2014 UAAO Forum 9-13-11 Lab 5 Static Symmetry (Dr.

Hendryx, 8-31-11)
I. Document curves of the spine on the Osteopathic Musculoskeletal Examination Form a. Note- this is to get you used to/learn how to formulate your diagnosiswe have never had to fill out the exam form during a practical Normal (AP) curves of the spine o Cervicals - lordosis o Thoracics - kyphosis o Lumbar lordosis Postures Kypholordosis Swayback Increased lordosis Posterior pelvis rotation Inrceased kyphosis Head forward Head forward

Military Anterior pelvis rotation Head back

Flatback Posterior Pelvis rotation Head forward

Scoliosis (lateral curves) is named for the convexity of the curve Left scoliosis/levoscoliosis RLSR Right scoliosis/dextroscoliosis RRSL

Observe from Anterior, Posterior, Lateral Stand behind when they bend over Have them swing their trunk side to side Functional goes away when bent to a side Structural stays when bent to both sides II. Plumb Line for sagittal posture Start at the ear and adjust to hit as many landmarks as possible Line should hit these landmarks: o External Auditory canal o o o

Head of the humerus L3 Anterior 1/3 of sacrum o Greater trochanter of femur o Lateral condyle of the knee o Lateral malleolus Use these landmarks to determine type of posture III. Symmetry (yet again) Compare sides of the body o Posterior evaluation Earlobes Shoulders Angle of the scapulas Iliac crests Normal Anterior Posterior Rotary Greater trochanters o Anterior evaluation Face Trapezius Body tilting or twisting Sternum pectus excavatum (bows inward), pectus carinatum (bows outward) o Check feet arches and leg length o o o

Lab 6 Rib/Thoracic Interplay (Dr. ODonnell, 9-7-11)

I. Landmarks Corresponding locations o T2 - Sternal notch o T4 sterna angle/angle of Louis (manubrium meets body) o T9 xiphoid process o L3/L4 interspace Umbillicus (the dermatome is T10, dont confuse these) Shoulder Girdle o Sternum o Scapula o Clavicle only connection of UE to axial skeleton Thoracic Inlet o Important for fluid movement normalizing lymphatic flow o Boundaries Manubrium 1st ribs T1 o Clinically consider Thoracic Inlet T1-T4 Ribs 1 & 2 Manubrium Ribs o Know the rib anatomy (ex. Head, neck, tubercle, angle) and be able to point out on a patient and/or skeleton True 1-7 False 8-12 Floating 11-12 Atypical 1, 2, 11, 12 (sometimes 10 - it may not articulate with 9) [Atypical ribs have 1

II.

or 2] Motion and Diagnosis Ribs rise in inhalation and fall in exhalation o Inhalation SD: Elevates with inspiration (ease) Stuck in inhalation Exhalation restriction Wont move inferior with expiration Key rib lower (INhalation = INferior rib) o Exhalation SD: Moves inferiorly with expiration (ease) Stuck in exhalation Inhalation restriction Wont move superior with inspiration Key rib upper o Mnemonic- BITE: fix the Bottom rib for Inhalation SD and Top rib for Exhalation SD Can spring the cage to feel for restriction Axis of motion o Pump Handle is around the costovertebral-costotransverse axis o Bucket Handle is around the costovertebral-costosternal (sagittal) axis o Caliper is around a vertical axis st 1 Rib o Pump handle and bucket handle o Best place to palpate earlobes down neck (will be tender) Do they rise and fall equally o 3 places to palpate Anterior just below clavicle at SC junction Laterally earlobes down neck to the boney resistance Posterior back and out from the lateral location o High 1st rib tells you sidebending (opposite direction) Ribs 2-5 o Pump Handle motion is in the sagittal plane / midclavicular line o When evaluating from the posterior motion is opposite from anterior o For males midclavicular line Can palpate from below or above o For females Can palpate the chondral portion of ribs with side of hand Can have them cover their chest and you palpate the midclavicular line like on the male

Males Technique

Females Technique

Ribs 6-10 o Bucket Handle motion in coronal plane / axillary line o Below the nipple line o To palpate Spread fingers Thumbs by xiphoid process

Ribs 11-12 o Caliper Inhalation spread apart and move posterior Exhalation come together and move anterior o To palpate Can squish up from iliac crest to find the 12th rib Have them put their arms at their side Thumbs just lateral to the transverse process of spine 2nd and 3rd fingers on the ribs

III.

Exercises DiGiovanna (pp. 400-402) Bend knees to take pressure off the abdomen Inhalation Treatments o Inhalation Rib stretch Flex arms to 90 degrees on inhalation Hold for 4-5 seconds Bring arms down on exhalation o Inhalation Rib Isometrics Press firmly on lower ribs Inhale and hold for 4-5 seconds Continue hand pressure during exhalation

Inhalation Rib Stretch

o

Inhalation Rib Isometrics

Exhalation Treatments Exhalation Abdominal Stretch Put hands on upper abdominals Push on abdomen while exhaling Maintain hand pressure as you Hold inhalation for 4-5 seconds

inhale

Muscles of Respiration
Elevate
Diaphragm Principal Ext Innercostals Interchondral part of Inter Innercostals SCM Ant/Med Scalene Post Scalene Acessory Serratus Post Superior Levatores Costarum Pectoralis Minor - forced inhalation

Depress Quiet Active Acessory

Passive, no muscle contraction, the diaphram relaxes Inter Innercostals Abdominal Muscles - abd rectus Transversus Thoracis Serratus Post Inf Ext/Int Obliques

Know what muscles attach to which ribs and their direction of motion! 1st rib anterior (pump) and middle (bucket) scalene 2nd rib posterior scalene (pump) Ribs 3-5 pectoralis minor (pump) Ribs 6-10 serratus anterior (bucket) Ribs 11-12 lattisimus dorsi (caliper) Rib 12 quadratus lumborum (caliper) IV. Chapman Points Looking for tenderpoints o Painful pea-sized nodule o Related to visceral-somatic reflexes Left o 5th intercostal space stomach acidity o 6th intercostals space - Stomach Peristalsis Right o 5th intercostals space Liver o 6th intercostals space Liver & Gallbladder Posterior points correspond to the anterior at level in the paraspinal muscles Treatment o Push on tenderpoint o Move in clockwise or counterclockwise motion o Continue until nodule disappears

the same