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Exam 2 OPP

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functions of thoracic cage (x4)
respiration
protection of vtal organs
pump fpr venous and lymph return
support sreucture for the upper extremities
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what are the true ribs?
1-7
3
what are the false ribs?
8-10
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what are the floating ribs?
11, 12
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what are the typical ribs?
3-9
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what are the atypical ribs
1,2,10,11,12
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ribs attach directly tp the sternum
true ribs
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ribs attach to the sternum via synchrondroses
false ribs
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ribs that do nt attach to the sternum
floating ribs
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what are the articulations of the typical ribs (x3)
head: vertebral bpdy at same level and anterior ;level
tubercle: transverse process
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what does R1 articulare with?
T1 body, has no angle
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what does rib 2 articulate wuth
large tuberpcity for serratus anterior
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what does R10 articulate with
single facer for costocavicular articulation
otherwise typical
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wjat do R11 and 12 articulate with
correspondng vertebral body
-no nexk or tubercles
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what type of joint is rib 1 tp the manubrium
symchrondrosis
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ribs 1-7 cpstrotransverse joint motion
rotation
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ribs 8-10 costotranverse joint motion
gliding
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primary rib motion 1-5
pump handle
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primapry rib motion R6-10
bucklet handle
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primary rib motion 11 and 12
caliper
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plane and axis pof motion pump handle (1-5)
sagittal plane
costovertebral-cpstrotranverse line (axis)
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pump handle motion of ribs 1-5
inspiration: anterior aspect of rib cephalad (superior)
posterior aspect moves caudad (inferiorly)
(opposite for expiration)
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what is this assessing?
pump handle motion ribs 1-5
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plane of morion and axis bucket handle (6-10)
coronal plane
cpostovertebral costosternal line (axis)
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bucket handle motion (6-10)
rib shaft lifts during inhilation
falls with exhalation
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what is this assessing?
bucket handle motion ribs 6-10
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caliper motion (11,12)
ribs externally rotate wth inhalation
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what is this assessing?
caliper motion (ribs 11 and 12)
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what plane of motion and axis caliper motion
horizontal plane
vertical line (axis0
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what runs through the intercostal space (in order)
intercostal v, a, n
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where are intercostal nerves locatedun
costal groove
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where are intercostalk nerves deribved from?
sympathetic chain ganglia
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what do intercostal nerves innervate?
thoracic and abdominal walls
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what nerve roots innervate the diaphragm
C3-5
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what structures pass thrugh the diaphragm? (x3)
IVC at T8
Esophagus T10
Aorta at T12
(I8 10 eggs at noon)
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If you have thoracuc cage somatic dysfunction, what do you treat first, ribs or vertebrae?
vertebrae
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an inhalation SD will elevate with _________- and _________- with restriction
inspiration, expiration
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key rib in inhalation SD
lowerottom
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exhalation SD: moves ________ with expiration (ease) and inhalates with restriction, will not move ________-
inferiorly; superior
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how do you evaluate the first rib for inhalation or exhalation somatic dysfunction
Patient  seated
DOc  stands behind the patient
Palpates the posterolateral shaft of each 1st rib immediately lateral to the costotransverse articulation
Start at the ear and move your thumbs inferior staying tight to the neck and medial. The first bony prominence will be the posterior first rib. (Anterior to the trapezius)
Place index finger on the first rib anterior
Observe the static position of the rib
Compare side to side
Compress the rib – resistance = dysfunction
Instruct the patient inhale and exhale
Observe & feel the motion
Somatic Dysfunction
Inhalation Dysfunction
Exhalation Dysfunction
Elevated
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which ribs have the pump handle motion
ribs 1-5
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how do you screen for somatic dysfunction pump handle motion
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how do you screen for somatic dysfunction bucket handle motion
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how do you screen for somatic dysfunction caliper motion
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Somatic dysfunction that maintains a total dysfunction pattern including other secondary dysfunctions”
key lesion
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Introduced in muscle energy technique seminars to help determine which rib should be treated first when a group costal dysfunction was evident
key rib
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what is the key rib if your ribs are stuck up in inhalation
botton rib
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what is the key rib if your ribs are stuck down in exhalation
top rib
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the celliac ganglia is post ganglionic to...
Distal Esophagus, Stomach, Liver, Gallbladder, Spleen, portions of Pancreas, proximal Duodenum (foregut)
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the superior mesentreric ganflia is post ganglionic to...
Portions of Pancreas, Duodenum, Jejunum, Ileum, Asc. Colon, Prox. 2/3 of Transverse Colon. (midgut); Adrenals, Gonads, Kidneys, upper ½ Ureter
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the inferior mesentreric ganglia is post ganglionic to...
Distal 1/3 Transverse Colon, Desc. Colon, Sigmoid, Rectum (hindgut); lower ½ Ureter, Bladder, Genitalia
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Nerve fibers via which organs communicate with the central nervous system
-Capable of transmitting stress (pain)
-Utilize Acetylcholine as their neural transmitter.
visceral afferents
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-A theory regarding the neurophysiological mechanisms underlying the neuronal activity associated with somatic dysfunction
-The maintenance of a pool of neurons in a state of partial or subthreshold excitation.
-Less afferent stimulation is required to trigger the discharge of impulses
Facilitation
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Disruption, Irritation, or Disease of an internal organ or tissue results in a reflex dysfunction in a segmentally related musculoskeletal region
Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures. (Glossary of Terms)
viscero somatic reflex
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A system of reflex points that are present as predictable anterior and posterior abnormalities in fascia - tissue texture changes – assumed to be a reflection of visceral dysfunction or pathology.
chapman reflexes
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how are chapman reflxes described
Pea-sized area
Boggy, ropey, shotty, and/or thickened
Do NOT radiate pain
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what is the criteria for a chapmans reflex
lymphatic congestion and altered myofascial texture
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4 categories of visceral motion
1.Somatic Nervous System
2. Autonomic Nervous System
3.Craniosacral Rhythm
4.Visceral Motility
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visceral motion: Voluntary motion of the
musculoskeletal system
somatic nervous system
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Visceral motion: diaphragmatic motion, cardiac motion, peristaltic motion
ANS
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Capable of rapid, wide spread
organ and somatic changes
“Sustained sympathetic activity
is a common factor in disease.”
sympathetic innervation
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sympathetic effects of foregut
Vasoconstriction
Alters HCO3- & mucus buffers
Increase sphincter tone
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sympathetic motions of the midgut
Vasoconstriction
Decrease peristalsis
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sympathetic motions of the hindgut
Vasoconstriction
Decrease peristalsis
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parasympathetic effects abdominal
Increased glandular secretion
Increased peristalsis → diarrhea
Sphincter relaxation
Occipital headache
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visceral motion: ciculation of CSF, pure;u autonomic
craniosacral rhythm
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visceral motion: intrinsic actove motion of individual cells; innate for each organs; independent to extrinsic factors; synchronous motion
visceral motility
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attachments abdominal obliques
 Internal – Iliac crest
 External: Iliac crest, Pubic tubercle
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attachments erector spinae
 Iliac crest
 ligaments
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attachments tensor fascia lata
 ASIS
 Iliac crest
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three true pelvic ligaments
anterior sacroiliac
interosseous
posterior sacroiliac
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three pelvic motion
 Pubic motions
 Ilial motions on the sacrum
 Sacral motions on the ilium
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pubic motions (x3)
caliper, torisonal, superoinferior translatory
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 One pubic bone is displaced
superiorly compared to the other
 Etiology – tight rectus
abdominus or trauma
superior pubic shear
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what m is tight in a superior pubic shear
rectus abdominus
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 ASIS level or inferior
 PSIS level or superior
 Etiology
- tight adductors or trauma
inferior pubic shear
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what muscles are tight in inferior pubic shear
tight adductors or trauma
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Suspicion of dysfunction by history
 Bulging of pubic symphysis
 Tenderness
 Urinary symptoms
pubic adduction
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 Suspicion of dysfunction by history
 Sulcus deeper than normal
 Tenderness
 Urinary tract symptoms
pubic abduction
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due to muscular imbalance
and the side of the
dysfunction is the side of the
positive standing flexion test
iliosacral somatic dysfunction
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ASIS - inferior
 PSIS - superior
 Ipsilateral hamstring taught
 Sciatica
 Tissue changes at ILA
 Iliolumbar ligament
 Can be associated with an anatomic short leg
anterior innominate rotation
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etiology of anterior innominate rotation
 Hypertonic quads
 Hypertonic QL
 Hypertonic adductors
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 ASIS - superior
 PSIS - inferior
 Inguinalroin pain
 Medial knee pain
 Inguinal tenderness
 Tissue changes at the sacral sulcus
 Can be associated with an anatomic long leg
posterior innominate rotation
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etiology posterior innominate rotation
 Hypertonic hamstrings
 Hypertonic rectus abdominus
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ASIS - superior
 PSIS - superior
 Pubic ramus
 Pelvic pain
 Ipsilateral SI joint and pubes
superior innominate shear
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etiology superior innominate shear
 Fall to the buttocks/knee - same side
 Sitting/standing unevenly
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 ASIS more inferior
 PSIS more inferior
 Pubic ramus inferior
 same complaint of pelvic
pain
 same tissue changes
 rare
inferior innominate shear
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anterior rotation
adducted
ASIS is medial or lateral to its usual position
innominate inflare
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posteriorly rotated
abducted
ASIS is medial or lateral to its usual position
innominate outflares
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Gross evaluation of iliosacral motion
• Standing position feet shoulder length apart
• Operator behind patient with thumbs UNDER the PSIS
• Patient bends forward
• Motion restriction = PSIS moves cephalad
standig flexion test
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what is a positive standing flexion test
PSIS moves cephalad
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• Evaluates sacroiliac dysfunction
• Patient is seated
• Operator behind patient, eyes level
and thumbs UNDER the PSIS
• Same as standing flexion test
• Removes innominates as a factor
seated flexion test
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 Patient supine
 Hips and knees bent
 Patient lifts the buttock up and sets it down
 Physician straightens the legs
 Patient passive and relaxed
 Assures alignment on the table
 Perform prior to any anterior landmark eval
hip flop
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when do you perform a hip flop?
prior to any anterior landmark eval
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what are they evaluating?
ASIS
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what are they evaluating
PSIS
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what are they evaluating
ischial tuberosity
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A healing-oriented medicine that considers the whole person (body, mind, spirit) and uses both conventional and alternative therapies
Integrative Medicine
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A model that is reductionistic, biochemical/physical, interventional, symptomatic, and emergency-focused
Conventional Medicine
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A model emphasizing prevention, self-healing, holistic paradigms, and root cause of illness
Complementary/Alternative Medicine (CAM)
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Underlying origin of illness, involving body, mind, emotions, and spirit
Root Cause
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The stage before disease develops, where prevention and early care are emphasized
Clinical Horizon
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A category of CAM therapies involving bioenergetic or vibrational approaches
Energy Medicine
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The vital life force or energy flow in traditional Chinese medicine
Qi
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Acupuncture applied to the whole body meridian system
Macrosystem Acupuncture
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Acupuncture applied to localized systems such as the ear, scalp, or hand
Microsystem Acupuncture
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A form of acupuncture where electrical current is applied to the needles
Electroacupuncture
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OMT (Osteopathic Manipulative Treatment)
Hands-on therapy to improve body function and self-healing
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A health system emphasizing natural healing, nutrition, prevention, herbalism, and holistic approaches
Naturopathy
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A system of medicine using highly diluted substances to stimulate the body’s healing response
Homeopathy
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A system of healthcare including herbalism, nutrition, acupuncture, massage (Tui na), and exercise
Oriental Medicine
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A therapy involving burning “moxa” (mugwort) on or near the skin to stimulate acupuncture points
Moxabustion
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Chinese therapeutic massage used in Oriental medicine
Tui Na
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A therapy involving suction cups placed on the skin to stimulate circulation and healing
Cupping
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An ear acupuncture treatment developed for addiction detoxification
NADA Protocol
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Various models of acupuncture including TCM 5 elements, neuroanatomical, Dr. Tan method, and microsystems
Acupuncture Repertoire
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Pathways in the body where Qi flows in Oriental medicine
Meridian
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Curious Meridians
Special acupuncture meridians with unique influence, such as Du Mai and Dai Mai
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Five Elements (TCM)
Wood, Fire, Earth, Metal, Water — used in Chinese medicine for diagnosis and treatment
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Kidney Yin Deficiency
A TCM symptom complex involving depletion of kidney energy
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Whole medical systems such as Osteopathy, Chiropractic, Naturopathy, Homeopathy, Oriental Medicine, and Ayurveda
Alternative Systems
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Therapies using herbalism, essential oils, and plant-based medicines (Western, Chinese, Ayurvedic)
Botanicals
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Energy Medicine Modalities
Acupuncture, Qi Gong, Reiki, Therapeutic Touch, Pranic Healing, Marma Therapy
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Energy medicine focusing on body energy centers
Chakra Therapies
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Healing approaches using magnets or electromagnetic fields
Magnetic Therapies
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A system balancing body energy fields
Polarity Therapy
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Zero Balancing
A hands-on therapy integrating body structure and energy
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PEMF
Pulsed electromagnetic field therapy
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TENSCAM
A device-based form of energy therapy
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Health practice involving direct contact with the earth’s surface
Earthing (Grounding)
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Sound Therapies
Healing using music therapy, Tomatis method, ultrasound
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Color Therapies
Healing using art therapy, laser therapy, and colorpuncture
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Craniosacral Therapy
A gentle hands-on method for releasing tension in the craniosacral system
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Spinal adjustments for improving health
Chiropractic Manipulation
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Manual therapy to relieve pain and stress
Therapeutic Massage
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Treatment targeting muscle trigger points
Trigger Point Myotherapy
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Deep tissue bodywork to reorganize connective tissue
Rolfing
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Reflexology
Therapy using pressure points on the feet, hands, or ears
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Education method improving posture and movement
Alexander Technique
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Exercise system for core strength and flexibility
Pilates
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Mind-body practice combining postures, breathing, and meditation
Yoga
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Chinese martial art practiced for health and relaxation
Tai Chi
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Water-based bodywork therapy
Aqua Healing (Watsu)
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Therapy using expressive movement
Dance Therapy
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Technique using feedback on body functions like EEG or HRV to improve health
Biofeedback
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Focused attention therapy for behavior and symptom change
Hypnosis
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Visualization practice for healing and relaxation
Guided Imagery
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Energy Psychology
Approach combining psychology and energy therapies
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Shamanism
Traditional healing using rituals and altered states
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Practice of mindfulness and awareness
Meditation
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Spiritual practice to promote healing
Prayer
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Treatment using agents that bind heavy metals for removal
Chelation Therapy
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Injection therapy to stimulate tissue repair
Prolotherapy
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Platelet Rich Plasma (PRP)
Injections using concentrated platelets to heal tissue
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Stem Cell Therapy
Treatment using stem cells for regeneration
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Orthomolecular Medicine
Use of nutritional supplements for health
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Diets
Therapeutic nutrition plans for prevention and treatment
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Ayurveda
Traditional Indian medicine system based on elements and doshas
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Five Elements (Ayurveda)
Ether, Air, Fire, Water, Earth
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True articular ligaments of the pelvis (x3)
anterior SI ligament
interosseus SI ligament
Posteriot SI ligament
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what is the normal degree of the ferguson (lumbosacral) angle
35*
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what are the promary pelvis muscles?
intrinsic pelvic floor: urogenital diaphragm and pelvoc diaphragm
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what is the axis of movement of the pubic symphysis during normal gait
trasnverse axis
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in flexion, the base of the sacrum moves?
anterior
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3 things needed for sacral diagnosis
sulcus, ILA, testing: indicating its forward or backward or stuck
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what is this ecaluating?
ASIS
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what is this evaluating
pubic symphysis and tubercles
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what is this evaluating?
PSIS
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ehat dpes this evaluate
sacral base
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what does this evaluate
iferior lateral angles
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what does this evaluate
ischial tuberosities
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what do you ecaluate with a standing patient at this view
PSIS, illiac crest; standing flexion test
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Patient – Standing (feet should width)
 DOc– Behind patient – EYE level (Dominant Eye)
 DOc– Locate INFERIOR border PSIS, hook under B/L
 Pt instructed to flex at waist & hips w/o flexing knees
 Then ask patient to return to neutral when don
Evaluation
 PSIS - moves first anteriorly/superiorly is dysfunctional
 The Iliosacral joint on the affected side does not have as
much freedom of motion as the other side.
Interpretation
 Ilio-sacral or Sacro-iliac – undefined pelvic SD
 Laterality (right or left)
standing flexion test
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what is positive in a standing flexion test?
side that moves fastest and farthest is positive
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what test? what side posituve
standing fkexion test; right
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what do you evaluate on a seated patient (innominate, pelvis, sacrum)
Illiac crest, PSIS, seated flexion test
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Testing for symmetry of motion between innominate and
sacrum
 Sitting on ischial tuberosities stabilizes the ilium and
focuses testing on the sacral motion
 And, eliminates the influence of the lower extremities
 Lateralizes dysfunction (which side is trouble)
 Also confirms that it is a "sacral" problem and not
necessarily a problems with an ilium (i.e. Sacroiliac
Dysfunction)
seated flexion test
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what is the advantage of the seated flexion test vs the standing
removes the innnominate as a factor/locks it in place
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what is the interpretation of a seated and standing flexion test
sacro iliac dysfunction and laterality (right or left)
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which side shows a positive seated flexion test
rightright
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what do you evaliate for iliosacral dysfunction
Supine
 Anterior Landmarks
 ASIS
 Pubic Tubercles
 Medial Malleolus
Prone
 Posterior Landmarks
 PSIS
 Ischial Tuberosities
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what do yiu evaluate fir sacroiluac dysfunction
Prone
 Posterior Landmarks
 Sacral Sulci
 Sacral Base
 ILAs
 Sacrotuberous Ligament
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Purpose: Tests lateralization of somatic dysfunction
 Patient: Supine
 DOc: side of table, Dominant Eye closet to table
 Contact both ASIS and apply a posterior compression on one side,
(approximately 45d toward the SI Joint) while stabilizing the other
ASIS/pelvis. Then repeat process on opposite side.
 Compare sides. There should be a sense of movement on the normal side
and a sense of resistance if dysfunction. Somatic dysfunction of the SI joint
produces resistance to the test or lack of spring.
 Most resistance = positive side.
 Indicates laterality only – not if iliosacral or sacroiliac
ASIS compression test
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what is the puroose if an ASIS copression test
test lateraization of somatic dysfunction
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what does the sprinbg test evaluate
Testing Passive ROM
 It’s purpose: Assess if sacral base has moved posterior. An
example would be a backward sacral torsion:
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1. Patient – Prone
2. DOc – Side of table
3. Find sacral base
4. Place heel of hand over Lumbosacral junction
5. Spring in an Anterior motion
6. Results:
a. Positive = If there is NO springing allowed = Non-neutral condition
(AKA Backward torsion)
b. Negative = If there is springing allowed = Neutral condition
spring test
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what is a negative spring test
If there is springing allowed = Neutral condition
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where is heel of hand placed in spring test
lumbosacral junction
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what is a positive spring test
If there is NO springing allowed = Non-neutral condition
(AKA Backward torsion)
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what does the sphynx test evaluate
Testing Active ROM
 It will help to point out any asymmetric motion of the sacrum
It will help to identify loss of motion
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 Patient: Prone
 DOc: Dominant eye closest to side of table
 Places thumbs in sacral sulci/sacral base
 Asks patient to prop up on elbows, inducing lumbar extension
which in turn should cause the sacral base to move anterior
sphinx test
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positive sphinx test
If one side of the sacral base is stuck posterior, it will resist moving
anterior with lumbar extension and thumbs will appear more
asymmetric. (Secondly, the bases could move posteriorly, instead of
normal – moves anteriorly.)
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negative sphinx test
f part of the sacral base is stuck anterior, when the patient extends
the lumbar region, the NON-dysfunctional side will move anteriorly
to “catch-up” with the dysfunctional side giving a more symmetrical
appearance.
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