What are the 4 key principles of the practice of osteopathic medicine?
1) Body is a unit 2) The body is capable of self-regulation, self-healing, and health maitenance3) Structure and function are interrelated 4) Rational treatment is based upon these^
What is somatic dysfunction?
impaired or altered function of related components of the somatic system (body framework): IncludesSkin, fascia, muscle, arthrodial, and related vascular, lymphatic, and neural elements
Since structure and function are interrelated, an essential question to the osteopath is:
Does the patient have a structural (somatic) component related to the chief complaint? We answer this by observing for somatic dysfunction
What does the acronym TARt stand for? How many do we need to diagnose somatic dysfunction?
Tissue texture abnormality A —> positional asymmetry Restriction of motionTissue tenderness Need at least 2 of these to diagnose somatic dysfunction
STeps of the exam for somatic dysfunction
1) Stranding structural exam—> Observation (be sure to adequately expose body to inspect/examine). Assess curvatures of spine 2) Screening palpatory exam —> determines location, severity, and relevance of dysfunctions in the somatic system. 3) Motion testing —> assess areas that had significant observation or palpatory findings for quality and quantity of motion4) Detailed palpatory exam and/or specialized test—> focus based on findings from previous steps
Significant posterior landmarks
Mastoid process, occipital, vertebral prominens (c7), Acromion process, Scapulae, spine of scapula (T3), Inferior angles of scapula (T7), RIbs 11 and 12, Iliac crests, PSIS, greater trochanters, Lateral and medial maleoli
WHat landmarks does the midpoint-gravitational line run through in a normal individual?
External auditory meatus —> Greater tuberosity of humerus —> Midbody of L3 —> Greater trochanter of femur —> Posterior to patella —> anterior to lateral maleollus
What are we palpating for when we palpate Skin
Elasticity, sympathetic tone, texture
What is the drag reaction skin test? What type of abnormality is a positive skin test related to? (Acute/chronic)
When we drag our fingers across the skin and look for areas of "skin drag" which tend to stop the fingers or require more effort to continue. Usually reflects and area of somatic dysfunction. Positive "skin test" is due to vasodilation, sweating, and decrease in elasticity. Typical of an acute abnormality
What is the skin rolling test?
When we grasp a "pinch" of skin btw our thumb and index finger over and area of palpable tissue to observe the degree of resistance. In areas of somatic dysfunction the skin will be tight and resistant which is related to increased sympathetic tone
What are we palpating for when we palpate subcutaneous tissue?
Connective tissue, fascia, and fat
What level are viscerosomatic reflexes found at? What do they feel like?
Subcutaneous layer. Puffy, boggy, or rubbery
What are we looking for when we palpate muscle? How do we know we are palpating muscle?
We are looking for hypo/hypertonicity We know we are palpating muscle if we are getting blanch under our finger nails. Well developed Muscle fibers full, smooth, and homogenous. Atrophied muscles are thin, ropy, and stringy
How can a tendon be described in terms of palpation?
-Taught band of tissue-Tense and smooth-Homogenous-Easily palpated
How can a ligament be described in terms of palpation?
-Tough fibrous brand-Difficult to palpate