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OMM > Practical 1 > Flashcards

Practical 1 Flashcards

1
Q

Skin changes of acute SDs

A

Skin is warm, moist, red, inflamed.

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2
Q

Sympathetic activty changes for acute SDs

A

Local vasodilation

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3
Q

Musculature changes for Acute SDs

A

Locally increased muscle tone, muscle contraction, spasm

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4
Q

Soft tissue changes for acute SDs

A

Boggy, edema, acute congestion, fluids from vascular leakage, chemical reactions on the tissues

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5
Q

Visceral changes from Acute SDs

A

Minimal somato-visceral reflex effects

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6
Q

Skin changes of chronic SDs

A

cool, pale

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7
Q

Sympathetic activty changes for chronic SDs

A

Local vasoconstriction

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8
Q

Musculature changes for Chronic SDs

A

Limited RoM, likely due to fascial contracture; feels ropy

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9
Q

Soft tissue changes for chronic SDs

A

Congestion, doughy, stringy, fibrotic, thickened, exhibits increased resistance to penetration, contracted

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10
Q

Visceral changes from Chronic SDs

A

Common somatovisceral reflex effects

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11
Q

First Rib

A

Patient supine. Place hands on lateral portion of cervical spine palpating inferiorly towards the shoulders. As you near the base of the neck, you will feel a firm structure protruding laterally: this is the transverse processes of T1. Lateral to these will be the first rib. Alternatively, grasp trapezius and push tissue posteriorly and add pressure toward the feet.

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12
Q

Clavicle

A

Stand behind seated patient and place hands on top of the shoulders, allowing fingers to drape down anteriorly. Palpate the long s-shaped bone; attaches medially to the manubrium (sternum) and laterally to the acronium of the scapula. Can be done from in front of patient as well

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13
Q

Jugular Notch

A

From front of patient. In the midline, lightly palpate anterior aspect of base of the neck. Continue inferiorly until you feel a notch or groove intermediate to the two medial clavicular heads.

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14
Q

Sternoclavicular Joint

A

Lateral to the jugular notch; where the medial head of the clavicle meets the sternum. Use both hands to trace clavicle towards midline until you reach the sternum

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15
Q

Synchondrosis

A

1st rib with manubrium. Palpate inferior to the medial clavicular heads on the anterior aspect of the chest wall. Bilateral structure.

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16
Q

Sternal Angle (Angle of Louis)

A

Palpate inferiorly from the jugular notch in the midline; you will feel a subtle shelf of bone.

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17
Q

Second Costal Cartilage

A

Palpate lateral to the sternal angle to feel the cartilage of the 2nd rib.

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18
Q

Costoclavicular Space

A

Space inferior to the medial third of the clavicle

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19
Q

Infraclavicular Fossa

A

Deep space inferior to lateral two thirds of clavicle. More lateral than costoclavicular space

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20
Q

Iliac Crest (Standing and supine)

A

Place hands on lower portion of rib cage and palpate inferiorly until you hit a bony structure. Higher in men

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21
Q

Anterior Superior Iliac Spine

A

Assessed supine. With hands on top of crests of ilium, drop palms onto the anterior bony structures bilaterally. You can hook thumbs underneath and assess height differences

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22
Q

Pubic Symphisis

A

Supine. Place heel of hand at umbilicus and palpate inferiorly until you feel bony structure. Once found, place index or middle finger pads of both hands on the SUPERIOR aspects. Pubic BONE is bilateral. ASK MEN TO ARRANGE THEMSELVES BEFORE PALPATING

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23
Q

Inguinal Ligament

A

Runs from ASIS to pubic tubercule; feels like tight band. Start at ASIS and palpate medially and inferiorly

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24
Q

Vertebral Prominens

A

Spinous process of C7. Standing behind, have the patient flex their head while looking for the most prominent midline structure at the base of the neck. To differentiate between C7 and T1 spinous processes, place your finger on the spinous process and have the patient look up: C7 will “dissappear” upon looking up.

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25
Q

Spinous Process of T1

A

Just below C7 spinous process. Will not disappear with extension

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26
Q

Spine of Scapula

A

Patient seated. Place palms on the superior/lateral aspect of the shoulders. Palpate bony shelf or “spine” traversing medially from the acromion process. Spine is at level of T3.

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27
Q

Inferior angle of scapula

A

“Point” of the scapula. Palpate medial border of the scapula inferiorly until you feel a tip or angle. The inferior angle of scapula is located at the level of the spinous process of the 7th vertebra; points to the 8th rib.

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28
Q

Rib angle

A

Palpate medially along border of scapula; angle of the rib is felt as a slight ridge, more prominent if the rib has moved posteriorly. You can feel rib angles if you have the patient huge themselves and lean forward.

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29
Q

Posterior Superior Iliac Spine

A

Either done while patient is standing or prone. Wrap palms around the iliac crests bilaterally: thumbs should fall onto the posterior bony protruberances of PSIS, then hook your fingers underneath the surface. If it can’t be found this way, you can do whole hand palpation to the superior buttocks area.

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30
Q

Sacral Sulcus

A

Thumbs on the PSIS. Move thumbs medially. Assess depth of sulci

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31
Q

Inferior Lateral Angle of the Sacrum

A

Palpate with heel of hand from PSIS until you “drop off”. From here, place thumbs just superior and lateral to coccyx.

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32
Q

Ischial Tuberosity

A

Sit bones. ASK SPECIFIC PERMISSION. Place thumbs on posterior aspect of thighs and palpate superiorly until you feel bony prominences deep to gluteal folds. Assess which is more caudad or cephalad.

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33
Q

Tip of the acromion Process

A

At AC joint, the most lateral structure on top of the shoulder is the tip of the acromion

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34
Q

Acromioclavicular Joint

A

Place hand on clavicle and palpate laterally until it meets the acromion. Have patient perform rowing/shrugging to palpate motion

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35
Q

Greater tubercle of the Humerus

A

Lateral to head of humerus

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36
Q

Lesser Tubercle of the Humerus

A

Medial to head. Start at greater tubercule and externally rotate arm bent at elbow.

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37
Q

Intertubercular groove of the humerus

A

Groove in between Greater Tubercle and Lesser Tubercle. Start at greater tubercle, bend an L, externally rotate.

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38
Q

Medial Epicondyle of the distal humerus

A

Make patient bend elbow. Medial bone of elbow

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39
Q

Lateral epicondyle of the distal humerus

A

Make patient bend elbow. Lateral bone of elbow.

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40
Q

Olecranon process of proximal humerus

A

Bony protruberance of elbow. Midline on posterior aspect of elbow joint.

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41
Q

Radial head of proximal humerus

A

Flex arm at elbow. Place thumb on the anterior lateral aspect of elbow with index finger wrapped around elbow laterally on posterior aspect. Supinate/pronate to feel motion. Can also go from the lateral epicondyle of the humerus and palpate distally to find the humero-radial joint space then palpate inferiorly to find radial head

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42
Q

Greater trochanter of femur

A

Place open hands on sides of hips near crests and push medially. “Walk hands down” the lateral aspects of the hips until a firm bony protruberance is palpated.

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43
Q

Patella

A

Supine. Palpate anterior aspect of the knee. Can have patient flex thigh to feel motion.

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44
Q

Tibial tuberosity

A

Directly below patella in midline.

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45
Q

Fibular head

A

Patient supine. Flex knee to 90 degrees. Using WHOLE HAND, palpate lateral aspect of knee.

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46
Q

Medial malleolus of tibia

A

Bony protruberance on medial aspect of ankle

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47
Q

Lateral malleolus of fibula

A

Bony protruberance on lateral aspect of ankle. More distal than medial malleolus

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48
Q

Calcaneal tendon

A

Achillies. Do while supine.

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49
Q

Gravitational Line

A

Compare external auditory meatus, lateral aspect of humerus/tip of shoulder, greater trochanter, lateral condyle of knee, and slightly anterior to lateral malleolus

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50
Q

Scoliosis Screen

A

Evaluate standing and bending. Scoliosis named for the side of convexity.

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51
Q

Trunk range of motion

A

Flexion (Touch your toes) vs Extension (bend backwards, can support them); Sidebending (standing, touch your fingers to your knees).; Rotation (Seated; cross arms and rotate).

52
Q

Hip, knee, ankle screen

A

Put arms out in front of you and do a squat

53
Q

Standing flexion test

A

Patient is standing. Hook fingers UNDER PSIS on skin and have the patient bend forward. Test is positive on the side that moves further.

54
Q

Seated flexion test

A

While SEATED. Hook fingers UNDER PSIS on skin and have the patient bend forward. Test is positive on the side that moves further.

55
Q

Active range of motion of C-Spine

A

Flexion vs Extension (Down and Up). Sidebending and rotation

56
Q

Passive range of motion

A

Flexion, extension, sidebending, rotation. Guarding opposite side

57
Q

Upper extremity range of adduction screen

A

Give yourself a hug; test ADDUCTION

58
Q

Upper extremity range of ABDUCTION screen

A

Reach above your head and down your back; tests ABDUCTION and external rotation

59
Q

Upper extremity extension and internal rotation

A

Reach behind your back and up your back

60
Q

Suboccipital Tension Release: How-To

A

Patient supine, physician seated at head of table. Physician places fingerpads together under the suboccipital area. Use the finger pads to direct pressure anteriorly and superiorly with a force comparable to the weight of the head.

61
Q

Suboccipital Tension Release: Utilization

A
  1. Tension headaches 2. Prepare for cervical correction 3. Assess and stretch dural attachments at C2, C3, and occiput
62
Q

Posterior Cervical Soft Tissue: How To

A

Patient supine, physician on patient’s die with one hand on patient’s forehead just above the eyebrows. Finger pads of their other hand rhythmically stretching and compressing the soft tissues between the spinous and articular processes of the cervical vertebrae while sidebending, rotating, and extending the cervical spine. Finger pads are brought laterally and anterior. Forehead hand is stabilizing only.

63
Q

Posterior cervical soft tissues: Utilization

A

Treatment of SHORT RESTRICTOR muscles of the cervical spine

64
Q

Cervical Stretching: How To

A

Physician seated at head of table with their arms crossed under the pt’s head and their hands placed on the anterior aspects of the patient’s shoulders. Physician raises their crossed arms (flexing pt’s cervical spine) until a pathological barrier of motion (ROM) is appreciated. Can either hold PT in this position until release is felt or utilize muscle energy (“Push back for 3 seconds” –> relax –> go past barrier, repeat x3). Follow this up with sidebending and rotation: one arm on patient’s shoulder, other arm on neck on same side to sidebend/rotate.

65
Q

Cervical Stretching: Utilization

A
  1. Address LONG RESTRICTOR muscles of C-spine 2. Stretch myofascial elements of the cervical and upper thoracic regions 3. Promote venous and lymphatic drainage of the tissues
66
Q

Rib raising: lateral recumbant: How To

A

ASK IF THE PT HAS ANY SHOULDER PROBLEMS. Lie on their side. Pt stands facing patient, with one arm abducted and hand placed on their head, cupping their ear. Physician holds their elbow with one hand (grounding) and places their other hand on the posterior rib cage/rib angles separating from transverse processes: go lateral to spinous process –> transverse process –> start of the angle of the rib). Ribs are moved ANTERIOR and LATERAL. Technique is done when a release of tissues is appreciated.

67
Q

Rib raising: supine: how to

A

Patient is supine. Physician sits on side of patient with hands under the rib cage and fingers contacting the rib angles. By flexing the fingers in a rhythmic manner, rib cage is raised to ward the ceiling (anterior) and pulled laterally, then released. Maintain forearms on the table to utilize as a counterforce.

68
Q

Rib raising(BOTH): Utilization

A
  1. To aid respiration (asthma) 2. Aid circulation of patient with congestion (pneumonia, chronic obstrective lung disease, CVD) 3. Pre/post-operative care
69
Q

Prone thoracic perpendicular stretch: How To

A

Patient prone, physician stands at the side of the table OPPOSITE side being treated. Put one hand (listening hand) on the patient’s spine with thumb and thenar eminence in the TROUGH between spinous and transverse processes. Other hand is used to apply force through the listening hand in a combined lateral and anterior motion (into the table) to stretch and compress tissues in a rhythmic fashion. Apply to length of T-spine. Do not slide across other tissues; remain on spine. Hold on 3 seconds then release.

70
Q

Prone thoracic perpendicular stretch: Utilization

A
  1. Laterally stretch fascial restrictions within the paravertebral musculature of the thoracic spine 2. Free up any rib or thoracic restrictions
71
Q

Pectoral Traction: How to

A

Patient is supine, with KNEES FLEXED/feet flat on the table. Physician is seated at the heat of the table. Have the patient put their hands together in otder to get better access to the space: grasp the patient’s anterior axillary folds with 2-4 digits of both hands. Apply traction superiorly to stretch muscles/underlying fascia in axillary spaces (lean back to pull). Patient instructed to inhale deeply while physician takes up any remaining slack and continues to hold traction. Traction maintained while patient exhales. Repeat X3

72
Q

Pectoral Traction: Utilization

A
  1. Increase A-P diameter of thorax 2. Improve venous and lymphatic drainage of the thorax 3. Release tension in the clavi-pectoral fascia 4. Drain atnerior axillary fold edema from the upper extremity 5. provide drainage from the head and neck
73
Q

Clavipectoral stretch: How to

A

Patient supine, physician standing at head of table. Place thenar eminances on anterior/superior shoulders at level of AC joint/humerus. Pressure through thenar eminences is directed posteriorly (into the table) and inferiorly (towards the feet) utilizing 10 lbs of force. Held for 20 seconds, then released.

74
Q

Clavipectoral stretch: Utilizations

A
  1. Provide drainage from head and neck 2. Any illness that may cause edema to the head or neck 3. Anteriro/rounded shoulders 4. Completed after inlet has been addressed
75
Q

Posterior axillary traction: How to

A

Patient supine, knees flexed with feet flat on the table. With 2-4 fingers of each hand, grab posterior axillary fossas between the table and pt’s body. Apply traction (lean back) while pt inhales deeply. Traction maintained as pt exhales. Repeat X3.

76
Q

Posterior Axillary Traction: Utilization

A
  1. Increase A-P diameter of the thorax 2. Improve venous/lymphatic drainage of thorax 3. Release tension in clavipectoral fascia 4. Drain congestion from posterior axillary fold, upper extremities, head, and neck
77
Q

Thoracoumbar soft tissue Prone How To

A

Pt in prone. Physician on opposite side being treated. Inferior hand grasps ASIS on opposite side of table. Other hand placed on paraspinal muscles adjacent to lumbar spine. Hand controlling pelvis at ASIS moved FIRST to gently pull pelvis off table toward physician. AT END OF THAT MOTION, other hand gently applies pressure into paraspinal muscles through heal of that hand as pelvis is slowly returned to table. “Kneading” motion. ASIS hand stays, paraspinal hand can move along length of muscles down to sacrum and up to lower thoracic

78
Q

Thoracoumbar soft tissue Prone Utilizations

A
  1. Relax paravertebrals/quadratus lumborum musculature 2. Free up motion of ribs 11/12 3. Therapeutic for somatic/visceral dysfunctions 4. Special attn may be given to those areas overlying the sympathetic nerve supply to the organs the physician wishes to affect through reflex mechanisms
79
Q

Upper, mid, and thoracolumbar soft tissue Lateral Recumbant: How to

A

Put them in lateral recumbat and make them stabilize. ut one hand (listening hand) on the patient’s spine with thumb and thenar eminence in the TROUGH between spinous and transverse processes. Other hand is used to apply force through the listening hand in a combined lateral and anterior motion (into the table) to stretch and compress tissues in a rhythmic fashion. Apply to length of T-spine. Do not slide across other tissues; remain on spine. Hold on 3 seconds then release.

80
Q

Upper, mid, and thoracolumbar soft tissue Lateral Recumbant: Utilization

A
  1. Relax the paravertebral and quadratus lumborum musculature 2. Free up ribs 4-12 3. Therapeutic as well as diagnostic for SDs/VDs
81
Q

Thoracoumbar soft tissue Supine How To

A

Supine, knees flex, feet flat on table. Physician stands at side of table; hand closest to pt’s feet holding on to knees, other hand (closest to hand) reaches around the patient at the level of thoracolumbar paravertebral musculature. Physician moves pt’s knees away from them and alternatively bringing paravertebral musculature laterally and anteriorly (kneading fashion)

82
Q

Thoracoumbar soft tissue Supine Utilizations

A
  1. Relax paravertebrals/quadratus lumborum musculature 2. Free up motion of ribs 11/12 3. Therapeutic for somatic/visceral dysfunctions 4. Special attn may be given to those areas overlying the sympathetic nerve supply to the organs the physician wishes to affect through reflex mechanisms
83
Q

IT Spread: How to

A

Patient in prone, knees bent and together, feet spread. Physician seated and behind, with arms at the patient’s knees. Using both hands, physician puts pads of their thumbs medial to patient’s ischial tuberosities and applies firm, lateral pressure. Pt instructed to cough 3 times; as they do, firm pressure maintained through thumbs and forearms to spread tuberosities laterally.

84
Q

IT Spread: Utilizations

A

1) Release fascia of the pelvis 2) Treat sacrum 3) Separate sacroiliac joints and allow for better motion of the sacrum between the inominates 4) Help sacrum “seat” itself between innominates 5) improve function of urogenital pelvic diaphragm 5) May be utilized as an adjunct treatment for a variety of conditions (cystitis, proctitis, hemorrhoids, prostatitis, constipation, sacroiliac dysfunction)

85
Q

Sacral Rocking: How To

A

Patient in prone. Physician’s hands cupped over sacrum. Patient asked to breathe several times; physician emphsizes the sacral respirator motion (Apex of sacrum rocked anterior on inhalation while base moves posterior; with exhalation, reverse is accomplished)

86
Q

Sacral rocking: Utilization

A
  1. Improve sacral respiratory motion 2. Relieve strains of sacral fascia 3. Enhance primary respiratory mechanism 4. Improve function of urogenital pelvic diaphragm 5. Treat constipation
87
Q

Sacral inhibition: How to

A

Patient prone, physician’s hands cupped on sacrum. Press anteriorlly on sacrum for 1-2 minute

88
Q

Sacral Inhibition: Treatment

A
  1. Diarrhea 2. Dysmenorrhea 3. USE CAUTIOUSLY WITH SPONDYLOISTHESIS OR STENOSIS OF LUMBAR SPINE
89
Q

Myofascial Shoulder Release via Scapular Lift: How To

A

Pt in lateral recumbant FACING PHYSICIAN. Left arm internally rotated and forearm placed behind the back. If this causes them pain, arm may be kept along side of their body. Physician places arm closer to feet under patient’s arm and grasps medial border of patient’s scapula. Other hand is used to depress shoulder (with caudal force) to further wing the scapula. Patient inhales deeply while physician lifts scapula towards the ceiling. Patient exhales while physician holds scapula in this position. Repeat X3

90
Q

Myofascial Shoulder Release via Scapular Lift: Utilization

A
  1. Release myofascial restrictions of the shoulder girdle 2. Address rib dysfunctions. CAUTION: Care should be taken if pt has history of bicep tendonitis, shoulder replacement, rotator cuff injury, impingement syndrome, bursitis, or adhesive capsulitis
91
Q

Trapezius Pinch: How to

A

Pt supine, physician seated or standing at head. Hands in “lobster claw” position grasping trapezius muscles bilaterally Hands may be moved medially or laterally along the bulk of the muscle applying gradual pressure between thumb and other four fingers. When area of restriction is met, apply a steady force until softening is appreciated.

92
Q

Trap pinch: utilizatiosn

A

1) Decrease congestion within thoracic inlet 2) Ease tension within trapezius 3) Tension headaches

93
Q

Lymphatic Pumping: How to

A

Pt supine, feet on the table. Physician places hands on plantar surfaces of feet NOT TOES, and rhythmically dorsiflexes feet causing motion of abdomen. 40-60 bpm

94
Q

Lymphatic Pumping: Utilization

A

1) Combat stasis, congestion, pooling of body fluids which are precursors to inflammation, symptions of disease, and frank disease. 2. Encourage natural venous return/circulation in pregnant people 3) good treatment for any infectious process. CAUTION WITH PATIENTS WITH METASTATIC DISEASE, RECENTLY POST-OPERATIVE, OR WITH ACHILLES TENDONITIS

95
Q

Foot/leg “flaring”

A

Head of bed. Assess angles of feet formed with table. CCP IS RIGHT FOOT MORE FLARED.

96
Q

Leg length

A

Foot of bed. Dorsiflex both feet and compare which heel is higher up. CCP IS RIGHT FOOT IS HIGHER UP, SO LEFT LEG IS LONGER.

97
Q

Leg external rotation

A

Evaluate external rotation of legs by pressing down on medial aspect of big toe at the M-P joint. CCP IS RIGHT LEG MORE EXTERNALLY ROTATED (Makes sense because of flaring)

98
Q

Motion testing of Feet

A

Cup pts heels with palms of hands, placing thumbs along lateral aspects and lift feet to 20 degrees. Internally rotate feet. CCP: RIGHT FOOT RESISTS MOTION MORE BC EXTERNALLY ROTATED

99
Q

Assessing respiration

A

Observe whether motion of respiration is coming from Diaphraghm, Ribs (Costal), or Mixed. CCP is Costal

100
Q

Observation of pelvic girdle

A

Observe the angle of the pelvic girdle/waist. CCP: PELVIC GIRDLE IS ROTATED CLOCKWISE.

101
Q

Iliac crest Heights

A

Assess which iliac cres is more cephalad/caudad. CCP: LEFT ILIAC CREST MORE CEPHALAD

102
Q

ASIS height (Compare to table)

A

Assess which ASIS is closes to the TABLE, using whole hand. CCP: RIGHT ASIS IS CLOSER TO TABLE (makes sense as pelvic girlde is rotated clockwise)

103
Q

Motion testing of pelvic girdle

A

Standing next to patient, place hands around lateral aspects of pelvis. Lift left side and roll pelvis to right. Lift right side and roll pelvis to left. CCP: Pelvis rolls more easily to the right and resists motion to the left

104
Q

Assessing the inguinal areas

A

Whole hand/all finger pads (not just 2-3, can be ticklish). CCP: TISSUES MORE TAUT ON LEFT SIDE, MORE SLACK ON RIGHT.

105
Q

Assessing ASIS heights (compare to each other)

A

Place thumbs beneath each ASIS and compare the two sides. CCP: RIGHT SIDE MORE INFERIOR AND MEDIAL/LEFT SIDE MORE SUPERIOR AND LATERAL

106
Q

Assessing pubic symphysis

A

Assess SUPERIOR aspect of symphysis. CCP: MORE CEPHALAD ON LEFT SIDE

107
Q

Inominate compression test

A

Place palms on ASIS; apply gentle pressure down into table. CCP: RIGHT SIDE YIELDS, LEFT SIDE OFFERS RESISTANCE. ERGO, LEFT SIDE RESTRICTED

108
Q

Fascial drag of ASIS

A

Place palms on ASIS with fingers on crests and evaluate fascial drag vertically with each hand in opposite directions. CCP: FASCIA GIVES FREELY CAUDAD ON RIGHT, CEPHALAD ON RIGHT.

109
Q

Inominate findings in CCP

A

Left iliac crest is more cephalad, right more caudad. Pubic symphisis is sheared superiorly on the left, sheared inferiorly on the right. Iliac compression resists on right, yields on left. Fascia moves freely cephalad on left and caudad on right. ERGO ANTERIOR ROTATION OF RIGHT INOMINATE, POSTERIOR ROTATION OF LEFT INOMINATE.

110
Q

Observation of lumbar spine

A

Observe the normal lordotic curve of the spine

111
Q

Palpation of lumbar spine

A

Note height, extend of curve, and apex of curve

112
Q

Motion testing of lumbar spine

A

Place fingertips underneath spinous processes of lumbar vertebrae. Lift spine away from table. Compare normal lumbar vertebrae to the lumbosacral junction. CCP: MOTION OF LUMBOSACRAL JUNCTION IS INHIBITED

113
Q

Observation of upper thorax

A

CCP: Upper thorax is rotated clockwise. Lower thorax is rotated counter clockwise. Lower ribs appear anterior on the left.

114
Q

Costal margins observations

A

CCP: Lower portion of thorax flares to the left

115
Q

Palpation of thorax

A

Place hands on lower lateral aspect of thorax. CCP: CONTOUR IS NEITHER TAPERED NOR SYMMETRICAL.

116
Q

Motion testing of costal margins

A

Place hands on costal margins and compress into table. CCP: LEFT SIDE MORE RESISTANT TO MOTION

117
Q

Motion testing: lateral motion of thorax

A

Place hands on side of lower lateral aspects of thorax. Move rib cage laterally and see which side is more resistant to motion. CCP: LOWER THORAX MOVES MORE EASILY TO THE LEFT AND RESISTS MOVEMENT TO THE RIGHT

118
Q

Assessing first rib

A

CCP: First rib anterior on the left, posterior on the right. First rib elevated on left.

119
Q

Diagnosis of T1

A

T1 is rotated and sidebent to right

120
Q

Palpation of infraclavicular area

A

Palpate contours and compare the two sides. CCP: Concave on the right, convex on the left.

121
Q

Motion testing of first ribs

A

Press on synchondrosis formed by 1st ri and mandubrium. CCP: SPRINGS ON RIGHT, RIGID ON LEFT. MAY BE TENDER ON LEFT

122
Q

Palpating sternal angle

A

Place hand on sternum with fingers pointing towards the jugular notch and palm of sternal body. CCP: Axis of sternum deviated to right; Sternal angle is flattened.

123
Q

Motion testing sternal angle

A

Hand on midline of sternum, fingers just below jugular notch. Move hand left and right to assess tissue dragging. CCP: TISSUES MOVE EASILY TO LEFT, RESIST MOTION TO RIGHT.

124
Q

Assessing arm length

A

Have patient flex shoulders up and see which arm falls closer to table. CCP: LEFT ARM APPEARS HIGHER THAN RIGHT ARM. Observe angle that arms form with table. CCP: ANGLE ON LEFT SIDE APPEARS LARGER THAN RIGHT SIDE. Grasp arms of pt and bring thumbs together to measure arm lengths. CCP: LEFT ARM SHORTER. Compare tensions. CCP: LEFT TENSION GREATER

125
Q

Head sidebending observation

A

CCP: HEAD TURNED TO LEFT AND SIDEBENT TO RIGHT

126
Q

Assessing sacrum

A

CCP: Right sulcus is deep. LEFT ILA IS POSTERIOR AND INFERIOR.

127
Q

Motion testing Sacrum

A

CCP: Fascial drag is cephalad. No sacral tender points. Sphinx test negative (no motion when going up on negative). Diagnosis: LEFT ON LEFT FORWARD SACRAL TORSION***

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