omt review

8/18/2019 OMT Review

1/12

Chapman Reflex Points

Diagnosis and Treatment

STRUCTURE ANTERIOR POINT POSTERIOR POINT

CNS

retina, conjunctiva lateral superior humerus

cerebellum tip of the coracoid process

ENTsinuses medial inferior clavicle

middle ear medial superior clavicle

pharynx superior lateral edge of manubrium

tonsils middle lateral edge of manubrium

tongue 2nd costosternal joint

neck medial superior humerus

GI

esophagus superior aspect of 3rd intercostal space T2-T3 between SP and TP

stomach (parietal) left 5th intercostal space T5 between SP and TP

stomach (peristalsis) left 6th intercostal space T6 between SP and TP

small intestine 8th, 9th, and 10th intercostal spaces

appendix tip of the 12th

rib T11 between SP and TPcolon iliotibial band

flip the colon over; cecum near the greatertrochanter and hepatic flexure near knee)

rectum lesser trochanter of femurHINT: attachment site of psoas major

SNS GANGLIA

celiac ganglion below xiphoid process

superior mesenteric ganglion between umbilicus and xiphoid process

inferior mesenteric ganglion above umbilicus

ORGANS

heart, thyroid, bronchi left 2nd intercostal space T2-T3 between SP and TP

upper lung 3rd intercostal space T3 between SP and TP

lower lung 4th intercostal sapce T4 between SP and TPliver right 5th and 6th intercostal spaces right T5-T6 between SP and TP

gallbladder right 6th intercostal space right T6 between SP and TP

pancreas right 7th intercostal space right T7 between SP and TP

spleen left 7th intercostal space left T7 between SP and TP

adrenal 1in lateral, 2in superior to umbilicus T11-T12 between SP and TP

ovary lateral to pubic symphysis (superior edge)

prostate posterior ilotiband

URINARY

kidneys 1in lateral, 1in superior to umbilicus T-12-L1 between SP and TP

bladder periumbilical upper edge L2 TP

urethra superior pubic ramus, 2cm lateral

to symphysis

L2 TP

COMLEX OMM Chapman’s Reflex Points

!"#$%#&'( $*+&,( #-. /+#0&*(./

#&,.-+*-12 #&/ ,-.#,./ $*(,.-+*-123

4-.#,%.&, +&5*15.( $-.((6-. #$$1+./

7+," # 8+-861#- -*,#,+*& 6&,+1

-.1.#(. +( 9.1,

:, +( 6&1+;.12 ,*


2/12

Anterior Chapman’s Points: Posterior Chapman’s Points:

COMLEX OMM Chapman’s Reflex Points

sinuses

cerebellum

retina,

conjunctiva

neck

larynx

pylorus

small intestines

appendix (R)

Umbilicus

intestinal

peristalsis

prostate or

broad ligament

colon

rectum

uterus

ovaries, urethra

middle ear

nasal sinuses

pharynx

tonsils

tongue

esophagus,

bronchus

thyroid,

myocardium

upper long

lower lung

stomach (acidity) (L)

left adrenal

left kidney

Bladder area

retina, conjunctiva

middle ear

pharynx, tongue,

larynx, sinuses, arms

neck, esophagus, bronchus

thyroid

upper lung, myocardium

upper lung

lower lung

stomach (acidity) (L)

liver (R)

stomach (peristalsis) (L)

liver, gallbladder (R)

adrenals

kidneys

abdomen, bladder

urethra

uterus

vagina, prostate, uterus,

broad ligament

rectum, groin glands

Fallopian tubes,

seminal vesicles

clitoris, vagina

cerebellum

nasal sinuses

cerebrum

arms

(and pectoralis m

neuroansthesia

(and pectoralis m

pyorus (R)

ovariesintestines (peristalsis

appendix (R)

large intestines

sciatic nerve (poster

hemorrhodial plexus

sciatic nerve (ante

Most likely to be asked

about on COMLEX(all are possible)


3/12

Segmental Sympathetic Innervation

STRUCTURE SEGMENT

sinuses , eustachian tube,

lacrimal glandsT1-4

thyroid T1-4

trachea, bronchiT1-6lower 2/3 esophagus T5-6

aortic arch T1-5

heart T1-6

lungs T2-4

stomach T5-9 left

dudodenum T5-9

liver T5 right

gallbladder, biliary tree T6 right

spleen T7 left

pancreas T7 right

small intestine T10-T11

proximal colon T10-T12distal colon T12-L2

appendix T12

adrenal glands, kidney, upper

ureter, ovary and testesT10-11

lower ureter, T12-L1

bladder, trigone/sphincter,

uterus, prostateT12-L2

genital cavernous tissue, penis,

seminal vesicleL2

mammary glands T1-6

arms T2-8

legs L11-L2

Parasympathet ic Innervation Vagal nuclei

STRUCTURE SEGMENT

pupils (constriction aka miosis) CN III (midbrain)! ciliary ganglion

lacrimal and nasal glands CN VII (pons)! sphenopalatine ganglion

submandibular and sublingual glands CN VII (pons)! submandibular ganglion

parotid gland CIX (medulla)! otic ganglion

heart, bronchial tree, esophagus

(lower 2/3), stomach, small intestine,

liver, gallbladder, pancreas, kidney

and upper ureter, ovaries and testes,

ascending and transverse colon,

ascending/transverse colon

CN X (medulla)! dorsal motor nucleus

lower ureter and bladder, uterus,

prostate, genitalia, descending colon,

sigmoid, and rectum

pelvic splanchnic (S2-4)

COMLEX OMM ANS Innvervation

Nucleus Solitarius ! 5+(8.-#1 !.&(*-2

+&9*-%#,+*& D.303 ,#(,.C 4 %*,*- 9+


4/12

Treatment order

COMLEX OMM ANS Innvervation

J3 "#$%& &($ )*+,-./&01. +$23$.& -.($*&(+


5/12

Upper extremity nerves

NERVE INNERVATES NOTES

Axillary (C5, C6) deltoid and teres minor (arm abduction,

external rotation)

sensory shoulder

injured by dislocated shoulder

Radial (C5-T1) arm and forearm (wrist) extensors supinator

sensory posterior arm and forarm

sensory part of thenar eminence on

palmar hand, PIPs and proximal dorsu

of hand from thumb to half of ring

finger

common injury with fracture of midshaft humorous

RES – radial, extensors, supinator

Median (C5-8, T1) wrist flexors, pronator teres

lumbricals 1 and 2, thenar muscles,

cutaneous sensation

sensory palmar hand! thumb, first and

second digit, half of third digitsensory dorsal hand! PIP and distal

thumb, index, middle, and half of ring

finger

Meat-LOAF

Median nerve, 2 Lateral Lumbricals, Oponens

pollicus, Abductor pollicis brevis, Flexor pollicis

brevis

MFP – median, flexors, pronator

Ulnar (C8, T1) flexor carpi ulnaris

intrinsic hand muscles

lumbricals 3 and 4, hypothenar

muscles, interossei, adductor pollicis,

flexor pollicis brevis

sensory fifth and! fourth digit on both

dorsal and palmar side

A OF A OF A

first AOF thenar muscles

Adductor pollicis, Opponens digit minimi, Flexor

digiti minimi, Abductor digiti minimi

Musculocutaneous

(C5-7)

anterior (flexor) compartment of the arm

sensory lateral arm

biceps brachii, brachialis, coroacobrachialis

flexion and supination

Rotator cuff muscles

Other shoulder muscles

COMLEX OMM Upper Extremity

Pectoralis major – one of two primary adductors, lateral and medial pectoral nerves (C5-T1)

Deltoid (anterior) – primary flexor, axillary nerve (C5-C6)

Deltoid (middle) – primary abductor, axillary nerve (C5-C6)

Deltoid (posterior) – one of three primary extensors, axillary nerve (C5-C6)

Teres major – one of three primary extensors, axillary nerve (C5-C6)

Latissimus dorsi – primary extensor and adductor, thoracodorsal nerve (C6-C8)

Supraspinatus – initiation of abduction, suprascapular nerve (C5)

Infraspinatus – external rotation, suprascapular nerve (C5-C6

Teres minor – external rotation, axillary nerve (C5)

Subscapularis – internal rotation, upper and lower subscapular nerve (C5-C6)

“SITS” muscles


6/12

Upper extremity nerve injuries

NERVE/MUSCLE TYPICAL INJURY MOTOR DEFICIT SENSORY DEFICIT SIGN/NOTES

Axillary (C5, C6) Fractured surgical neck of

humerus, dislocation of

humeral head

Deltoid – arm

abduction at

shoulder

Over deltoid muscle Atrophied deltoid

Radial (C5-T1) Fracture at midshaft of

humerus; “Saturday night

palsy” (extended

compression of axilla by

back of chair or by

crutches)

“BEST extensors” –

Brachioradialis,

Extensors of wrist

and fingers (C6-7)

Supintor, Triceps

Posterior arm and

dorsal hand and

thumb

Wrist drop

Median (C5-8, T1) Fracture of suprachondylar

humerus (proximal lesion

Opposition of thum

Lateral finger flexio

Wrist flexion (C7-8)

Dorsal and palmar

aspects of lateral

3/12 fingers,thenar eminence

“Ape hand”; “Pop

blessing” (hand

Travels through ttwo heads of

pronator teres

Ulnar (C8, T1) Fracture of medial

epicondyle of humerus,

“funny bone”

Hook of hamate injury

(bicycle riders)

Medial finger flexio

Wrist flexion (C7-8)

Medial 1! fingers,

hypothenar

eminence

Radial deviation o

wrist upon wris

flexion

Musculocutaneous

(C5-7)

Upper trunk compression Biceps, brachialis,

coracobrachialisFlexion of arm at

elbow

Lateral forearm

Tear of rotator cuff muscles

Radial head somatic dysfunction A nterior radial head! radial head does not glide posteriorly;Restricted Pronation, +/- pain with pronation

most likely to occur with backswords fall on extended arm

Posterior fibular head ! radial head does not glide anteriorly;

Restricted Supination; wrist and elbow pain

FOOSH injury (fall on out-stretched hand)

“Restricted PPS”

acute, sharp pain in shoulder followed

by ongoing dull achh and tenderness at

acromion process

(+) drop arm test, weak abduction

treat less severe cases with RICE, NSAIDS,

and OMT

more commonly an injury of the tendons rather

than the actual muscles

supraspinatus tendon most frequently affected

because it passes below the acromion

the site of injury usually occurs at the point of

insertion at the greater tubercle of the



7/12

Shoulder dysfunctions

DYSFUNCTION DEFINITION ETIOLOGY NOTES

Erb-Duchenne palsy injury to upper brachial

plexus, usually lateral

stretching

infant! lateral traction on

neck during delivery

adult! trauma

waitor’s tip posturing,

C5-6 upper trunk

arm extended and pronated Klumpke’s Palsy injury to lower branchial

plexus,

most often trauma during

childbirth

paralysis of intrinsic hand muscles

C8-T1 sensory loss+/- Horner’s syndrome

winged scapula long thoracic n injury!

paralysis of serratus

anterior muscle

trauma to the long thoracic n

shoulder blow, repetitive

movements, mastectomy)

while patient pushes anteriorly (e.g.

against a wall) scapula protrudes

posteriorly

thoracic outlet

syndrome

compression of brachial

plexus, subclavian vein,

and subclavian artery

can occur between:

ant and mid scalenes

clavicle and 1st rib

pectoralis minor and

upper ribs

ache and/or paresthesia of neck or ar

COMLEX OMM Upper extremity


8/12



9/12

Upper Extremity Special Tests

STRUCTURE EVALUATES TECHNIQUE

Apley’s scratch test range of motion patient reaches behind head to scratch back –

evaluates abduction and external rotation;

patient reaches across chest to scratch other

should and/or reaches around the back at

waist and scratches back – evaluates internalrotation and adduction

Adson’s test thoracic outlet syndrome patient extends elbow and arm, turns head

towards ipsilateral side.

positive if radial pulse markedly weakened or

absent

Roos’s test thoracic outlet syndrome patient abducts both arms to 90˚, externally

rotates, then flexes the elbows to 90˚; patient

repetitively opens and closes firsts for 3min

positive if exacerbations of symptoms

drop arm test rotator cuff tear patient abducts arm to 90 degrees and slowly

drops arm to side

positive if arm rapidly falls

Speed’s test biceps tendon patient extends elbow; supinates forearm whileflexing the arm at the shoulder against

resistance

positive if there is tenderness in the bicipital

groove

Yergason’s test stability of biceps tendon

in bicipital groove

patient flexes elbow to 90 degrees while

clinician holds the patient’s wrist with one

hand and elbow with the other

clinician resists the patient’s flexion/pronationforce while passively externally rotating

positive if there is pain in biceps tendon as it

pops out of the bicipital groove

Wrist Special Tests

STRUCTURE EVALUATES TECHNIQUE

Tinel’s test carpal tunnel syndrome clinician taps over volar aspect of patient’s

traverse carpal ligament (Tinel Tap)

!test = paresthsia of thumb, index, ring fingers

Phalen’s (and reverse Phalen’s)

tests

carpel tunnel syndrome patient's wrist passively but maximally flexed

(extended in reverse) by the clinical, held for

one minute

!test = paresthsia of thumb, index, ring fingers

Allen’s test radial and ulnar artery

patency/blood flow

patient opens and closes hand several times an

makes a tight first

clinician occludes oneartery and has patient open hand

test failed if hand remains pale

Finkelstein test tenosynovitis of pollicis

longus and extensor

pollicis brevis

(DeQuervain’s

tenosynovitis)

patient makes a tight first with thumb tucked

into first clinician induces adduction of

the wrist

!test = pain over tendons of wrist



10/12

Lower extremity nerves

NERVE TYPICAL INJURY MOTOR DEFICIT SENSORY DEFICIT SIGN

Obturator (L2-L4) Anterior hip dislocation Thigh adduction Medial thigh

Femoral (L2-4)Pelvic fracture

Thigh flexion and

leg extension

Anterior thigh and

medial leg

Common peroneal

(L4-S2)

Trauma or compression of

lateral aspect of leg or

fibula neck fracture

Foot eversion and

dorsiflexion; toe

extension

Anterolateral leg and

dorsal aspect of foo

Foot drop, foot sl

steppage gait

Tibial (L4-S3) Knee trauma Foot inversion and

plantarflexion; toflexion

Sole of foot

Superior gluteal

(L4-S1)

Posterior hip dislocation or

polio

Thigh abduction !Trendelenberg s

contralateral hi

drops when stan

on leg ipsilatera

to lesion

Inferior gluteal

(L5-S2)

Posterior hip dislocation Can’t jump, climb

stairs, or rise from

seating position;can’t push

downwards

Lateral forearm

PED = Peroneal E verts and Dorsiflexes; if injured, foot droPED

TIP = Tibial Inverts and Plantarflexes; if injured, can’t stand on TIPtoes

Sciatic nerve (L4-S3) – posterior thigh, splits into common peroneal and tibial nerve

Lower extremity muscles

MUSCLE ACTION INNVERVATION

Ilopsoas hip flexion L1, L2, L3

gluteus maximus hip extension inferior gluteal n (L5, S1, S2)

gluteus medius, minimus thigh abduction superior gluteal n (L5, S1)

hamstrings

semitendinosus

semimembranosus

biceps femoris (long head)

biceps femoris (shorthead)

knee flexion

(hip extension)

L5, S1, (S2)tibial ntibial n

tibial ncommon peroneal n

adductors

adductor brevis, longus, magnus, and

minimus

gracilis

hip adduction obturator n (L2, L3)

pirformis abduction of flexed thigh S1, S2

quadriceps

rectus femoris

vastus lateralis, medialis, and

intermedius (deep)

knee extension femoral n (L2, L3, L4)

COMLEX OMM Lower Extremity


11/12

Lower extremity muscles continued)

MUSCLE ACTION INNVERVATION

anterior tibialis dorsiflexion and inversion

of foot

deep peroneal n (L4)

extensor halluces longus foor dorsiflexion and

great toe extension

deep peroneal n (L5)

gastrocnemius foot plantarflexion tibial n (S1, S2)

peroneus longus and brevis foot eversion superficial peroneal n (S1)

Fibular head somatic dysfunction A nterior fibular head! foot stuck in internal rotation and plantarflexion; treat with

muscle energy by placing the foot in Inversion (loose pack fibula), External rotation of

tibia, and Dorsiflexion

Tx = AED plus inversion

Posterior fibular head ! 9**, (,68; +& .H,.- -*,#,+*& #&/ /*-(+91.H+*&S ,-.#, 7+," %6(81.

energy by placing the foot in Inversion (loose pack fibula), Internal rotation of thetibia, and Plantarflexion

Tx = PIP plus inversion



12/12

Pir i f ormis syn drome

Ankle sprains

Important angles

Osgood-Schlatter Disease

Neuromuscular disorder in which the sciatic nerve is compressed by the piriformis

muscle. Characterized by tingling and numbness in buttocks descending into the

lower thigh and leg

Treatment includes muscle energy and counterstrain:

ME: patient abducts against resistance

CS: patient prone, knee and thigh flexed, thigh abducted and externally rotated(“peeing dog” position) “peeing dog with a problem” is for LPL5 point

alternate treatment is extension on prone patient


Ankle strain! muscular injury

Ankle sprain! ligament injury

Grade 1 (first degree) microtears

Grade 2 (second degree) partial tear

Grade 3 (third degree) complete tear

Lateral ankle sprain much more common than medial ankle sprain (deltoid

ligament supporting medial ankle very strain)

Classifications

Type I = sprained ATFL ATFL “Always Tears First Ligament”

Type II = sprained ATFL and CFL

Type III = sprained ATFL, CFL, and PTFL

Femoral head angulation! the angulation between

the neck of the femur and the shaft of the femur>135 degrees = coxa valgum

12 degrees = genu valgum

135˚Coxa varum

=

omt review

Documents