Terms in this set (212)
HVLA of the navicular, cuboid or cuneiforms
Used for diagnosis of the 1st metatarsal dorsal glide: force is applied to the joint of the 1st metatarsal and first cuneiform
dysfunction of downward rotation of the cuboid on the calcaneus (talus is stable)
Method directed at the talocalcaneal joint
Origin: lumbar spine vertebrae and iliac spine vertebrae and iliac foss
Inserts: lesser trochanter of the femur
Due to this attachment, a posts spasm not only causes unilateral torso flexion and side bending, but it will also cause some thigh external rotation as the lesser trochanter is pulled anteriorly and medially
ureter runs anterior and adjacent to the posts and the inflammation associated with passing a kidney stone can cause irritation muscle leading to spasm
originates at the posterior ilium portion of the sacrum
inserts on the gluteal tuberosity and connects to part of the iliotibial band
spasm would lead to extended, which momentarily causes a short leg appearance
Originates at the anterior sacrum and connects to te greater trochanter
spasms at this muscle are common and cause EXTERNAL rotation of the leg
Do not cause functional leg shortening nor torso unilateral flexion
Originates from the ischial tuberosity and insert on the medial condyle and medial aspect of the tibia
contraction of these muscles can lead to posterior innominate rotation and a unilaterally shortened leg, but would not cause torso flexion nor external rotation of the thigh
Rectus femoris and Vastus muscles combine to form the quadriceps
Muscles originate from the ASIS and proximal femur respectively and all muscle insert together on the patella
contraction of these muscles leads to hip flexion and knee extension
tight quadriceps can cause a contralateral shortened leg as the ipsilateral innominate is pulled anteriorly and the leg is lengthened slightly
Masseter tender point
localized tenderness over the temporomandibular joint, and jaw deviation to the ipsilateral side
tenderpoint is located along the ascending ramus of the mandible
signs of temporomandibular joint dysfunction
Jaw pain, headaches, otalgia, jaw deviation with opening, and tenderness over the TMJ and muscles of mastication
present with tender points along any of the muscles of mastication sued to open and close the mouth
masseter TP is located anterior to the ascending ramus of the mandible (palpated through the soft tissues of the cheek)
masseter hypertonicity can also cause jaw deviation to the ipsilateral side when lowering the jaw
tenderness of c1
located posterior to angle of the mandible
medial pterygoid TP
located behind the ascending ramus, 2-cm above the angle of the mandible and inferior to the ear
tender points at the base of the tongue and are palpated intra-orally
fan-like muscle found over the temporal bone on the lateral side of the head, tender points are located in the belly of the muscle, above and anterior to the ear
alternative name for counterstain?
spontaneous release by position
What is the nerve relationship associated with counterstrain?
alpha Ia afferent and gamma efferent relationships
Treatment procedure of counterstrain
Placing the patient into a position that eliminates or greatly reduces the tenderness of the point and either waiting 120 second or until palpatory change is felt
where are posterior costal tender points for CS located and what muscles are they associated with
Located on superior aspect of the rib angle
For ribs 2-6 associated with the levatores costarum and serratus posterior superior muscles, and with inhaled rib dysfunction
treatment for posterior rib angle tender points?
Extension, Sidebend away, Rotate away
operators knee is placed beneath the axilla on the side of the TP
the operator shift their knee away from the patient translating the patient to engage the affected rib (SB to opposite side)
the shoulder area of the opposite side is brought poterior and the arm is allowed to hang down --> induces sidebending and roatation away
shorten muscle being treated
What is a counterstrain tenderpoint?
small, tense, edematous area of tenderness about the size of fingertip
typically located near bony attachments of tendons, ligaments, or in the belly of some muscles
CS points that do not resolve with treatment and require placing the patient in the opposite position to conventional treatment
CS treatment for anterior cervical TP
FSARA (P1-C6 and C8)
posterior cervical CS treatment positions
ESARA (most points located on lateral aspect of spinous process)
inion: marked flexion
Anterior thoracic spine CS point treatment
T1-T-6 located at the midline of the sternum at attachment of corresponding ribs
T7-T12 most located in the rectus abdominus muscke about one inch lateral to the midline on the right or left
posterior thoracic CS TP treatment
rib CS TP
lumbar anterior counter strain points
L1: Medial to ASIS
L2-L4 around AIIS (M,L,B)
L5: one cm lateral to the pubic symphysis on the superior ramus
Treatment for anterior thoracic CS
patient supine, with hips and knees flexed and markedly rotated away
posterior thoracic CS TP
on either side of the spinous or transverse processes
treatment of dysmenorrhea?
sacral inhibition has been shown to be helpful in patients suffering from dysmenorrhea
Sacral inhibition treatment
effective in treating dysmenorrhea
muscle and nerve associated with winging of the scapulae?
Injury to the long thoracic nerve, resulting in paralysis of the serratus anterior muscle
usually injured during acute or recurrent trauma during sporting events
what motion is impaired with paralysis of serratus anterior?
rotation of the scapula
how can you diagnose winged scapula?
1. have patient push against wall
2. have patient abduct the arms over the head
treatment for winging of the scapula?
Brace the scapula to the rib cage to alleviate and stabilize the shoulder and to protect from overstretching the serratus anterior
attachment of latissimus dorsi and innervation?
Attached to the inferior angle of the scapula and is innervated by the thoracodorsal nerve
motion of the latissmus dorsi?
anchors the scapula to the chest during motions of the shoulder
Not involved in winging of the scapula
where does rhomboid major attach and what does injury lead to?
attaches to the medial border of the scapula
injury leads to weakness in aDduction of the scapula
trapezius attachment to scapula and results of injury?
trapezius attaches to the spine of the scapula, damage to spinal accessory nerve will results in lateral winging of the scapula
primary mechanism of injury to long thoracic nerve?
recurrent trauma during sports events
Mechanism of injury of the axillary nerve?
surgical neck of the humerus fracture or shoulder dislocation
What will injury to the axillary nerve result in?
paralysis of the deltoid
spinal accessory nerve?
Provides motor innervation fro the CNS to the SCM and the trapezius
Injury can result in SCM dysfunction or trapezius (lateral winging of the scapula)
nerve roots of the long thoracic nerve?
What nerves are made up of the nerve roots C5-C6
musculocutaneous, radial, axillary, suprascapular, superior subscapular and inferior subscapular
innervates muscles of the arm, shoulder girdle,
C6-C8 nerve roots innervate?
muculocutaneous, median, and radial nerve
muscles in the arm, forearm, and latissimus dorsi
what nerves do the Roots C7-T1 supply
median, ulnar, radial (posterior interosseus)
supply the muscls of the forearm and hand
What nerve is injured during injury to midshaft of the humerus?
RAdial nerve resulting in wrist drop
What nerve is injured during ANTERIOR shoulder dislocations?
results in loss of sensation over the deltoid and upper arm
What form of shoulder dislocation is more common? WHich one is most associated with tonic-clonic seizures or electrocution?
Most common = anterior
Associated with electrocution and tonic-clonic seizures = posterior
Clinical presentation of posterior shoulder dislocation?
result in INTERNAL rotation and adduction of the arm
acromium/coracoid is prominent
anterior shoulder is slightly flattened
What nerve may be compromised with fracture of the medial epicondyle?
ulnar nerve (runs very superficially)
thompson test (aka calf squeeze) is used to test for what?
achiiles tendon pathology
Method: patient lies prone with their feet hanging off the end of the examination table, or kneels on a chair. The physician squeezes the gastroc muscle belly while watching for plantar flexion
positive exam: absence of plantar flexion
used to examine the medial or lateral tendons of the ankle for excessive laxity
patient is seated and the physician grasps the foot while stabilizing the tibia and fibula and puts the foot into inversion and eversion
used to assess the psoas
patient is supine and brings one knee to chest
positive test: when the contralateral hip flexes
Cranial torsion and its axises?
sphenoid and occipital bones rotate in opposite directions around an AP axis that runs through the sphenoid and occiput
Shears of the cranium
Occur when the sphenoid and occiput rotate in the same direction around two transverse axiss
Side-bending cranial strain?
Occur around three separate axes
sphenoid and occiput rotate in the same direction around one AP axis that passes through the sphenoid and occiput
Rotate in opposite direction around two vertical axes (one through the sphenoid and the other through the foramen magnum
named after the side of the convexity
what part of the body is drained by the right thoracic duct?
Right upper extremity, right side of face and neck, part of the lungs
What is the right thoracic inlet also known as?
flexion phase of CRI? What does the occiput vs. sphenoid do?
sphenoid: SBS opens superiorly and the sphenoid moves anteriorly
occiput rotates posteriorly
both on respective transverse axes
both occiput and sphenoid move in same direction
direction of sphenoid in lateral shears?
right shear = counterclockwise
left shear = clockwise
Axis of side-bending rotation of the occiput and sphenoid?
3 axises: one AP, two vertical (one through the center of the sphenoid, one through the foramen magnum)
move in the same direction (clockwise/counterclockwise via AP), (right/left about vertical axises)
what cranial strains are considered physiological and what does this mean?
Right and Left torsions
lateral strains of the cranial vault?
Present when the sphenoid deviates laterally in relation to the occiput
if the sphenoid deviates to the left, it is termed a LEFT lateral strain
If it deviates to the right, it is termed a right lateral strain
rotation will occur about two vertical axes, one through the center of the sphenoid, the other through the foramen magnum
feels like a parallelogram
Morton foot (toe)
Shortened first metatarsal in relation to second metatarsal (known as Brachymetatarsia)
majority off weight bearing is transfered from first to second metatarsal, resulting in pain in the ball and arch of the foot, as well as callus formation under the 2nd and 3rd metatarsal head to compensate for increased pressure of weight-bearing
causes excessive PRONATION of the foot with INTERNAL hip rotation and functional shortening of the leg
treatment for morton foot?
foot metatarsal pad under the first toe and metatarsal to redistribute weight-bearing to the first toe
abnormal bony protuberance on the lateral side of the fifth metatarsophalangeal joint with an overlying hard corn frequently present
aka Tailor's bunion
associated with tight-fitting narrow pointed shoes
treatment for bunionette deformity?
wider footwear, foot orthotics and decrease pressure over the fifth metatarsal head and surgery
calcification of the plantar fascia
plantar aponeurosis extends from the calcaneus to the phalanges
functional demands causes chronic stress of this structure
irritation caused by either excessive pronation or high-arched cavus foot result in plantar fascitis
with time calcium is laid down along the lines of stress, leading to formation of calcaneal heel spur
Treatment for calcification of plantar fascia?
Correction of underlying biomechanical dysfunction or surgery if very severe
hallux valgus (aka bunion)
Characterized by lateral deviation of the first metatarsophalangeal joint
female to male ration of symptomatic hallux valgus is 10:1
weight bearing AP radiographs of the foot may be used to calculate the hallux valgus angle
Treatment for hallux valgus
Wider footwear, foot orthotics, surgery for symptomatic hallux valgus
Fixed flexion deformity of PIP without deformity of the DIP or MTP
associated with a myofascial trigger point in the dorsal interossei
treatment of hammer toe?
Deformation of hammer toe may disappear after treatment of this somatic dysfunction
wide comfortable shoes, avoidance of heel height greater than 2 1/4 inches and protective cushion in the area of corns to develop
surgery may be required to repair severe deformities in order to accomodate proper alignment for footwear
What does persistent hammertoe deformity with high arches (pes cavus) possibly signal?
underlying neuropathy or rheumatologic disease
four important rules for diagnosing the sacrum
1. Sidebending of L5 and the sacral oblique axis mmust be engaged on the same side
2. The sacrum rotates in the opposite direction of L5
3. The seated flexion test must be positive for the diagnosis of sacral torsion
4. The seated flexion test will be positive on the side opposite of the oblique axis
What is the most common knee injury
Anterior cruciate ligament (ACL), medial collateral ligament, medial meniscus
MEchanism of injury of medial meniscus?
When the leg is twisted as it remains planted on the ground
The pain is medial and there is often clicking or locking sensation as the meniscus catches
Who gets posterior tibia or anterior talus dysfunction?
individuals whose activities required prolonged plantar flexion, such as dancers or woman who wear high heels frequently
patients will have restricted dorsiflexion at the ankle because of the anterior position of the talus
HVLA treatment of the ankle?
direct, an the restrictive barrier is met by dorsiflexing and applying traction to the ankle until a firm bony restrictive barrier is met
Fibular head HVLA method
ankle EVERSION cause the proximal fibular head to move ANTERIORLY
This is the initial position to treat posterior fibular head dysfunction with HVLS or muscle energy
ankle INVERSION causes the proximal fibular head to move POSTERIORLY
used to treat a anterior fibular head dysfunction
In plantar flexion the distal talus moves...?
anteriorly and the tibia moves posteriorly
treatment of posterior distal tibia and anterior talus?
HVLA with foot dorsiflexed and traction to the ankle
What is scheumermann Kyphosis?
Rigid curvataure not corrected by change in position
Radiographic findings that include anterior wedging of at least 3 adjacent vertebral bodies and endplate abnormalities
Schmorl's nodes are small protrusions of the intervertebral disc into adjacent vertebral bodies
etiology unknown but usually diagnosed in adolscent boys during rapid growing phase
small protrusions of the intervertebral disc to adjacent vertebral bodies
Osteopathic treatment of maxillary sinusitis?
Manipulation of the pterygopalatine fossa that houses the pterygopalatine ganglion, known as the sphenopalatine ganglion
OMM should be directed toward this fossa because stimulation of this ganglion produces parasympathetics reflex response and encourages production of profuse, thin nasal secretions to reduce sinus congestion and pain
What organs share the viscerosomatics of T10-T11
Mid GI tract (small intestine, large intestine up to and includng the proximal 2/3 of the transverse colon) and genitourinary structures (ovaries, testes, kidneys, adrenal, upper ureters)
Viscerosomtics of GI system?
Upper GI: T5-T9
MIddle GI: T10-T11
Lower GI: T12-L2
Testing L4 motor function?
L4: ask patient to walk on heels with feet inverted (essentially in dorsiflexion)
medial side of leg, ankle and foot (medial portion of digit 1)
Effects of L5 impingement via L4-L5 posterolateral disc herniation
toes extension (L5 innervates extensor hallucis longus, extensor digitorum longus and brevis) gluteus medius (responsible for aBduction)
sensation loss: proximal lateral leg and middle dorsum of foot
L3 nerve root muscle and dermatome testing?
Muscle: iliopsoas (T12-L3) via hip flexion; quadriceps (L2-L4) via knee extension; adductor group (L2-L4)
dermatome: anterior thigh (proximal medial to distal lateral knee)
What is the goal of OA treatment?
Targets the vagus nerve and increases its activity, thereby increasing parasympathetic tone
parasympathetics function in the lungs acts on bronchiolar smooth muscle to enhance respiration and respiratory epithelium to decrease goblet cell production therefore promoting thin copious secretions
AKA radial head subluxation
patient present holding their arm in pronation and holding it against their chest
treatment of nursemaids elbow?
Reduction involves flexing the child's arm while slowly supinating the already pronated arm
REduction of anteriorly dislocated shoulder joint
Flex the elbow to 90 degrees of flexion and externally rotate the arm
What is the most common form of scoliosis?
90% of cases are convex on right of the thoracic spine
2nd most common is thoracolumbar
3rd most common is lumbar scoliosis
Fryette principle associated with scoliosis?
Fryette type I spinal mechanics
assymetric paravertebral prominence results from the rotational component of spinal group curves
isometric contraction in muscle energy
acheived when the operators force is matched by the patient's force, resulting in increased muscle tension without change in muscle length
reciprocal inhibition muscle energy
Placing the patient into the restrictive barrier and then asking the patient to engage the restrictive barrier (same direction) against slight resistance
engaging the restrictive barrier and instructing the patient to move opposite direction with increased muscle tension and approximation of origin and insertion
contents of the fle
contents of the carpal tunnel
9 tendons of flexors of the hand (4 flexor digitorum profudundus, 4 flexor digitorum superficialis, 1 flexor pollucis longus)
Receives afferent input form the thoracic splanchnic nerves and sympathetic output of postganglionic fiber to various structures, such as the stomach, live,r gallbladder, spleen, and portions of the pancreas and duodenum
chapman point for intestinal peristalsis?
near the ASIS
Would be seen in a diangosis involving volvulus or bowel obstructin
Chapman point for the prostate?
Percutaneous reflex of Morely
inflammation source (ie. peritonitis) can lead to activation of the related A-gamma fibers innervating the structures affected, these fibers transmit this irritation back to the corresponding spinal root levels, leading to facilitation
These fibers conduct nerve impulses at an increased speed when compared to the C-fibers carryng visceral pain to the CNS
this reflex increases the intensity of acute abdominal pain and rebound tenderness in response to the visceral pathology, this can also result in abnormal musculature contraction and guarding
Law of Laplace
Pertains to the forces exerted against the walls of a structure from the inside
this is usually applied to vascular structures which have become aneurysmal
Ie. abdominal aortic aneurysm becomes exceedingly dangerous as the aneurysm increases in diameter
least splanchnic nerve innervation?
innervates the hindgt
greater splanchnic nerves innnervate?
contributed to dorsal nerve roots supplying specific dermtomes; however some adjacent spinal segments may cross over in a sense, the seond explains reciprocal inhibition when a muscle receives a neural impulse to contract the antagonist muscles(s) are sent an impulse
explains that the bone structure will remodel to help support patterns of stress, namely weight-bearing will lead to increased bone density to accomodate the increased demand
attachment of the inguinal ligament?
Pubic tubercle and the ASIS
tensing of the ligament can lead to ipsilateral innominate superior shear
First-line treatment of acute low back pain?
NSAIDs , particular Meloxicam (selective COX-2 inhibitor at low doses)
loses selectivity at higher doses
good option for patients with history of GI ulcers
acetaminophen is also first line in patients without liver pathology
symptoms of protatitis?
acute fever, myalgias, low back pain, perineal pain, urethral discharge and chronic dysuria, BPH symptoms
Chapman points of the upper lobes of lungs?
located in the 3rd intercostal space on both sides of the sternum
posterior: bt the right transverse process and spinous process of T3
chapman point of rectum?
located at the lesser trochanter of the femur
present inpatients withperirectal abscess or Ulcerative colitis (always involve the rectum)
chapman's point of the sinuses?
superior edge of the 2nd rib anteriorly
this is approximately midclavicular line (reflexes of larynx and tongue are locted more medially)
Chapman's reflex of gallbladder?
6th intercostal space on the right side only
T6 transverse process on right
goal of lymphatic treatment?
1. Open myofascial pathways at transition zones: craniocervical, cervicothoracic (thoracic inlet), thoracolumbar, lumbopelvic junction
- cervicothoracic (thoracic inlet) is the most important transition zones because it is where the lymph drains
2. maximize normal thoracoabdominal diaphragm motion
3. augment fluid fl9ow
4. mobilize tissue fluids into lymphatic system
plantar fasciitis and its treatment?
micro-tears in the plantar fascia leading to inflammation
pain usually increased in the morning when patient takes first step (this is due to dorsiflexion required to step after hours of sleeping with the foot in relatively plantar-flexed position)
primary treatment: arch support (particularly with heels), ice, and anti-inflammatory meds + stretcing
if not effective treat with injections or surgery
cranial flexion and extension and its relation to the sacrum?
Extension of cranium (loosens dura) dura moves anterior and inferior (nutation)
Flexion of cranium sacrum moves posterior superior (counter-nutation)
five components of the primary respiratory mechanism
1. fluctuation of CSF
2. Inherent motility of neural tube (the CNS, brain and spinal cord
3. Mobility of reciprocal tension membranes (Intracranial and intraspinal meninges including: dura, arachnoid, and pia mater
4. articular mobility of the cranial bones
5. Involuntary mobility of the sacrum in between the ilia
Location of iliacus CP and treatment?
Location: 1/3rd distance from ASIS to midline and pressing deep posterolaterally toward iliacus
patient is supine treatment: b/l flexion of hips, knees with external rotation of hips
treatment of lumbar L5 maverick tender point counterstrain ?
patient is prone, with hip and knee flexed and legs interanlly rotated and adducted
management of chronic constipation: agents must be useful
hinges on patient education and diet modification to include an adequate amount of fiber, water and natural sugars
supplemental fiber such as psyllium and other
Spencer technique series
Extension, flexion, circumduction with compression, circumduction with traction, abduction, internal rotation, pump
predominantly in females due to widened Q angle
caused by muscle imbalance as the vastus medialis and vastus lateralis compete for tracking pf the patella during motion of the knee
patients complain of pain with loading of the joint during flexion extension such as climbing stairs or running (at worst the patella can sublux laterally
rule of 3's for transverse process/spinous process relation of the thoracics
T1-T3 (T12)= spinous process is at the level of transverse
T4-T6 (T11)= spinous process is 1/2 below the transverse process
T7-T9 (T10)= spinous process is 1 level below transverse process
Sever disease (Calcaneal apophysitis)
Disease of children and adolescents affecting the posterior bony tubercle of the calcaneus (near the insertion of the achilles tendon
in children 5-11, the calcaneal apophysis develops an independent center ossification that fuses around the age off 17
During a period of rapid growth, shear stress on the apophyseal heel pain with mild swelling that worsens with activity
pain is reproduced with medial and lateral compression (squeeze test), forced dorsiflexion (toe raises) or passive dorsiflexion
radiographic imaging of Sever disease?
typically normal, diagnosis is mostly clinical
What type of kids are at higher risk of of Sever disease?
Children with flat or high foot arches, pronation of the foot, short-leg and obesity
treatment of Sever's disease (calcaneal apophysitis)?
Correct underlying biomechanical dysfunction, NSAIDs for pain relief, heel pad for cushioning, heel lift for reducing strain on Achilles tendon, foot orthotics, acticity modification to avoid provoking symptoms (especially running and jumping)
stretching and strengthening of the gastroc-soleu muscles, this disease is typically self-limited and resolved in 2-8 weeks
in rare cases short term casting may be required for 2-3 weeks
Due to excessive repetitive strain on the tendon which causes posterior heel pain with exercise
Differential for severe in children by the location of pain reproduction on physical exam, 2-6 cm proximal to insertion of achilles tendon
treatment: relative rest, ice, NSAIDs, heel cup for cushioning and taping
plantar fasciitis is common cause of plantar heel pain, pain is throbbing medial heel discomfort
worse with first few steps in the morning after prolonged periods of rest and improves with continued activity
Tarsal Tunnel syndroe
compressive neuropathy of the tibial nerve, or its branches, posterior to the medial malleolus (pain is diffuse and poorly localized to the medial ankle
paresthesia (tingling) or dysesthesias (burning) are common in the area of the medial ankle into the arch of the foot
pain is worse with walking or exercise but may also occur at night
physical exam reveals tenderness over the tarsal tunnel posterior to the medial malleolus (nerve conduction studies may reveal nerve entrapment and MRI for possible ganglion compression at site)
Treatment of C3-C5 helps in treating which nerve?
Phrenic nerve normalization
At what level does the crus attach?
Muscles associated with rib motion?
3-5 pectoralis minor
2-8 serratus anterior
9-12 latissmus dorsi
12 quadratus lumborum
Waht can help substitute for a stranding glexion test?
Iliac compression test
What muscle imbalance is associated with innominate dysfunction?
Imbalance between the quadriceps and hamstrings
treatment for patellofemoral syndrome?
focus on strengthening of vastus medialis oblique (active during the last 10-15 degrees of knee extension) via isometric contraction
parasympathetic input to the foregut and midgut?
From the occiput, C1, and/or C2 (the vagus)
What are anterior vs. posterior chapman points used for?
Chapman points of upper and lower lungs?
3rd and 4th intercostal space near the sternum
hapman point for heart?
2nd ICS near the sternum
chapman points of the stomach?
5th and 6th ICS on LEFT
Chapman points for liver?
5th and 6th ICS on right
Chapman point for gallbladder?
6th ICS on the right
Muscle energy treatment for backward sacral torsions
Patient starts in lateral recumbant position with axis side on the table
Combination of indirect articulation, and long-levered HVLA at times that is defined as a specific non-repetitive articulatory method that is indirect then direct
First step: involves placing the joint in the position of ease (indirect) and then directing it into physiologic barrier
apply slight compressive force (go to restrictive barrier but don't pass through)
muscle energy helps reduce what?
golgi tendon organ reflex
corresponding talus motion when fibular head is anterior?
Proximal fibular head that resist posterior spring
distal fibula may be posterior
talus is externally rotated causing foot to evert and dorsiflex
mechanics of the ankle when pronatee?
Foot is dorsiflexed, everted and abducted
talus is externally rotated
Mechanics when foot is supinated?
Plantarflexed, inverted, adducted
Talus is internally rotated
Lymphatic drainage technique used to relieve tension on the root of the mesentery to the posterior abdominal wall
used to treat a wide variety of GI problems ie. diarrhea, constipation, nausea, vomiting and abdominal pain
parasympathetics to the GI tract?
Vagus: up to the splenic flexure of the colon
Pelvic splanchnic: beyond
CV-4 cranial technique
Cranial technique: lateral angles of the occiput squama are manually approximated, slightly exaggerating the posterior convexity of the occiput and producing cranial EXTENSION
cranial nerves V-XII are located on the floor of the fourth ventricle (normalized function via treatment)
What cranial nerves are located at the floor of the fourth ventricle?
TMJ can be acute or chronic
Associated with stress, jaw clenching and nocturnal bruxism
pain radiates to ear, jaw, or posterior cervical region
What is the only muscle involved in the opening of the jaw/
Lateral pterygoid: Concentric contraction of the muscle lowers the mandible, but with unilateral contraction the jaw deviates to the contralateral side
muscles involved in the closing of the jaw?
Masseter, medial pterygoid, and temporalis muscles
What nerves make up the sciatic nerve (L4-S3)?
Tibial nerve and common peroneal nerve (common fibular nerve)
bound in one common sheath
diverge at the apex of the popliteal fossa
common peroneal nerve goes along the border of the biceps femoris muscles, and passes laterally around the fibular head and enters the lateral leg
muscles innervated by the superficial and deep peroneal nerve respectively
superficial: fibularis longus and brevis which plantar flex and evert the ankle
deep: anterior tibialis (foot dorsiflexion and inversion, extensor hallucus longus and brevis, extensor digitorum longus and brevis (foot/toe dorsiflexion) and fibularis tertius (foot dorsiflexion/eversion) and skin sensation in the space between the 1st and 2nd digits
RArely injured but possible sites of injury: popliteal fossa or gluteal region
depending on where it is injured can cause: loss of plantarflexion, digit abduction/adduction, foot eversion knee flexion, weakened inversion, impaired hip extension, shuffling gait with toe crawling
Hangs from the maxillary nerve and is located in the pterygopalatine fossa
parasympathetic supply to the nose is from the facial nerve, its pre-ganglionic fibers form part of the greater petrosal nerve, synapsing in the sphenopalatine ganglion (include both vasodilators and secretory fibers
post-g fibers are distributed from the sphenopalatine ganglion with sensory and sympathetic fibers
Chapman's points of the sinuses and the nasal sinuses/pharynx?
1st ICS midclavicular for sinuses
1st ICS infraclavicular for the nasal sinuses and pharynx
Chapman's points for rongue and tonsils?
1st ICS sternal
Way that the sphenopalatine ganglia treats nasal congestion
stimulation of the ganglia, inhibition of the lateral pterygoid muscle triggers points, and CV4 and trigeminal nerve stimulation techniques will produce parasympathetic and production of thin nasal secretion
Lateral winging of the scapula
caused by spinal accessory nerve injury during radical neck surgery resulting in trapezius paralysis
Ottawa ankle rules
1. tenderness to palpation along the posterior margin of the medial or lateral malleolus
2. Inability to bear weight immediately after injury and inability to take four steps in the ED
3. The presence of mid-foot pain along with pain at the navicular or fifth metatarsal along with the inability to bear weight as defined above
In the absence of these symptoms, a fracture is unlikely and the injury can be managed as a sprain with RICE and NSAIDs
How do you calculate the heel lift height adjustment for a patient with scoliosis?
Measure the sacral base unleveling difference
components of the medial longitudinal arch
calcaneus, the talus, the navicular, the cuneiforms, and first three metatarsal
Diagnosis of a dropped navicular?
collapsed medial longitudinal arch
quite tender on palpation and results in pain when weight-bearing
Facilitated positional release modality
Passive, indirect, meant to reduce muscle hypertonicity and restore normal motion to a restricted articulartion
primary neurophysiologic mechanism is though to be related to the I-alpha afferent and a gamma-efferent activity (same as counterstrain)
FAcilitate positional release technique
Procedure includes placing the region to be treated into a neutral position to diminish tissue and joint tension (also called flattening the spine)
S1 motor and sensory innervation?
Sensory: dermatome covering much of the posterior thigh and lateral lower leg (including the lateral aspect of the foot)
Tested by the achilles reflex
gastrocnemius is responsible for plantarflexion (toe-walking) receivieving motor innervation by S1
often mimics radicular pathology of sciatica
can cause radiating pain and weakness
less likely to have a positive straight leg raise
patients usually complain about pain with palpation
Dermatomal coverage of the medial buttocksat the natal fold distally to the medial malleolus
has some motor innervation of the hamstrings (not tested by muscle reflex
Horner's syndrome (ocuylosympathetic paresis)
results due to decrease sympathetic input from the cervical chain ganglion
causes: 1st rib elevation, stroke, tumor, trauma, carotid dissetion should always be considered with a history of neck pain ad abrupt movement of the head
pstosis, miosis, anhidrosis
seminmembranous and semitendinous musculature
compose the muscles of the posterior compartment of the thigh, found in clos relation to one another with very similar bony attachments of ischial tuberosity to the pes anserinus
actions include hip extension and knee flexion with some element of internal rotation
tensor fascia latae
Relatively small muscle found on the lateral aspect of the hip, it is connected intimately with the iliotibial band and ultimately connects at the lateral aspect of the proximal tibia
purpose of the TFL
stabilizes the pelvis when the contralateral leg is lifted off the ground
serves to abduct and internally rotate the femur along the gluteal muscles
In what set of patients is the pedal pump contraindicated?
Contraindicated in patients who have just undergone any abdominal procedure
Known to increase thoracoabdominal pressure with potential endangerment of stability of the surgical site
other contraindications include recent DVT or recent fractures to the lower extremity
Causes of medial epicondylitis ("Golfer's elbow")q
Caused by strain or overuse of the flexor muscles within the forearm
RAdial nerve palsy
weakness of the supinators and extensors of the forearms as well as paresthesias in the posterior aspect of the arm, forearm and hand
Travell's Trigger point of the right pectoralis muscle
Part of a system that is a mapped out relationship between damaged myofascial nexus and region of referred pain
trigger points may be treated in a variety of ways including dry needling and local injection of anesthetic and/or steroid medication
trigger point of right pectoralis muscle may be causative or perpetuating role in causing SVTs
other name for counterstrain point?
AT what degree of scoliosis does cardiac function become threatened>
at degrees >75
Distinguishing between patellofemoral syndrome and patellar tendonitis?
Focal findings ie. tenderness at proximal tibial tuberosity and slight anterior knee effusion
Somatosomatic reflexes of median nerve
may be seen at C5-T1
Causes of carpal tunnel syndrome?
- hypothyroid myxedema
- edema of pregnancy
- chronic inflammation
structural findings of short leg syndrome
sacral base unleveling with more inferior on affected side, ipsilateral anterior inominate, contralateral leg will be internally rotated with pronated foot
Trauma associated with SBS compression
History of direct blow in the anterior-posterior direction and vice versa
palpatory changes include a rock hard "bowling ball" feel to the CRI or the impression that all dysfunctional patterns are present
Sulcus sign test and indications of positive test
Perform by pulling humerus inferiorly
Positive test: inferior subluxation dislocation and visible/palpable sulcus
Test performed by flexing the patients arm and elbow to 90 degrees, stabilize the position and then internally rotate the shoulder
Test is positive if there is pain at the AC joint/subacromial space
way to remember: "Hawk" perched on the forearm
Jobe's test (AKA empty beer can test)
Used to assess tear in the supraspinatus muscle
Performed by having the patient internally rotate their arm to have the thumb pointing to the floor, patients arm is aBducted and resistance is applied downward while the patient attempts to keep the arm in this position
Test the bicipital tendon stability in the bicipital groove
Performed by having the patient flex their arm to about 90 degrees with elbow extended and forearm supination, then apply a downward force as if to place the arm back into neutral position, but instruct the patient to keep the arm flexed
positive is causing pain
Test for stability of the bicipital tendon stability in the bicipital groove
It is performed by stabilizing the forearm, then flexing the elbow to 90 degrees with the humerus in neutral position then externally rotating the shoulder/supinating the forearm against resitance
positive is pain upon supination
Post-partum osteopathic findings
bilateral sacral flexion
(base moves anteriorly about a middle transverse axis)
difficult to diagnosis due to false negative seated flexion test (because both sides are affected)
patients have an increased lumbar curvature and will have a negative spring test (patients have low back pain that is worse with backward bending)
PE findings: ASIS superior to PSIS
Associated with tight hamstrings muscles
Muscle energy treatment involves using quadriceps muscle
Treatment of acute variceal hemorrhage?
Maintaining a patients airway and hemodynamic stability, addressing coaguloathy, prophylactic antibiotics and stopping the bleeding (pharmacologic: octreotide or terlipressin) and more direct approaches
Direct methods of treating esophageal varices?
variceal ligation or banding via endoscope to stop bleeding, sclerotherapy is another option
other options: transjugular intrahepatic portosystemic shunt (TIPS procedure)
parasypathetics to the kidney and prosimal ureter?
vagus nerve (spinal levels C1-C2 dysfunction are associated with kidney and proximal pathology)
What organs does the splanchnic nerves supply paraympathetics to?
Distal ureter and bladder
Prostate and urethra
Rectum and sigmoid colon
Uterus and proximal fallopian tubes
What cranial dysfunctions are associated with tinnitus?
Internal an External rotation of temporal bone
External Rotation: associated with low bitched (ipsilateral mandible deviation)
Internal Rotation: associated with high-pitched (contralateral mandible deviation)
Ulnar nerve pathology
claw hand deformity caused by injury to the ulnar nerve
associated with weak pinch and grasp
Can present with pain along the medial arm both proximal and distal to the elbow especially with throwing
Mechnaism of injury median nerve
anesthesia to the antecubital fossa (nerve is adjacent to the medial cubital and basilic veins
Mechanism of injury of the radial nerve
Direct pressure as the radial nerve transverses the spiral groove of the humerus in the lower third of the arm
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