Term
| what model are sympathetics and parasympathetics a part of? |
|
Definition
| the neurologic-autonomic model |
|
|
Term
| what model are lymphatics a part of? |
|
Definition
| the respiratory-circulatory model |
|
|
Term
| what are chapman's reflexes representative of? |
|
Definition
| hypersympathetic tone, which cause facilitated segments which can affect the CV system (vasoconstriction) |
|
|
Term
| how can OMM best support homeostasis in attempting to treat SDs? |
|
Definition
| by modifying the relationship between the sympathetic and parasympathetics - facilitated segments are most commonly linked w/the interface between somatic sysfunction and the sympathetic nervous system, which can be supported through the respiratory-circulatory model (better drainage of venous and lymphatic fluids and basic metabolites that go with it) |
|
|
Term
| where are the sympathetics for the heart located? where are good tx locations for these? |
|
Definition
| T1-6, where the cell bodies lie. the thoracic inlet is a good location to treat these (it is made up of T1-4, the 1st 2 ribs and the manubrium) |
|
|
Term
| where do the parasympathetics for the heart originate? where are good tx locations for these? |
|
Definition
| the vagus (CNX), which can be treated with the V-spread for the occipital mastoid suture. there are direct anatomical connections between C2 and the vagus, so dx/tx of C2 dysfunction is important, and CV4 (technique)can help with heart rate variability |
|
|
Term
| where are the lymphatics for the heart located? what are some treatments that can help it? |
|
Definition
| they drain mainly through the right side, again tx of the thoracic inlet can address this as well as pectoral traction (there is a relationship between the pectoralis major muscle and caridac disease) and CV4 |
|
|
Term
| what are the somatic or biomechanic components of treating cardiac pts? |
|
Definition
| the sternum (OMT post-chest compress/post-coronary artery bypass) and hyoid (its fascia is continous with that of the mediastinum) can both be manipulated |
|
|
Term
| how are VS/SV/VV/SS reflexes named? |
|
Definition
| for the order of the reflex |
|
|
Term
| how might a V-S reflex happen? |
|
Definition
| there can be heart pathology that has input on the cord at the segmental level T1-6, which has palpable effects on the back |
|
|
Term
| how might a S-V reflex happen? |
|
Definition
| changes in the back can feed into a faciliated segment and produce some kind of cardiac event |
|
|
Term
| what would a V-V reflex be? |
|
Definition
|
|
Term
| what would a S-S reflex be? |
|
Definition
| one part of the somatic system to another part of the somatic system |
|
|
Term
| what do the VS/SV/VV/SS reflexes all share in common? |
|
Definition
| the faciliated segment (central region of the nervous system w/a lowered threshold), which acts as a neurologic lens. |
|
|
Term
| where are the cell bodies for the sympathetic system located? |
|
Definition
| T1-L2, collateral ganglia and chapman's reflexes |
|
|
Term
| where are the cell bodies for the parasympathetic system located? |
|
Definition
| cranial nerves 3,7,9,10 and S2-4 |
|
|
Term
| what did the korr/denslow research prove concerning facilitated segments? |
|
Definition
| there were sweat gland changes associated with hypersympathetic tone in facilitated segments as well as hyperreactivity in muscles, (the facilicated segment can be fired by applying pressure somewhere other than at that segment) |
|
|
Term
| what is is the conclusion in terms of treatment related to the korr/denslow research? |
|
Definition
| you treat the area of the faciliatated segment first to eliminate it, otherwise treating other places in the body may fire the facilicated segment |
|
|
Term
| what organs are the facilitated segments of T1-4 associated with? |
|
Definition
|
|
Term
| what organs are the facilitated segments of T5-9 associated with? |
|
Definition
| the stomach, gall bladder, all of the GI tract down to the ligament of treitz via synapses in teh celiac ganglia carried by the greater splanchnic |
|
|
Term
| what organs are the facilitated segments of T10-11 associated with? |
|
Definition
| the small intestines, 1st half of the ascending colon to the mid-transverse colon, kidneys and gonadal tissues through the superior mesenteric ganglia |
|
|
Term
| what organs are the facilitated segments of T12-L2 associated with? |
|
Definition
| the descending colon and pelvic organs, (uterus, urinary bladder, etc.) |
|
|
Term
| what does tx of a facilitated segment consist of? |
|
Definition
| reducing as much nociception as possible (stress/pain) |
|
|
Term
| what do the sympathetics to the upper extremities share? |
|
Definition
| T2-8 (sympathetic cell bodies have to be somewhere bet. T1-L2) |
|
|
Term
| what is complex regional pain syndrome type 1? |
|
Definition
| post-traumatic hyperirritability syndrome after carpal tunnel sx or an MI can lead to causalgia if a nerve is injured, if another structure is injured you can have reflex sympathetic dystrophy (both are complex regional pain syndrome type 1 and can be S-S or V-S), where the sympathetic to the extremities can cause vasoconstriction, osteoporosis, exaggerated pain, and sweat gland activity that kicks off even more sympathetic activity, worsening the origninal issue |
|
|
Term
| what are the facilitated segments predominantly associated with cardiac issues? what can irritate them? |
|
Definition
| T2-3 on the L side which can be stimulated by organ dysfunction, infection, inflammation, trauma, tumor (if its pushing against a faciliated segment), MI, coronary artery dys, angina, CHF, SBE, and myocarditis |
|
|
Term
| what is the main clue that you are dealing with a facilitated V-S reflex (not articular)? |
|
Definition
| if the tissue texture changes are more predominant than the range of motion restriction and when HVLA thrusts "bounce off" (b/c tissue texture changes are predominant, responds better to muscle energy or BLT) |
|
|
Term
| what are other clues that you may be dealing with a V-S reflex? |
|
Definition
| a flat spot b/c the viscera preferentially activate rotatores muscles = hyperextension = type 2 dysfunction (more uncomfortable due to non-neutral position - constant stimulation of FS), changes in sweat gland activity with cool skin are more likely in acute situations (vasoconstriction = cool, hypersympathetic tone = sweat), but chronic would be cool and dry (sweat glands have died off). *coronary artery disease is often a mix of acute and chronic |
|
|
Term
| in V-S reflexes, what side does the rotation usually go towards? |
|
Definition
|
|
Term
| what is the earliest type of reflex? |
|
Definition
| visceral reflex, which doesn't usually have a somatic component, it's just viscera talking to collateral ganglia manifested as vague pain and tender muscle hypertonicity over the midline of the ganglie (but nothing in the back) |
|
|
Term
| what happens if a visceral reflex is continously stimulated? |
|
Definition
| if the afferent info is increased enough to set up a FS, it becomes a V-S and you get paraspinal muscle hyperactivity = changes in the thoracic, lumbar, or ribs depending on what structures you are looking at (can get CRs and other muscles on the same segmental level may be affected - may get trigger points) |
|
|
Term
| what happens if a visceral reflex not only sets up a faciliated segment, but also irritates associated segments due to rupture or inflammation? |
|
Definition
| you can get a peritoneo-cutaneous reflex, such as irritated pleura in the lungs or muscle rigidity (hypertonicity) and rebound tenderness |
|
|
Term
| where do visceral afferents from the anterior of the heart get most of their innervations from? |
|
Definition
| segments associated with T1-6 (especially T2-3) |
|
|
Term
| what are the posterior and inferior of the heart rich with? |
|
Definition
| vagal receptors (C2 segment) |
|
|
Term
| is there an increased risk of sudden death with facilitated segments? |
|
Definition
|
|
Term
| what do 60% of pts with coronary artery disease develop in the pectoralis major muscle? |
|
Definition
| trigger points. this muscle can also refer pain down their arm. |
|
|
Term
| are chapman's points associated with the endocrine system? |
|
Definition
| no, they are thought to be associated with the autonomic system (V-S/S-V) |
|
|
Term
| if a midline organ, where are the points usually found? unilateral? |
|
Definition
| midline: CP are found bilaterally, unilateral: on the L/R side, corrolating with the organ affected |
|
|
Term
| why are chapman's points by definition a form of SD? |
|
Definition
| they are predictable anterior and posterior fascial tissue texture changes |
|
|
Term
| are anterior or posterior chapman's points used for dx? |
|
Definition
| anterior, b/c there are fewer things in front that hurt |
|
|
Term
| where do chapman's points lie in the skin? |
|
Definition
| just under the skin, in the subcutaneous tissue. they can however be located in the deep fascia. |
|
|
Term
| how are chapman's points palpated? |
|
Definition
| they are small, smooth, firm nodules that are approximately 2-3 mm in diameter. they will get larger depending on severity |
|
|
Term
| what does palpation of a chapman's point produce? |
|
Definition
| non-radiating, pinpoint pain that is sharp and exquisitely distressing. (60 % overlap between CPs, acupuncture points, trigger points, etc.) |
|
|
Term
| what treatments work on chapmans points? |
|
Definition
| acupuncture, counterstrain, injection |
|
|
Term
| what are chapman's points used for mostly in osteopathic medicine? |
|
Definition
| dx of a V-S, telling you that the primary problem is visceral (which needs its own tx apart from the somatic) |
|
|
Term
| where do you tend to find the chapman's points? |
|
Definition
| where the nerve pierces the fascia |
|
|
Term
| what characterizes the anterior chapman's reflexes? |
|
Definition
| they are diagnostic, more tender, and more spread out (fewer things to confuse them with) |
|
|
Term
| what characterizes the posterior chapman's reflexes? |
|
Definition
| they are therapeutic, less tender and if treated, the corresponding anterior point may go away |
|
|
Term
| how do chapman's points, jone's counterstrain points, and travell's trigger points compare? |
|
Definition
| chapman's points are V-S, counterstrain points are purely biomechanical, and travell's trigger points are either V-S or biochemical. jones+chapmans are locally tender w/no referral but travell's points are locally tender w/referral. chapmans points are located near the periosteum, and travell's are located near the motorpoint of the muscle in a taut bind |
|
|
Term
| what can the T1-4 CPs be primarily associated with? |
|
Definition
|
|
Term
| what can the 2nd-4th intercostal interspace CPs be primarily associated with? |
|
Definition
|
|
Term
| what can the 5-7th intercostal interspace + R sternal border CPs be primarily associated with? |
|
Definition
|
|
Term
| what can the CPs around the umbilicus be primarily associated with? |
|
Definition
|
|
Term
| what can the CPs around the pubic symphysis be primarily associated with? |
|
Definition
|
|
Term
| what can the R+L illiotibial CPs around the pubic symphysis be primarily associated with? |
|
Definition
| R: ascending colon, L: descending colon or both:prostate, broad ligament |
|
|
Term
| why would you find something involving V-S reflexes in the lower extremities? |
|
Definition
|
|
Term
| where are posterior chapman's points treated? |
|
Definition
| halfway between the spinous and transverse processes (except for the EENT, which are found at the base of the skull where the sup cervical ganglia are) |
|
|
Term
| what must you do before treating a chapman's point? |
|
Definition
| use it for dx, because if you do soft tissue - it may disappear |
|
|
Term
| where are the chapman's reflexes located for EENT-repiratory? |
|
Definition
| sinuses: laterally above + below clavicle-2nd rib complex. pharynx and tonsils, larynx: medial to the sternal edge. middle ear: above clavicle. 2nd intercostal space: bronchus. 3rd intercostal space: upper lung. 4th intercostal space: lower lung. |
|
|
Term
| why does a chapman's point of the 2nd intercostal space need to be differentiated by other means? |
|
Definition
| b/c the bronchus, heart, thyroid and esphagus are all innervated by T2, so it could be any of them |
|
|
Term
| for the posterior EENT, where are the middle ear, sinuses, pharynx, larynx and nasal sinuses chapman's reflexes found? bronchus and lung? |
|
Definition
| middle ear, sinuses, pharyns, larynx and nasal sinuses: at the base of the skull - correlating with the superior cervical ganglia. bronchus and lung: spinous and transverse processes |
|
|
Term
| what would CR of the 5 and 6th rib on the L side be associated with? |
|
Definition
|
|
Term
| what would CR of the 5 and 6th rib on the R side be associated with? |
|
Definition
|
|
Term
| what do the anterior thoracic CR share? what would be likely to be found in terms of somatic dysfunction on the back? |
|
Definition
| the celiac ganglia, which is just under the xiphoid. if the pt was turned over, you'd be likely to find a type II dysfunction with the segment rotating towards the side of the organ |
|
|
Term
| what do CR on the 9-12 ribs indicate? |
|
Definition
| V-S reflexes with the small intestine, *except the 12th on the right which is associated with the appendix |
|
|
Term
| what do CRs on the IT bands indicate? |
|
Definition
| ascending (R)/descending (L) colon |
|
|
Term
| what CR are associated with the R and L kidneys? adrenals? |
|
Definition
| kidneys: the corresponding side about an inch up and lateral from the umbilicus. adrenals:the same as kindeys, but 2 inches up |
|
|
Term
| where are the CRs located for the ovaries and testicles? |
|
Definition
| on the corresponding side of the pubic symphisis |
|
|
Term
| what ganglia are the kidneys, adrenals, and ovary/testes associated with? the bladder? |
|
Definition
| kidneys, adrenals, and ovary/testes: superior mesenteric ganglia. bladder: inferior mesenteric ganglia |
|
|
Term
| where are the CR for the bladder? |
|
Definition
| a triangle around the umbilicus, one just above it, two just below and to the side |
|
|
Term
| where are the CRs for the prostate (men) and broad ligamint (women)? |
|
Definition
|
|
Term
| where are the cardiac sympathetics located? is there a correlation between ventricles/atria and segments? where is the correlated CR? what is correlated with the R + L sides? |
|
Definition
| T1-6 (esp T1-4 on the anterior wall) w/the ventricles at T1-3 and the atria at T4-6 (upside down b/c the heart flips embryonically). the CR is at intercostal space 2. there is a strong R -> L predominance. R side: SA node, L side: AV node |
|
|
Term
| what organs are CR at the 2nd intercostal space dx for? |
|
Definition
| afferent info from the heart, esophagus, bronchus and thyroid. the travell trigger points in the pectoralis major muscle are close and may correlate with these CR. 60% of pts with cardiac disease will have these trigger points and 80% of pts with cardiac disease will have these CR |
|
|
Term
| what are the effects of active sympathetic innervation on general vasculature? |
|
Definition
| vasoconstriction, increased total peripheral resistance (from innervations T1-L2), increased blood pressure, increased cardiac output, and decreased venous and lymphatic return (due to venous/lymphatic constriction) |
|
|
Term
| what are the general effects of active sympathetic innervation on the general heart? |
|
Definition
| increase in chronotropism, ionotropism, decreased cardiac output and increased cardiac workload |
|
|
Term
| what are the general effects of active sympathetic innervation on the right heart? |
|
Definition
|
|
Term
| what are the general effects of active sympathetic innervation on the left heart? |
|
Definition
| PVCs, long Q-T, ectopic foci, and V fib |
|
|
Term
| if a pt has higher sympathetic tone to the heart are they at higher risk for sudden death? |
|
Definition
| yes, the size of and MI is likely to be larger as is the zone of injury due to *less collateral circulation |
|
|
Term
| why is the first rib also important in dx of sympathetic cardiac pathophysiology? |
|
Definition
| the stellate ganglia from C8-T1 sit merged on the first rib |
|
|
Term
| if a pt has a CR on the pectoralis major trigger point that extends down the left arm and you treat it, is that enough? |
|
Definition
| no, they can then die of a silent heart attack - it is V-S and not just somatic. *this V-S reflex is 80 % specificity and sensitivity for heart problems |
|
|
Term
| where is the supraventricular tachyarrhythmia trigger point? what happens when you treat it? why? |
|
Definition
| at the R 5th intercostal space. it causes a fast heart rate, but not referred pain. when you treat it, you get a normal sinus rhythm. this is a S-V reason for tachycardia. *the R side specifically goes to the SA node |
|
|
Term
| how does the biopyschosocial model inform osteopathic tx of cardiac pts? |
|
Definition
| pts with depression, anger, or fear have a higher incidence of not surviving MIs. |
|
|
Term
|
Definition
| the process of adaptation to acute stress, involving the output of stress hormones which act to restore homeostasis in the face of a challenge (increased norepinepherine, adrenaline, and other chemicals associated with heightened sympathetic activity) |
|
|
Term
|
Definition
| the price the body pays for being forced to adapt to adverse psychosocial or physical situations |
|
|
Term
| have cardiac pts treated with OMM shown improvement vs those not? |
|
Definition
| yes, arrhythmia, shock, and mortality all dropped - treatment is most important where the homeostatic balance is disturbed (treat facilitated segment first then biomechanical) |
|
|
Term
| what should you do after stabilizing a pt w/an acute coronary intervention? |
|
Definition
| indirectly treat the facilitated segment, which in this case is going to be the T1-4 rib region (calm the neurologic lens) then as you rehab the heart in weeks after, also rehab the somatic component so the reflex cycle can be broken |
|
|
Term
| where are the areas you can look and treat for cardiac pts in terms of parasympathetic tone? |
|
Definition
| the occipitomastoid suture and OA-C2 both have points involving the vagal/CNX nerve and C2, which are indicative of posterior heart wall problems. the vagal nerve is also related to the stomach and lungs (pt w/MI may vomit) and C2 is related to posterior headaches |
|
|
Term
| can treating the occipital suture and OA-C2 segments improve sympathetic and parasympathetic balance (fix variability)? |
|
Definition
|
|
Term
| what might happen if the C2 nerve (which becomes the greater occipital nerve) becomes entrapped as it passes through the semispinalis capitis and trapezius? |
|
Definition
| posterior headache, which can be relieved by OMT. (tx here may speed up the HR due to bodily compensation) |
|
|
Term
| what is the R vagus associated with? |
|
Definition
| the right vagus to the SA node is associated with bradyarrhythmias |
|
|
Term
| what is the L vagus associated with? |
|
Definition
| the L vagus to the AV node is associated with AV blocks |
|
|
Term
| what does parasympathetic stimulation do to the heart? |
|
Definition
| slow it down via vagal innervation of the posterior and inferior walls |
|
|
Term
| what is the pain pattern that tends to goes with bradyarrhythmias? |
|
Definition
| to the jaw and lower teeth |
|
|
Term
| can OMM affect traube hering mayer waves? |
|
Definition
| yes -> this can be very effective in decreasing stress |
|
|
Term
| what happened when lymphatics in dogs were tied off in the R thoracic region? |
|
Definition
| increased morbidity, subacute bacterial endocarditis, and circus rhythms after induced MI |
|
|
Term
| how do scalene trigger points affect lymphatic return? |
|
Definition
| these decrease lymphatic return, and give a sense of chest pain going down the arm and swelling |
|
|
Term
| what is the big component in terms of pregnancy and CV issues? |
|
Definition
| resp-circulatory system and venous return |
|
|
Term
| what is a contraindication for deep palpitation of collateral ganglia in the abdominal area? |
|
Definition
| hx of an abdominal aorta aneurysm |
|
|
Term
| what can cause a post-traumatic migrane headache and can OMM treat it? |
|
Definition
| the middle meningeal artery is at the squamous portion of where the temporal bone crosses over the spenoid and if jammed, the trigeminal nerve can give you a reflex pain in that area everytime the blood vessel beats. these headaches do respond well to OMM |
|
|
Term
| if you treat the kidney CRs (inch superior and lateral of umbilicus T11-T12) and adrenal CRs (same as kidney, plus another inch), what happens? |
|
Definition
| you can decrease HTN by 16 pts systolic and 8 pts diastolic. aldosterone levels are seen affected up to 36 hrs out (aldosterone change is not seen with tx of T8-9) |
|
|
Term
| can soft tissue on the posterior chapmans points help with HTN? |
|
Definition
|
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