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OMM Ch 1 - 7

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mhewett's version from 2016-07-16 13:43

Ch 1 Introduction

Question Answer
TARTtissue texture, asymmetry, restriction, tenderness
physiologic barrierpoint to where pt can actively move
anatomic barrierpoint to where pt can passively move
Type 1 Fryette nomenclaturesidebending precedes rotation
Type 2 Fryette nomenclaturerotation precedes rotation
concentric contraction2 ends of muscle approximates
eccentric contractioncontraction that results with that muscle lengthening d/t external opposite force (placing book on table)
isolytic contractionforcing muscle to lengthen during contraction d/t outside force (loser in arm wrestling)
orientation of superior facetsBUM-BUL-BM for C-T-L
Maverick pointa tenderpoint that is not responsive to counterstrain; tx by folding away instead of towards
MOA for muscle energyactivation of the Golgi tendon organs allows for reflex relaxation of agonist muscle
memorize

Ch 2 Cervical Spine (2-7)

Question Answer
What differentiates C7?doesn't have a bifid spinous process, has the vertebra prominens
What is the purpose of the uncinate/uncovertebral jts of luschka in the mid cervical vertebrae?provides stability
alar ligamentsides of odontoid process to lateral aspects of foramen magnum
transverse ligamentbetween the 2 C1 lateral masses and holds dens in place (post to dens)
cruciform ligament4 components - transverse ligament, superior band (from transverse ligament to occiput), inferior band (from transverse ligament to body of C2)
tectorial membranesuperior continuation of the posterior longitudinal ligament
which muscles aid in elevation of 1st rib?ant and middle scalenes
which muscles aid in elevation of 2nd rib?post scalenes
brachial plexus nerve rootsC5-T1
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4-5 Ch 3 Thorax

Question Answer
What facets do ribs articulate with?superior facet of the same-numbered vertebrae and inferior facet for the vertebrae above
Why is rib 1 atypical?no angle; only articulates with T1
Why is rib 2 atypical?extra tuberosity on shaft
Why is rib 11, 12 atypical?no neck or tubercle; only articulates with one vertebra
Which ribs are true?1-7
Which ribs are false?8-10, 11, 12
Primary motion of thoracicsrotation
Which ribs are pump handle?1-5
Which ribs are bucket handle?6-10
Which ribs are caliper motion?11-12
What are the primary muscles of respiration?diaphragm, intercostals
What does the diaphragm do on inspiration/expiration?inspiration=contract; exhalation=relax
What is the attachments for the diaphragm?ribs 6-12, L1-3, xiphoid process
Landmarks- sternal notchT2
Landmarks- spine of scapulaT3
Landmarks- sternal angleT4
Landmarks- inferior angle of scapulaT7
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Ch 4 Lumbar Spine

Question Answer
How does the PLL change in lumbar spine?it narrows; at L4-5 it is only half as wide as it was at L1
A herniation in the lumbar region affects what nerve root?the nerve root at the level below the segment affected (L4 disc affects L5 nerve root)
Where does the spinal cord end?L1-2
What is the typical site for a lumbar puncture?L4-5
What is the normal Ferguson's angle?(lumbosacral angle) 25-35 degrees
What are the different types of spina bifida?occulta- no herniation
meningocele- meninges
meningomyelocele- meninges and nerve roots
rachischisis- open spine
What is the primary motion of the lumbar spine?flexion extension > sidebending > rotation
How does L5 sidebending affect the sacrum?causes ipsilateral sacral oblique axis
How does L5 rotation affect the sacrum?causes rotation in opposite direction
herniated nucleus pulposusmostly between L4-5 or L5-S1; sharp, intense pain during flexion/carrying; often causes sciatica
cauda equina syndromed/t massive central disc herniation; saddle anesthesia in combo with urinary and/or fecal incontinence
spondylolysisfracture, disintegration, dissolution of vertebra; achy low back pain; pars interarticularis fx (collar)
spondylolisthesisant displacement of one vertebra w/ respect to vertebra inferior to it (4 grades); usually between L4-5; d/t fx of pars interarticularis; achy low back pain
5 classifications of spondylolisthesisType I- Dysplastic spondylolisthesis: congenital
Type II- Isthmic spondylolisthesis: most common type and involves pathology of the pars interarticularis
Type III- Degenerative spondylolisthesis: degeneration of zygapophyseal joints, secondary to chronic segmental instability
Type IV- traumatic spondylolisthesis: fx anywhere in the intervertebral bony connections except the pars interarticularis
Type V- pathologic spondylolisthesis: d/t bone disease secondary to such disorders as cancer, Paget's disease, osteogenesis imperfecta
ankylosisabnormal immobility of the joint; causes movement restriction accompanied by muscle spasms and achiness if there's impingement
spondylosisdegenerative changes of intervertebral discs accompanied by ankylosis; causes chronic achy low back pain
osteoarthrosisaka degenerative joint disease aka osteoarthritis; chronic achy focal pain exacerbated by rest and relieved by non weight bearing or non jarring movement
spinal stenosismost commonly d/t osteoarthritis; causes achy low back pain with sharp, shooting pain radiating to LE; pain exacerbated by standing/walking/backward bending
iliopsoas flexion contracturefrom long held positions with psoas shortened
What is the most common congenital anomaly in the lumbar?zygapophyseal tropism- asymmetry of the joint facets
What is the second most common congenital anomaly of lumbar area?sacralization
Level of iliac crest?L4-5
Level of umbilicus?L3-4
memorize

Ch5 Sacrum and Innominates

Question Answer
what is the sacral hiatus?opening which represents failure of S5 laminal closure on inf post aspect of sacrum; it is the site of performance for sacral epidural nerve blocks
what are the accessory ligaments of the pelvis/sacrum?sacrotuberous, sacrospinous, iliolumbar ligaments
what is the true ligament of the pelvis/sacrum?sacroiliac ligament
sacrotuberous ligamentligates sacrum to ischial tuberosity
sacrospinous ligamentconnects sacrum to ischial spines
anatomical significance of sacrospinous ligamentdivides greater and lesser sciatic foramen
iliolumbar ligament attachmentsL4, L5, iliac crests, SI joints; these are the first to become tender when there's lumbosacral dysfunction
pelvic diaphragm is comprised oflevator ani, coccygeus muscles ; functions to support pelvic viscera, raises pelvic floor, constricts lower rectum and vagina
piriformis attachmentsinf ant aspect of sacrum and inserts onto greater trochanter of the femur
piriformis functionexternally rotates the thigh, extends the thigh, abducts the thigh when hip is flexed
piriformis innervationS1, S2
iliopsoas attachmentssides of T12-L5 and joins iliacus within true pelvis; lesser trochanter of femur and body of femur inf to lesser trochanter
psoas innervationL1-3
lumbar plexusT12-L4
sacral plexusL4-S3 and some of S4
sciatic nerveL4-S3
ganglion imparant to coccyx; fusion of the left and right sacral sympathetic trunks
4 types of sacral motioninherent motion- cranial, S2
respiratory motion- inhalation/exhalation, S2
postural motion- flexion/extension of torso, S3
dynamic motion- ambulation, weight bearing leg with ipsilateral oblique axis
L5 sidebending engages sacral oblique axis on which side?ipsilateral
lumbosacral spring test is negative ifthere's good springing = flexion
etiology of ant innominate rotationtight quadriceps; rectus femoris or adductor group dysfunction
etiology of post innominate rotationtight hamstrings
etiology of sup innominate shearfall on or thrust up the ipsilateral gluteal area; surprise step off curb into a hole
etiology of inf innominate sheartrauma/car accident
etiology of sup pubic sheartight rectus abdominus muscle, unusual trauma, innominate rotation (post), third trimester pregnancy or delivery
etiology of inf pubic sheartight adductor muscles, inusual trauma, innominate rotation (anterior), third trimester pregnancy or delivery
etiology of innominate inflaretrauma
etiology of innominate outflaretrauma
etiology of bilateral sacral flexiondelivery or trauma
etiology of bilateral sacral extensiontrauma
etiology of unilateral sacral flexionsurprise step into hole or off curb, or lumbar dysfunction
unilateral sacral flexion findings for ipsilateral legshort leg
most common type of sacral shearunilateral sacral flexion
etiology for unilateral sacral extensiontrauma or lumbar dysfunction
unilateral sacral extension findings for ipsilateral leglong leg
memorize

Ch6 Upper Extremities

Question Answer
Role of the rotator cuff musclesSITS "up, out, in"
supraspinatus = first 90 degrees of abduction
infraspinatus, teres minor = primary external rotator
subscapularis = primary internal rotator
The brachial plexus runs where?between ant and middle scalenes medially; underneath the clavicle laterally
The right upper extremity lymphatics drain intothe right lymphatic duct which drains into the junction of the right internal jug and right subclavian veins
The left upper extremity lymphatics drain into thethoracic duct which drains into the left brachiocephalic vein at the junction of the subclavian and internal jugular veins
What is the most common site for obstructed lymphatic flow?Cervicothoracic diaphragm (Sibson's fascia)
What nerve root innervates the deltoid? Biceps?C5; C5-6
What nerve root innervates the brachialis? Triceps?C5-6; C7-8
What nerve root innervates the wrist extensors? Wrist flexors?C6-7; C7-8
What nerve root innervates the interossei (palmar and dorsal)?T1
What nerve root is associated with the triceps reflex? Biceps reflex? Brachioradialis reflex?C7; C5; C6
What does apley's scratch test evaluate?ROM
What does adson's test evaluate?thoracic duct syndrome/its effects on subclavian a
What does roos test evaluate?thoracic outlet syndrome
What does drop arm test evaluate?rotator cuff tears
What does speed's test evaluate?biceps tendon
What does yergason's test evaluate?stability of biceps tendon in the bicipital tendon in bicipital groove
What is the most common brachial plexus injury?Erb-Duchenne (C5-6) - causing upper arm paralysis
What is Klumpke's palsy?injury to C8-T1 roots resulting in paralysis of intrinsic muscles of the hand
What nerve innervates the extensors of the wrist and hand? Flexors of the wrist and hand?Radial n.; Median n. (except flexor carpi ulnaris)
Do the extensors of the wrist and hand attach to the lateral or medical epicondyle? How about the flexors?Lateral epicondyle; Medial epicondyle
When the forearm pronates does the head of the radius move anterior or posterior? How about when the forearm is supinated?Posterior; Anterior
When the wrist is abducted is the ulna adducted or abducted? How about when the wrist is adducted?Adducted; Abducted
Normal female carrying angle10-12 degrees
Normal male carrying angle5
What are the bones of the hand?scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hook of hamate
What does Allen's test evaluate?radial a and ulnar a patency/blood flow
What does finkelstein's test evaluate?tenosynovitis of the abductor pollicis longus and extensor pollicis brevis (De Quervain's tenosynovitis)
What nerve provides sensory nerve innervation to the dorsal and palmar portion of the medial hand?Ulnar n.
What nerve provides sensory nerve innervation to the dorsal part of the lateral hand? Palmer part of the lateral hand?Radial n.; Median n.
What nerve is damaged in the claw hand deformity? Ape hand? Bishops?Ulnar n.; Median n.; Median or Ulnar n.
What nerve innervates the deltoid muscle?Axillary n.
What nerve is often injured by shoulder subluxation?Axillary n.
What nerve root is associated with the waiters' tip pose (i.e. elbow extension with wrist flexion)?C7-8
memorize

Ch7 Lower Extremities

Question Answer
What are the primary knee flexors?semimembranosus and semitendinosus
What is the largest joint in the body?tibiofemoral joint
Which of the knee ligaments prevents knee hyperflexion? Hyperextension?PCL; ACL
What does the anterior drawer test assess?ACL tear
What does the posterior drawer test assess?PCL tear
What does Apley's compression and distraction test assess?meniscal tear; collateral ligaments
What does the Lachman's test assess?ACL tear
What does McMurray's test assess?tears of posterior aspect of menisci
What does patellar femoral grinding test assess?disorders like chondromalacia patellae, osteochondral defects, degenerative changes in trochlear groove
What are nerve roots comprise the femoral nerve? Sciatic nerve?L2-4; L4-S3
What nerve innervates the quadriceps? What nerve innervates the hamstrings?Femoral n; Sciatic n
Normal angle for femoral head angulation120-135
Normal Q angle10-12
What three motions cause pronation of the foot/ankle?(1) Dorsiflexion (2) Eversion (3) Abduction
What three motions cause supination of the foot/ankle?(1) Plantar flexion (2) Inversion (3) Adduction
Does the tibial division of the sciatic nerve innervate toe extensors or flexors? Plantar flexors or dorsiflexors? Foot invertors or evertors?Toe flexors; Plantar flexors; Foot invertors
Does the peroneal (common fibular) division of the sciatic nerve innervate toe extensors or flexors? Plantar flexors or dorsiflexors? Foot invertors or evertors?Toe extensors; Dorsiflexors; Evertors and invertors
Pronation of the foot cause the fibular head to move anteriorly or posteriorly? How about supination?Anteriorly; Posteriorly
If a patient is said to have a posterior fibular head, does the foot appear to be more pronated or supinated? What about an anterior fibular head?Supinated; Pronated
Strain vs Sprainmuscle injury, ligamentous injury
What condition is associated with an enlargement of the semimembranosus bursa?Baker's (Popliteal) cyst
What part of the leg is associated with Osgood-Schlatter disease?Tibial tuberosity
What condition is marked by characterized by softening and fraying of the patellar cartilage?Chondromalacia patellae
What are the three components for O'Donahue's triad? What is another name for this triad? What type of injury might cause this?(1) ACL tear (2) MCL tear (3) Medial meniscus tear; Terrible triad; Stuck on lateral side of knee
What is more likely, a fracture of the medial malleolus or sprain of the deltoid ligament?Fracture of the medial malleolus
What ligaments are associated with a type I ankle sprain? Type 3?Type I: Anterior talofibular ligament; Type 3: Anterior talofibular ligament, Calcaneofibular ligament, Posterior talofibular ligament
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