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...
- anteriorly
- Bucket handle motion is primary action of ribs
- 7-10
- 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..
- laterally
- 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...
- posteriorly
- 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
-
Sternum
Anterior and posterior scalene
Diaphragm
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
- IML T1-L2
- 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
Compartmentalization
Nutrition
Immunity/lymphatics
Repair
Sensorimotor
Communication - Superficial fascia is also called
- Subcutaneous
- Deep fascia is also called
- investing
- Subserous fascia is located in ...
-
pleura
pericardium
peritoneum - 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
-
-Skeletal
-Arthrodial
-myofascial
-vascular
-lymphatic
-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
RA
Fibromyalgia
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
2.Exercise
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
-
Respiration
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
- Lumbarization
- S1 becomes additional lumbar vertebra articulating with S2
- Sacralization
- 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
- No
- Name 3 true ligaments
-
Anterior sacroiliac
Interosseous
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
- Rotation
- 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
- Sacroiliac
- Which axis provides inominate rotation
- Inferior transverse
- Name motions of pubis
-
Caliper
Torsional
Superior inferior translatory - Name motions of ilium
-
AP
Ilial translatory - superoinferior + AP - Flexion and extension of sacrum occurs around which axis
- Middle transverse
- Rotation occurs around which axis
- Vertical
- Sidebending occurs around which axis
- AP