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POM Block 8
KYCOM Block 8
57
Medical
Graduate
04/26/2013

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Cards

Term
what are the parts of a history for opp
Definition
o Onset, location, duration, character, aggravating factors, relieving factors, time/temporal, severity
Term
Spinal column motion testing
1. if most restricted region is T1-5 screen the...
2. if most restricted region is L1-5 screen the...
3. if it is thoracic area screen the...
4. if it is over SI or innominate screen the...
5. if it is at the occiput screen the...
Definition
 if most restricted region is 1. T1-5 think about upper extremity
2. if most restricted region is L1-5 think about lower extremity
3. if it is thoracic think about ribs (if it gets harder as you palpate rib out it is an issue)
4. if it is over SI or innominate screen pelvis and sacrum
5. if it is at the occiput screen the cranium
Term
what should you always rule out before treatment
Definition
always consider worst case scenario

rule out severe injuries

be sure there is no nerve damage with reflexes, neuro screen, and ortho tests
Term
how do you test the A/C and S/C joints
Definition
use thumb as fulcrum at T1
Pinky on A/C
3rd finger on S/C
Posterior lateral motion

Dysfunction: cannot glide posterior
Term
how do you test the A/C joint
Definition
check level of spine of scapula to determine if restriction is superior or inferior
Term
how do you test the S/C joint
Definition
Palpate medial end of clavicle

Have patient shrug shoulders

S/C should dip inferior and return superior when shoulders drop to normal

Test for anterior and posterior asymmetry
Term
how do you test glenohumeral joint
Definition
7 stages of spencer
Term
what are the joints of the upper extremity
Definition
acromioclavicular, sternoclavicular, glenohumeral, scapulothoracic, radial head, wrist
Term
how do you check for proper radial head placement
Definition
put thumb on distal radius

pronate and supinate arm

note restriction and end feel
Term
how is the wrist tested
Definition
palpate anterior and posterior

induce flexion and extension over each carpal

feel for restriction
Term
dysfunctions in what other areas can cause upper extremity issues
Definition
cranial at occipital mastoid surface
jugular foramen
cervical dusfunction: brachial plexus
thoracic / rib dysfunction
lower body: latissimus dorsi, thoracolumbar fascia
mind, body spirit
Term
what indications do thoracic and rib dysfunctions give to upper extremity issues
Definition
Rib 1: impede brachial plexus

Rib 1-7: effect pecs and brachial plexus

T3-T6: alter sympathetic function
Term
how can mind, body, and spirit causes upper extremity issues
Definition
Stress causes hormone, cytokine, and autonomic nervous system stimulation
Cortisol and epinephrine: protective and damaging

Emotions take toll of musculoskeletal system (Shouldering your burdens / broken back)
Term
sucscapularis tenderpoint: location and position
Definition
o Anterior lateral border of scapula, pressing from anterior-lateral to posterior-medial
o Shoulder extension and internal rotation
Term
supraspinatus tenderpoint: location, position
Definition
o In belly of supraspinatus above scapular spine
o Flex shoulder, abduct, external rotation
Term
levator scapulae tenderpoint: location, position
Definition
o Superior medial border of scapula (attachment)
o Glide scapula superior and medial
Term
biceps long head tenderpoint: location, position
Definition
 Over tendon of bicep in groove
 Flex elbow, flex shoulder, abduct, internal rotation
Term
biceps short head / coracobrachialis tenderpoint: location, position
Definition
 Infero-lateral coracoid process
 Flex elbow, flex shoulder, adduct and internal rotate
Term
radial head tenderpoint: location, position
Definition
o Antero-lateral radial head at supinator attachment
o Extend elbow, supination, slight valgus
Term
medial epicondyle tenderpoint: location, position
Definition
o On common flexor tendon at attachment of pronator teres
o Flexion, pronation, slight abduction of forearm, slight flexion of wrist
Term
extension of wrist dorsal tenderpoint: location, position
Definition
o Dorsal 2nd and 5th metacarpal and in extensor carpi radialis and ulnaris
o Wrist extend, slight abduct / adduct
Term
palmar wrist tenderpoint: location, position
Definition
o Palmar base of 2nd and 5th metacarpals of flexor carpi radialis and ulnaris
o Wrist flex, slight abduct / adduct
Term
lateral first cervical tenderpoint: location, position
Definition
o Tip of C1 transverse process. Inferior anterior to mastoid
o Supine exaggerate side bend away
Term
anterior first cervical tenderpoint: location, position
Definition
o Posterior of ascending ramus of mandible at earlobe
o Rotation away, flexion, side bend away
Term
anterior 2-6 cervical tenderpoint: location, position
Definition
o Anterior lateral transverse process
o Flex, side bend towards, rotate away
Term
anterior 7 cervical tenderpoint: location, position
Definition
o On clavicular attachment of SCM
o Flex, side bend towards, rotate away
Term
anterior 8 cervical tenderpoint: location, position
Definition
o At sternal attachment of SCM at mid clavicle
o Flex, side bend toward, rotate away
Term
posterior 1 cervical tenderpoint: location, position
Definition
o Below nuchal line midway between inion and mastoid
o Extend, side bend away, rotate toward
Term
inion / EOP tenderpoint: location, position
Definition
o On nuchal line lateral to inion
o Flex, side bend and rotate away
Term
posterior second cervical tenderpoint: location position
Definition
o Inferior nuchal line at semispinalis capitus attachment
o Extend, side bend and rotate away
Term
posterior second cervical spinous process tenderpoint: location position
Definition
o Superior spinous process C2
o Extend, side bend and rotate away
Term
posterior third cervical tenderpoint: location position
Definition
o Side of inferior-lateral spinous process C2
o Extend, side bend, and rotate away
Term
posterior 4-6 cervical tenderpoint: location position
Definition
o Inferior or inferior lateral tip of spinous process
o Extend, side bend away, rotate toward
Term
wat are 3 unique characteristics of lumbar vertebra, what are they for
Definition
o Tend to be thicker for weight bearing
o Spinous processes thick and blunt
o Wedge shaped disc allow for translation from vertical vertebral column to horizontal sacrum
Term
what should be included in motion testing for the lumbar spine
Definition
o General overview of musculature
o Sidebending: iliac crest height, hip drop test
o Rotation: pelvic roll
o Flexion / extension testing
o Lordotic curve
Term
what is a physologic dysfunction of the inominate, why
Definition
anterior and posterior rotation because it is part of the gait cycle
Term
what is a pathologic dysfunction of the inominate
Definition
superior or inferior shear, inflaire or outflaire
Term
what do the ASIS compressions mean
Definition
• Inferior ITA: innominate
• Down MTA: sacrum
• Superior STA: cranial
Term
what are physiologic dysfunctions of the sacrum, why
Definition
forward rotation (right on right or left on left) is part of gait cycle
Term
what are pathologic dysfunctions of the sacrum
Definition
posterior rotation (right on left, left on right)
unilateral flexion or extension
Term
explain how to name a sacral dysfunction
Definition
o Find side of positive test
o Find anterior / posterior on positive side
o If sacral base is not same level as ILA it is unilateral flexion or extension
o If sacral base is the same level as the ILA there is a torsion
 If base and ILA on the side of the positive test are going anterior it is a forward torsion (left on left, right on right)
 If base and ILA on the side of the positive test are going posterior it is a backward torsion (left on right, right on left)
 **remember axis is opposite to the positive seated flexion test
Term
explain how L5 and the sacrum are integrated
Definition
o L5 rotation is opposite sacral rotation
o If sacral base is posterior L5 is usually extended
o If sacral base is posterior L5 is usually flexed
Term
how are the inominate and sacrum integrated
Definition
o In gait cycle sacrum alternates between right on right and left on left forward torsions in conjunction with anterior innominate rotation on that site
Term
how are the pelvis and L spine integrated
Definition
hip drop test
Term
what do you treat first, how do you determine if the dysfunction qualifies
Definition
worst dysfunction first: treat with comparison of motion and restriction characteristics
Term
what do you do if there isn't a worst area, what do you treat first
Definition
sacrum! then innominate, L2, T12, other L spine...
Term
explain muscle energy for sacrum for forward torsion, backward torsion, and unilateral flexion
Definition
 forward sacral torsion: use both legs patient pushes down, patient supine deep sulci down with hips sideways and shoulders toward ceiling
 backward sacral torsion: patient supine deep sulci down with hips sideways and shoulders toward ceiling, lift one leg, localize motion of the lumbosacral junction
 unilateral sacral flexion : Abduct and internally rotate ipsilateral lag to gap the SI joint, pressure on posterior ILA
Term
explain how to do HVLA on the sacrum
Definition
SI articulation: Patient hugs table with dysfunctional hip up. Bend knee, bring forward and around to straight
Term
explain how to to BLT on the sacrum
Definition
 Patient supine, physician hand on sacrum other on L5
 Ease sacrum into nutation and counternutation for ease of motion
 Patient breathes with motion
 Hold in position of ease and feel for shifting of sacrum
 Adjust to new positions of ease until it stops moving
Term
explain how to fix a flare with muscle energy
Definition
• Leg and hip bent and in external rotation, patient pushes knee up
Term
explain how to do HVLA on an anterior innominate
Definition
• Patient on side, Flex hip and knee on affected side
• Physician facing patient, forearm on ischial tuberosity
• Roll patient towards you
• Thrust directed anteriorly and towards the floor
Term
explain how to do HVLA on a posterior innominate
Definition
• affected hip up, knee flex with foot in popliteal fossa
• physician facing patients, forearm on ischial tuberosity
• roll patient towards you
• thrust anterior and toward floor
Term
explain how to do BLT on an innominate
Definition
 One hand under pelvis fingers on SI joint other on ASIS
 Rotate anterior and posterior to find position of ease
 Decompress and hold until strain is corrected
 Augment with respiration
 If standing cross effected leg over
Term
what are some common dysfunction patterns in the lumbar spine
Definition
o Prone to type 1 movement
o Treat at base L5: Usually in type 2 mechanics
o Treat at top T12: Usually in type 2 mechanics
Term
explain how to do muscle energy on a type 2 flexed at T12, type 2 flexed at L5, and a type 1 lumbar issue
Definition
 Two step technique for T12 flexed: Translate to put T12 into barrier, extend at T12
 Flexed dysfunction type: Patient lays on side to flatten side bend, lower leg straight. Flex knee until motion is felt at restricted segment. Rotate shoulders back towards table to induce rotation
 Type 1: Patient lays on side to flatten curve. Use knees as fulcrum to monitor apex of curve for movement
Term
explain two ways to to HVLA on a type 1 lumbar dysfunction
Definition
• Lumbosacral junction technique. Brings lower sacral base cephalid. Lay on side to flatter curve
• Thoracolumbar junction technique: Brings upper sacral base caudad. Lay on side to not flatten curve
Term
explain how to do function for L5
Definition
 Translate to localize segment
 Apply compression towards segment and wait for unwinding
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