OS Exam 2 Flashcards
(230 cards)
1
Q
How many cervical vertebra do we have
A
7
2
Q
The atlas lacks what vertebral structure
A
Has no vertebral body
3
Q
What is the atypical feature of C2
A
Dens (odontoid process)
4
Q
Articular facets in the cervical spine are oriented in what direction
A
Superior: upward toward eye
Inferior: point toward opposite shoulder
5
Q
C2-c7 follow what type of mechanics
A
type II
6
Q
From a lateral view. We can check alignment along what imaginary lines
A
Anterior vertebral line
Posterior vertebral line
Spinolaminar line
Posterior spinous line
7
Q
What view must you use for x ray of the dens
A
AP (anteroposterior view) with an open mouth
8
Q
What do we think is the cause of cervical spine somatic dysfunction
A
Compensatory after for dysfunction of lower parts of spine
9
Q
Rotational testing in the. Cervical spine. Requires us to contact lateral mass (lateral to spinous process) and rotate them in what plane
A
Transverse plane
10
Q
If you induce a force in the transverse plane on the left lateral mass what motion are we inducing in cervical vertebra
A
Rotate right
11
Q
Translation of cervical vertebra (lateral segment movement: left to right or right to left) induces motion in which plane
A
Coronal plane
12
Q
If we move a cervical vertebra in the coronal plane: translation from left to right what do we document this motion as
A
Sidebent left
13
Q
If there is more restricted motion in the cervical vertebra while the neck is flexed how would we name it
A
Extension dysfunction
14
Q
Which part of the chart should include documentation of somatic dysfunction
A
Objective portion (of SOAP note)
15
Q
Normal flexion of the neck
A
45-90
16
Q
Normal extension of the neck
A
45-90
17
Q
Normal side bending of the neck
A
45
18
Q
Where do we palpate while checking cervical ROM actively and passively
A
At the C7-T1 junction
19
Q
Normal rotation of the neck
A
70-90
20
Q
What are the major motions of OA joint
A
Flexion and extension (Sagittal plane motion)
21
Q
What type of mechanics are displayed at the OA joint
A
Flex/extend but SB/Rot to opposite directions ALWAYS making it modified type I
22
Q
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?
A
Left
23
Q
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?
A
Translation
24
Q
antlantoaxial joint (AA) has what primary motion
A
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
