers on superior aspect of the head of both clavicles and have patients shrug their shoulders-- proximal end of clavicle moves inferiorly

171

how can you assess adduction of the clavicle

place index fingers on superior aspect of the head of both clavicles and from a shrugged position, have patient relax shoulders to neutral-- proximal end of clavicle moves superiorly

172

describe horizontal flexion of the sternoclavicular joint

proximal clavicle moves posteriorly (when pt lies supine and reaches toward ceiling)

173

describe horizontal extension of the sternoclavicular joint

proximal clavicle moves anteriorly (when pt lies supine and relaxes shoulders from a position of reaching toward the ceiling)

174

when proximal clavicle moves inferiorly

abduction

175

when proximal clavicle moves superiorly

adduction

176

which muscles are responsible for scapular elevation

upper trapezius, levator scapulae

177

which muscles are responsible for scapular depression

middle trapezius, rhomboids

178

which muscles are responsible for scapular protraction

serratus anterior

179

which muscles are responsible for scapular retraction

rhomboids, middle trapezius

180

which muscles are responsible for scapular upward rotation

serratus anterior, upper trapezius

181

which muscles are responsible for scapular downward rotation

levator scapulae, rhomboids, latissimus dorsi

182

what does TONGO stand for

Type One (somatic dysfunction of thoracic spine) Neutral Group Opposite (side bending and rotation)

183

what type of force do we use to evaluate the thoracic spine for PTP (posterior transverse processes)

load and spring

184

if there is no change in end feel between flexed and extended positions when evaluating for PTP's then what can we assume

the dysfunction follows Type I Mechanics

185

what can be used to evaluate side bending at each segmental level

translatory glide

186

if a segmental level has ease of translation from left to right that would indicate what

L SB (left side bending dysfunction)

187

in a seated position how can we evaluate side bending at the thoracic vertebra

examiner pushes down on patients shoulder with one hand and monitors side bending of the ipsalateral transverse process with the other hand

188

how can we evaluate rotational motion of thoracic vertebra from a seated position

examiner induces rotation by pulling shoulder girdle posterior and pushing anteriorly on ipsilateral transverse process

189

ease of motion relative to side bending and rotation would be palpated as opposite in what type of dysfunction

neutral (type I)

190

what are we looking for when we assess thoracic vertebra in flexion or extension

type II dysfunction (SB and R to same side)

191

what does it mean if segment improves or rotational end feel becomes more symmetric in flexion

flexion Type II dysfunction

192

what kind of dysfunction can live in the lateral malleolus

restriction to gliding (anterior or posterior)

193

expected ROM for dorsiflexion

15-20

194

expected ROM for plantar flexion

50-65

195

dorsiflexion and plantar flexion: motion is occurring between what bones

talus and tibia/ fibula

196

how do we check talus dysfunction

plantar flexion and dorsi flexion

197

how do we check calcaneus dysfunction

inversion and eversion

198

how do we avoid excess laxity in subtalar joint when checking for calcaneal dysfunction

place ankle in standing position (dorsiflex to 90 degrees between tibia and foot)

199

expected ROM for inversion

35

200

expected ROM for eversion

20

201

what do we call motion occurring between talus and calcaneus

subtalar motion

202

expected ROM for subtler inversion

10

203

expected ROM for subtler eversion

10

204

what motions of the navicular bone must we check for dysfunction

plantar and dorsal glide

205

what is the more common kind of navicular dysfunction

plantar glide dysfunction

206

if the patient has a dorsal navicular dysfunction what is that commonly associated with

tight plantar fascia

207

what motions of the cuboid bone must we check for dysfunction

plantar and dorsal glide

208

what is the more common kind of cuboid dysfunction

plantar glide dysfunction

209

what motions of the cuneiform bone must we check for dysfunction

plantar and dorsal glide

210

what is the more common kind of cuboid dysfunction

plantar glide dysfunction

211

what motions of the metatarsal bone must we check for dysfunction

plantar and dorsal glide

212

what is the more common kind of metatarsal dysfunction

plantar glide dysfunction

213

what motions must be checked for dysfunction at the metatarsophalangeal joints

plantar/dorsiflexion, adduction/abduction, internal/external rotation

214

how do we check abduction and adduction of the wrist

place wrist into supination and radial deviate (abduct) then ulnar deviate (adduct)

215

the thumb can be abducted by moving it anteriorly when the hand is supine and adducted by moving it posteriorly in the same position. where does the thumb like to live?

abduction

216

what kind of motion occurs in rib 1

50% bucket, 50% pump

217

what kind of motion occurs in rib 2

primarily pump handle

218

which rib (in a group dysfunction) is key to address with treatment for INHALATION dysfunction

most inferior

219

lets say ribs 1-2 on the left delay moving into inhalation position while right side moves into inhalation easily (both move into exhalation just fine) how do you name the dysfunction?

left ribs 1-2 exhalation group, pump handle somatic dysfunction

220

what kind of motion occurs in ribs 3-6

mixed pump and bucket handle (more inferior = more bucket handle... rib 6 is 50/50)

221

where do you palpate ribs 3-10 to assess for somatic dysfunction

with ulnar aspect of hand contact costochondral junction bilaterally

222

which rib (in a group dysfunction) is key to address with treatment for Exhalation dysfunction

most superior

223

what kind of motion occurs in ribs 7-10

mainly bucket handle

224

what kind of motion occurs in ribs 11-12

caliper motion

225

how do we position patient to assess motion of ribs 11-12

patient prone

226

restriction of motion in ribs 11-12 is influenced by what muscle

quadratus lumborum

227

what kind of force do we apply to the ulna to test ulnar abduction

valgus

228

what kind of force do we apply to the ulna to test ulnar adduction

varus

229

a posterior radial head dysfunction will have ease of motion to posterior glide and ___

pronation

230

an anterior radial head dysfunction will have ease of motion to anterior glide and ___

supination