The OMM Standardized Question Lori A Dolinski, MSc, PhD, DO

Transcription

1 The OMM Standardized Question Lori A Dolinski, MSc, PhD, DO Executive Director, Boards Boot Camp President & Chairperson, Mindworks Corporation

2 Goals Understand common OMM concepts for Levels 1, 2, and 3 Appreciate common OMM areas of misunderstanding

3 Fryette Mechanics: Freedom Freedom = that movement involving the least facet and ligamentous/bony interference Being more free on one side = being more restricted on the other side! = somatic dysfunction

4 Fryette Mechanics: Types Applies only to T and L spine Neutral (type I): N rotation and sidebending to the opposite side Non-neutral (type II): F/E rotation and sidebending to the same side

5 Where is the freedom of the sagittal plane? Whatever position allows for the most freedom of the segment It is not the freedom for rotation It is not the freedom for sidebending

6 Case #1 A patient is found to have T4-5 rotate more to the right than the left when flexed. What is the diagnosis? T4-5 rotates more to the right rotated right This dysfunctional position is induced by flexion flexion is NOT the freedom If it is T4-5 ERR, applying Fryette T4-5 ERRSR

7 Cervical Motion Rules Cervical somatic dysfunction: guided by what segment it is, and not by whether it is neutral or non-neutral Cervical segments do not follow standard Fryette mechanics

8 What is the dysfunction of THAT cervical segment? C0-C1: rotation and sidebending are always to the opposite side (type I-like) C1-2: rotation and sidebending are to the opposite side but rotation prevails (sidebending is not tested) C2-C7: rotation and sidebending are always to the same side (type II-like)

9 But what are C0, C1, and C2? C0 = occiput; refers to occipito-atlantal joint (OA) C1 = atlas; refers to atlanto-axial joint (AA) C2 = axis

10 Case #2 A patient is evaluated and the OA is determined to be stuck rotated right when flexed. What is the somatic dysfunction? Somatic dysfunction = freedom = nomenclature = diagnosis OA refers to actions of C0 C0 stuck rotated right movement it does best = rotation right C0 RR therefore, C0RRSL The dysfunction is induced by flexion freedom = extension Dysfunction = C0ERRSL

11 Case #3 On evaluation of a patient, C4 is found to be sidebend more to the left than the right while in neutral. What is the restriction? Restriction = opposite of freedom Have to 1 st know the freedom to determine restriction SB more to left freedom is SB left C4 SL C4 SL C4 has rotation to same side C4 RLSL Neutral position induces the dysfunction freedom is NON-neutral So, freedom = C4 F/E RLSL Restriction is the opposite of freedom C4 NRRSR

12 Herniated Discs Intervertebral discs are named for the segment they support or cushion If herniated, the nucleus pulposus ruptures through the annulus fibrosus, creating a bulge that can potentially impinge nearby nerve roots Not all herniated discs will cause impinged nerve roots

13 Which nerve root is impinged? C spine: the next numbered nerve root T spine: the same numbered nerve root L spine: the next numbered nerve root

14 Herniated Discs

15 Case #4 A patient has a herniated C7 disc. What nerve root risks impingement? C7 disc (C7-T1 disc) supports C7 segment C8 nerve root emanates from that level C8 is the nerve root in jeopardy

16 Case #5 A patient has a herniated L4 disc. What nerve root risks impingement? L4 disc (L4-L5 disc) supports L4 segment L4 nerve root exits at that level, but above disc Lumbar discs herniate posterolaterally impinging nerve roots of cauda equina Nerve root lining up for exit first to be impinged The larger the herniation the more nerve roots impinged

17 Lumbar Pathologies There are numerous pathologies! Includes spondylolisthesis, spinal stenosis, osteoarthritis, herniated disc

18 What causes achy lumbar pain? Spinal stenosis Osteoarthritis Spondylolysis (chronic) Spondylolisthesis

19 What causes sharp lumbar pain? Spinal stenosis Herniated disc Cauda equina syndrome

20 Important Upper Extremity Disorders There are many! Includes thoracic outlet syndrome, carpal tunnel syndrome, rotator cuff tear

21 Important Lower Extremity Disorders There are many! Includes Osgood-Schlatter syndrome, Sprained ankle, Lateral Femoral Patellar Tracking Syndrome

22 Signs of Cranial Dysfunction Bulging or sunken in eyes Protruding or close-to-head ears Headache

23 What do these outward findings mean regarding cranial dysfunction? Bulging eyes: pushed out by B/L superiorly placed sphenoid Protruding ears: left exposed when occiput moves away from the ipsilateral temporal bone Prominent mastoid process: appears more obvious when occiput moves towards temporal bone

24 Case #6 You take one look at a conference attendee and notice immediately that his right eye is bulging while his left eye is receded, AND his right ear is sticking out while the left ear looks to be part matted down in his hair! What is his diagnosis? R eye bulge & L eye recession sphenoid is superior on R and inferior on L R ear is prominent & left ear is close to head occiput has moved away from R temporal bone and is closer to L temporal bone Dx = right torsion How about the mastoid process findings? Prominent L mastoid

25 Sympathetics, Facilitation, and Reflex Arcs Sympathetic nervous system = fight or flight mechanism Activated when there is pathology, injury, illness, etc. If chronically or massively stimulated, can case facilitation Facilitation = decreased threshold to activation of spinal cord Facilitation inappropriate outgoing impulses from that segmental level of the cord Innervation of the remote tissue yields a reflex arc

26 Sympathetics, Facilitation, and Reflex Arcs

27 Sympathetics are Activated: What s the effect? Muscle Hypertonicity or Spasm Referred Pain Sympathetic response in remote tissues innervated by same segmental spinal cord level

28 Autonomic Nervous System

29 Case #7 A patient complains of umbilical pain, though nothing appears to be abnormal about the umbilicus. What could be the cause? Referred Pain! Pain T10 dermatome Facilitation of T10 spinal cord level Pathology of ovary, intestine, or kidney

30 Case #8 A patient develops T2-4 spinal somatic dysfunction, with accompanying muscle hypertonicity and spasms in the same region. He also has fever, cough, and dyspnea. What could be the cause of the musculoskeletal problems? Reflex Arc involving motor neurons! Muscle hypertonicity/t2-4 spinal SD T2-4 facilitation Pathology of lungs, heart, aorta, esophagus Cough, SOB, and fever point towards lung as the source

31 Case #9 A female patient presents with complaints regarding urinary retention. She is recovering from diverticulitis. What could be the cause of her urinary problems? Barring any more serious complications from her diverticulitis.probably Reflex Arc involving sympathetics! Urinary retention SNS activation of bladder T12-L2 spinal cord facilitation Pathology of descending colon, sigmoid, or rectum, or uterus Hx of recent diverticulitis points to sigmoid colon as source

32 What else can help with standardized OMM questions? Answer what the question is requesting Consider all answer options, and pick the one best one Think avoid knee-jerk or memorized responses

33 The OMM Standardized Question Lori A Dolinski, MSc, PhD, DO Executive Director, Boards Boot Camp President & Chairperson, Mindworks Corporation