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OMM Exam 2


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What do anterior scalene muscles do
Attach cervical vertebrae to 1st rib
Brachial plexus emerges between
anterior and middle scalenes
Posterior scalene attaches to
2nd rib
1st rib is also attached to the clavicle by
costoclavicular ligament and its sternoclavicular joint
Describe chest movements on inhalation
Manubrium swings forward lifting body and mediastinum creating negative pressure
Respiratory axis of manubrium
3d costal cartilage
Which diameter enlarged during inspiration
AP diameter
Which ribs primarily have pump handle action
Ribs 2-5
In pump handle motion axis of rotation is closer to
transverse plane
What do ribs do in pump handle motion
Rise up and go down with sternum
Lifted by pectoralis minor (ribs 3-4-5)pectoralis major rib2 - posterior scalenes
Pump handle motion enlarges chest...
Bucket handle motion is primary action of ribs
In bucket handle motion axis of rotation is closer to
saggital plane
What do ribs do in bucket handle motion
Rise and fall laterally
Lifted by serratus anterior
Bucket handle motion enlarges chest..
Which ribs have primarily caliper motion
Ribs 11-12
In caliper motion axis of rotation close to
Transverse plane
What do ribs do in caliper motion
Rise and fall posteriorly
Caliper motion enlarges chest...
What is the motion of rib 12 in quiet breathing
Rib 12 is anchored by quadratus lumborum and has no movement in quiet breathing
Which rib has 1/2 bucket and 1/2 pump motion
Rib 1, lifted by anterior and middle scalenes, practically no motion in quiet breathing
What causes most respiratory restrictions of ribs
Thoracic vertebral segmental dysfunctions
How do you know which rib is restricted
Restricted rib will stop moving first and start moving after its partner
Exhalation dysfunction
Restricted inhalation
Rib is "down"
Inhalation dysfunction
Restricted exhalation
Rib is "up"
To treat an inhalation dysfunction treat...
lowest rib in group
To treat exhalation dysfunction treat
highest rib in group
Key rib for exhalation restriction is
bottom rib of the group
Key rib for inhalation restriction is
top rib of group
What is the relationship between rib and vertebra
Rib has two demifacets so two vertebrae influence motion of one rib
Which ribs have only one connection with body of vertebra
1, 11, 12
What can compress stellate ganglion
1st rib elevation
What kind of motion does T1 have
Type II, side bend rotate in same direction
What type of motion does C1-C7 have
type II mechanics
If elevation of the rib is on the right , what would be side bending and rotation of T1
to the left
Which lymphatic structure can be damaged in thoracic inlet
Thoracic duct
How can 1st rib affect upper extremity
On top of 1st rib is anterior trunk of brachial plexus - C8-T1, can get parasthesias and pain along ulnar nerve distribution of upper extremity
Which muscles responsible for principle rib elevation
External and internal intercostals
diaphragm for lower ribs
What are accessory muscles of rib elevation
Anterior and posterior scalene
Serratus posterior superior
Levatores costarum
Which muscle elevates ribs during forced inspiration
Pectoralis minor
What is used for rib depression in quiet breathing
Passive recoil from lungs
Diaphragm relaxation
What is used for rib depression in active breathing
Abdominal muscles
Internal and innermost intercostals
Accessory muscles for rib depression
Serratus posterior inferior
External internal obliques, transversus abdominis
Transversus thoracis
Describe inhalation somatic dysfunction
Inhalation is good, cant exhale --> ribs do not go down
Key rib --> lower
Describe exhalation somatic dysfunction
Ribs go down with ease, but wont go up
Key rib --> upper
Preganglionic sympathetic fibers have cell bodies in
Post ganglionic sympathetic fibers are in
Sympathetic chain ganglia (paravertebral and prevertebral)
Preganglionic parasympathetic fibers
Brainstem nuclei of CN 3, 7, 9, 10
S2-S4 lateral cord
Postganglionic parasympathetic fibers come from
Parasympathetic ganglia - head, effector organs
Pre vs post ganglionic fibers length in sympathetic
SHort pre
Long post
Pre vs post ganglionic fibers length in parasympathetic
Long pre
Short post
Describe viscerosomatic reflex
Organ is dysfunctional, affects segmental part of musculoskeletal system
ex. Heart attack --> pain in jaw, shoulder
GERD - middle back pain
From autonomic to somatic nerves
Describe somatovisceral reflex
Dysfunction in neuromusculoskeletal system results in disease of the organ
ex - something wrong with ribs, presses on sympathetic nerves, increases heart rate - you get palpitations, tachycardia
Define facilitation
Area of impairment or restriction develops lower threshold for irritation or dysfunction when other areas are stimulated
Describe facilitated segments
Chronically hyperirritable, hyperresponsive
Muscles hypertonic, tender
Define Chapman reflexes
Anterior and posterior tender points that may result from viscerosomatic reflexes
Chapman point for stomach is located
rib 5, 6 on the left
Chapman point for liver, GB is located
Between ribs 5 and 6 on the right
Palpatory characteristics of facilitated segment when its acute
Congestion, warm, moist, tender, muscle contraction, sidebending rotation on the side of problem
Palpatory characteristics of chronic facilitated segment
Ropey, stringy, cool, dry, color changes (white), decreased range of motion due to contracture, fibrotic
Functions of CT/fascia
Structural support
Superficial fascia is also called
Deep fascia is also called
Subserous fascia is located in ...
Submucosal fascia is located in
lamina propria - intestinal mucosa, bronchial mucosa
Fascia can be considered to consist of
Horizontal diaphragms and longitudinal cables
Describe horizontal diaphragms
Fibrous or myofascial partitions acting as tension/counterstrain sheets
Connected to fascial cables
Anchored to skeletal structures
Give examples of horizontal diaphragms
Tentorium cerebelli
Thoracic inlet/outlet
Respiratory diaphragm
Pelvic diaphragm
Plantar fascia/arches of feet
Give examples of longitudinal cables
-Dural sleeve to S2
-Longitudinal ligaments occiput -S2
-Psoas major to lower extremity
-Pre vertebral, alar , bucopharyngeal fascia
-Rectus abdominis, quadratus lumborum, internal obliques
-trachea, esophagus, pericardium on central tendon of diaphragm
What is included in somatic dysfunction
-nerural elements
Name fascial OMT techniques
Soft tissue
Myofascial release
Indirect balancing
Balanced ligamentous tension
What are indication for fascial OMT technique
acute painful conditions
chronic pain
metastatic patients
Myofascial pain
Visceral disorders
Relationship of asymmetry to looseness and tightness
Tightness creates
Looseness permits
Describe direct action
Gentle forces are applied with the hand TOWARD THE BARRIER or direction of least ease
Describe indirect action
Gentle forces are applied with hand AWAY FROM barrier - direction of most ease
Describe recoil technique
Gentle forces are applied with the hand AWAY from the barrier (indirect technique) while patient breathes in and out. The force is suddenly released on in breath during 3d repitition
Describe unwinding technique
Gentle forces applied in various vectors until tissue unwinds and returns to state of balance
Sequence of events in myofascial release
1. Apply forces gently either in direct or indirect relation
2. Wait for tissue to melt, soften
3. Retest motion for symmetry
5 components of myofascial health
1.Eliminate postural stresses
3.Nutritional - vitamins, minerals
4. Reduce psychological stress
5. OMT, massage, shiatsu, accupuncture
Describe American diet
High - in total calories, fat, protein, salt, phosphates, simple sugars
Low - fiber, calcium, potassium, trace minerals, vitamins
How do you calculate ideal body weight for men
for 5 "" height, ideal body weight is 106 lb, add 6 lb for every additional inch + 10 % for frame
Ideal body weight for females
5 feet - 100 lb, add 5 lb for each additional inch + 10 % for frame
Percent ideal body weight
Current weight /ideal weight * 100 %
Normal procent ideal body weight
90-109 %
What is other name for superior transverse axis
Craniosacral motion axis
Where is superior transverse axis located
at S2 segment
Where is middle transverse axis located
at S2 body
Where is inferior transverse axis located
inferior part of SI joint
What happens to sacrum/lumbar when you inhale
Sacrum flexes, lumbar extends
What happens to sacrum/lumbar when you exhale
Sacrum extends, lumbar flexes
Left on left
Deep sulcus on R
ILA on L
Spring neg.
Seated flexion on R
Which torsion is most common
Left on left
Which torsions are flexed
L on L
R on R
Right on right
Deep sulcus on L
Post ILA on R
Spring neg.
Seated flexion on L
Left on right
deep sulcus on R
Post ILA on left
Spring pos.
Seated flexion on left
Right on left
Deep sulcus on left
Posterior ILA on right
Spring Pos
Seated flexion on right
Inominate flare
ASIS is medial or lateral to normal
S1 becomes additional lumbar vertebra articulating with S2
L5 takes characteristics of sacral vertebra
Fergusons angle
Lumbosacral angle, inclination of S1 to horizontal
Normal - 25-35 degrees
SI joint
L shaped , converges posteriorly
Are there direct muscular attachments from sacrum to ilium
Name 3 true ligaments
Anterior sacroiliac
Posterior sacroiliac
Name 3 accessory ligaments
Sacrotuberous - ischial tuberosity to sacrum
Iliolumbar - TP L5 to iliac crest
Sacrospinous - ischial spine to sacrum
What do true ligaments restrict
What do accessory ligaments restrict
Anterior movement, rotation, give vertical stablity
Sacral plexus give what kind of fibers
Motor + sensory
What is another name for middle transverse axis
Which axis provides inominate rotation
Inferior transverse
Name motions of pubis
Superior inferior translatory
Name motions of ilium
Ilial translatory - superoinferior + AP
Flexion and extension of sacrum occurs around which axis
Middle transverse
Rotation occurs around which axis
Sidebending occurs around which axis

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