Section 1
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what happened in 1947?
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Section 1
(50 cards)
what happened in 1947?
First approval for osteopathic residencies
William Halstead
first used sterile rubber gloves in surgery in 1890
What happened in 1936
Opened osteopathic hospitals for internships
Ingaz Semmelweiss
-reduced OB mortality by 90% by washing hands
John Snow
Used epidemiology to trace source of cholera outbreak in london in 1854
Still's parents names?
Abram and Martha Still
When did Mary Elvira die?
1910 - after 50 years of marriage
When did Still die?
1917
Significance of 1900
ASO was largest school of healing in country with 700 students and 18 faculty
Joseph Lister
-Father of Antiseptic surgery -Reduced surgical mortality from 45-15%
When did KC DO school open and who opened it?
1916 - by Kaiser and Conley (K + C)
What is important about 1892?
American School of Osteopathy opened
When was Still born?
August 6, 1828 in Lee County, virginia
What did still do in 1860?
Married Mary Elvira Turner
Wilhelm Rontgen
studied xrays
What happened in 1910 with the med schools?
Dr. Abraham Flexner went to them all and offered a report -- left 8 DO schools
When was his autobiography published?
1897
What happened in 1980
KCCOS-->UHSCOM
What was the California incident, and when was it?
1961 - California stopped giving licenses to DO's, but allowed them to obtain MD degree -- 85% traded DO for MD degrees
When did Still fight in the war, and what rank did he achieve?
61-64, Major
What did still do in 1855
Studied anatomy on Indian cadavers
4 Osteopathic Principles
-Body is a unit, and person is a unit of mind, body, spirit -Body can self heal -Structure and function related -Rational treatment based on understanding basic premise of other 3
What did still do in 1849
He married his wife Mary Margaret Vaughn
What happened in 1886?
Still became busy enough to stay in Kirksville
William Budd
Proved cholera came from contaminated water in Bristol
What happened in 1885?
Still coined the term Osteopathy
When did Still's parents move to MO?
1830s
What all happened in 1864?
-Battle of Westport -3x still babies die of spinal meningitis -goes back home to farm
What happened in 1874 besides banner of osteopathy?
-Presented ideas to Baker university -Removed from methodist church -first OMT in Macon, MO
What year were DO's first licensed?
1896
What happened in 1977?
College of Osteopathic Medicine of the Pacific
What happened in 1875?
Still moved family to Kirksville, MO
What did still do in 1850
Took over mission in Eudora
What happened in 1972
OSU became first free standing, state funded DO school
What did still do in 1857
Elected to KC legislature
Fernando Sanford
discovered xrays in 1891
What state was the first to liscence DOs
Vermont
What is the significance of osteopathy with the influenza pandemic?
Only 0.25% death rate
Who were the first professors of the ASO?
AT Still and Will Smith
Pasteur
discredited spontaneous generation
What happened in 1917-1918
Influenza pandemic
What happened in 1859?
Mary Margaret dies
What was the enrollment in 1895 and 1896?
28 and then 102
When did Still fly banner of osteopathy?
10AM, June 22 1874**
Nils Finsen
used UV light in medicine
What did germ theory replace?
Miasma theory
Koch
isolated anthrax
What did still do in 1839?
Used a rope swing to treat headaches
When and what was the Cline committee?
1955 -- AMA inspected DO schools and found education good but facilities lacking
Theucydides
Disease spreads by seeds (Germ Theory?)
Section 2
(50 cards)
Passive range of motion
Greater than active - normally, only ligaments stop motion
Hooks law
strain on elastic body is in proportion to stress on it
Acute texture change vs chronic
Acute: Warm, moist, red, and inflammed Chronic: Cool, pale, increased tone, dry, scaly, hairless
Pannicular Fascia/Panniculus
Outermost layer of fascia that surrounds the entire body
What happened in 1986
First DOs accepted to Canada residency
Anatomic Barrier
limit of motion imposed anatomically
Newtons third law
equal and opposite force
Examples of abnormal end feel
-early muscle spasm -late muscle spasm -hard capsular -soft capsular
Barbara Ross Lee
First female dean of medical college (Ohio)
Whats hysteresis
energy lost in connective tissue between loading and unloading
Mamie Johnston
First graduate from KCU, retired in 1981 as professor here
Pathologic barrier
permanent restriction of joint motion associated with pathologic change of tissue
Who was first woman to get DO degree?
Jeanette Bolles
Stress vs Strain
Stress: force that attempts to deform Strain: Percentage of deformation of tissue
Elastic Barrier
Region between physiologic barrier and anatomic barrier
Viscoelastic material
Any material that deforms according to rate of loading and deformity
Restrictive Barrier
Limit prior to the normal physiologic range of motion
Dynamic flexibility ROM
ROM an athlete can produce and speed which they produce it
What would be chronic tissue changes?
-chronic congestion, doughy, stringy, fibrotic, ropy, thickened, contractures
When were DO's allowed to join military?
1957
End feel
palpatory experience/perceived quality of motion when joint is at its limit
Axial/Appendicular fascia
Internal to pannicular layer - fused to panniculus and surrounds all muscles
ABC's of Skin Lesions
Assymetry Border Color Diameter Evolution
Contracture
abnormal shortening of muscle due to fibrosis, usually in tissue itself, and often result of chronic condition
Bogginess
Increased fluid in hypertonic muscle, like wet sponge
Louisa Burns
-treated with osteopathy for spinal meningitis -postulated connective tissue model of somatic dysfunction
tissue changes of vascular
Acute: Inflammation, vasodilation Chronic: increase vascular constriction, hypersympathetic tone
Tetralogy of Fallot
Baby gets cyanosis during crying/feeding
Marcelino Olivia
Born in Cuba, grad of KCU, first minority AOA president
Fascia is...
Complete system with blood supply, fluid drainage, and innervation -its involved in tissue protection and healing of surrounding systems
TART
Tissue texture change Assymetry Restriction Tenderness
Osteopathic Women's national association (OWNA) founded when?
1920s --> led to female DO increase
Ectomorphic
-thin body build, tall and lean -high ROM -prominence of stuff from embryonic ectoderm
Ropiness
hard, firm, rope like
Who was the first DO in the armed forces?
Harry J Walter
Physiologic barrier
limit of active ROM -- may increase with warm up activities
Continuity of fascia
Perimysium (fascia)-->peritendium-->periosteum
Mesomorphic
-study/muscular -- average guy -mid ranges of ROM
Tone
Normal feel of muscles in relaxed state -- contrast with hypertonicity or hypotonicity
Visceral fascia
surrounds organs
When was NOWPA established?
1988
Wolff's law
bone develops according to stresses placed on it
William Anderson
associate dean at AT still university, big with civil rights movement
Endomorphic
-obese -low ROMs -high structure from endoderm
How many DO schools today?
33
Static flexibility ROM
maximum ROM a joint can get to with externally applied force
Who was first DO who was surgeon general?
General Ronald R. Blank, DO
Meningeal Fascia
surrounds nervous system
Contraction
Normal shortening of muscle when activated
Who was first flag officer in medical corps
1983 - Louis H Eske
Section 3
(50 cards)
MFR treatment endpoint
-warmth, softening, increased compliance/ROM
Spleen?
Largest single mass of lymphoid tissue beneath ribs 9-11 on left, normally NOT palpable
Eccentric isotonic contraction
separate origin and insertion
Common compensatory pattern
LRLR
Right lymphatic duct
Covers R head and neck, RUE, R thorax, heart and lungs sans LUL
Shoulder adduction
-Starting with arm straight in front of you, 40-50 degrees
Crossed extensor reflex
-used when the muscle requiring treatment is in area we cant otherwise touch directly -uses learned cross pattern locomotion reflex engrammed into CNS - when flexor of one extremity is contracted voluntarily, the flexor in contralateral extremity relaxes and extensor contracts *Left leg cant flex. We will flex right leg to make left leg flex
Muscle force to move one region of body to achieve movement of another
...its in the name
Lumbar sidebending
15-30 degrees at waist
Cervical rotation
70-90 degrees at neck
Isometric contraction
contraction of muscle with no change in distance between origin and instertion
uncommon compensatory
RLRL
Virchow's node
Left supra-clvicular-->intra thoracic/abd CA
Normal lymph flow
Lymph capillaries plexus-->larger vessels-->lymphatic/thoracic duct-->venous system
isolytic contraction
attempted concentric contraction with external force causing separation of origin and insertion
T.J. Ruddy came up with what, and when?
1914 - Ruddys rapid rhythmic resistive duction
Parallel traction
stretch parallel with muscle fibers
What can go wrong with MET on operator end?
-not controlling joint position in relation to barrier -not providing counterforce in right direction -poor instruction -move to new joint position too soon
Isolytic lengthening
-Lengthen muscle shortened by contracture -vibration used here has effect on myotatic units in addition to mechanical and circulatory
Epitrochelar nodes
-secondary syphilis
Shoulder extensioin
Hand straight back in saggital plane - 60 degrees
Reciprocal inhibition
When gentle contraction initiated in agonist muscle, theres relax of antagonist group --- ounces, not pounds
Lumbar extension
20-45 degrees at waist
Transition zones of the spine
C1, C2 C7/T1 T12/L1 L5/sacrum
Perpendicular traction
Repetitive stretch perpendicular to muscle fibers
concerntric isotonic contraction
contraction of muscle with approximation of origin and instertion
Sherrington's Law
When a muscle receives a nerve impulse to contract, its antagonists receive an impulse to relax
Isometric vs Isotonic
Isometric - light force with unyielding counterforce Isotonic - hard to maximal force with controlled motion counterforce
When does lymphatic system develop?
5th week
Isokinetic strengthening
-Establish normal tone and str in a muscle weakened by hypertonicity of opposing muscle group -with asymmetry of ROM, might be asymmetry in muscle str. -Treat shortening of antagonist muscle-->agonists spontaneously increase str if shortened muscles lengthened first
Cervical sidebending
20-45 degrees at neck
How much does the lymphatics move per day?
30L
Fred L. Mitchell Sr
-59 grad of chicago -wrote about muscle energy -"pelvis and its environs"
Joint mobilization using muscle force
-hypertonicity of muscle across joint cause distortion of articular relationships -can compress joint surfaces and thin synovial fluid -restoration of motion to articulation results in reseating of distorded joints
Whats the thoracic duct?
Master lymph vessel that drains left head and neck, LUE, L abd, and everything umbilical down
Respiratory assistance
Muscular forces in breathing provide help with technique
Oculocephalogyric reflex
eye movements affect cervical and truncal musculature as body attempts to follow -- do very gentle force
Cervical flexion
Chin to chest - 45-90 degrees
What can go wrong with MET on patient end?
Contract too hard contract wrong direction sustain contraction for too short time dont relax well after contraction
Inhibition
hold perpendicular at musculotendinous part of hypertonic musle
Cervical extension
Looking up - 45-90 degrees
Relative contraindications of ST
Osteoporosis, acute injuries
What is the most common form of MET
Post Isometric relaxation -muscle contract-->increased tension in GTO--inhibition of muscle contraction
Lumbar Flexion
40-90 degrees at waist
Liver?
RUQ - palpable at right costal margin Forms half of bodies lymph
Shoulder abduction
Starting with arm straight in front of you, 130-145 degrees
Shoulder flexion
Raise hand in saggital plane - 180 degrees
Articulatory approach
-springing techniques -LVHA -gentle and repetitive motions through restrictive barrier
Consequence of poor lymphatic system?
Edema
How much force should be put forth for MET?
30-50lb
Section 4
(50 cards)
Anatomically, what are the palapatory landmarks we care about for thoracic?
-T2: Sternal notch -T3: Spine of scapula -T4: Sternal angle of Louis -T7: Inferior angle of scapula
Hip flexion with knee straight
90 degrees
That defines the thoracic region?
thoracic cage + thoracic cavity + the contents
What are the Chapman's reflexes?
These are tender points anteriorly and posteriorly that help us diagnose the visceral dysfunctions.
What % of general population has low back pain?
85%. Its the second most common reason for patients to go to the doctor (I didn't look it up, but im pretty sure the most common is belly pain)
What are some of the etiologies of back pain?
-Mechanical like arthritis or disc disease or somatic dysfunction -Non mechanical: Viscerogenic like renal colic, or vasculogenic like an AAA (abdominal aortic aneurysm)
What is the most common location of spina bifida occulta?
L5-S1
Ankle inversion
20 degrees
What composes the thoracic cage?
Vertebra + Ribs + Sternum + Costal cartilage
Knee flexion
145-150 degrees
Ankle dorsiflexion
15-20 degrees
What is the first fryette principle?
When thoracic or lumbar are in neutral position, then sidebending and rotation in opposite directions -Usually affects a group of vertebra **He emphasizes that with these, you rotate towards the CONVEXITY *Remember TONGO
What is sacralisation of L5, or lumbarisation of S1? I Think this will be a question on the exam
1) L5 fuses with sacrum 2) S1 doesn't fuse with rest of sacrum and acts like a lumbar
Why do we say that the stuff in the neck is type 1 or type 2 "like?"
Couple reasons 1) Fryette didn't really study the neck 2) They follow the rules of sidebending/rotation as you would expect for type 1 or 2, but the flexion/extension component isn't taken into account here
Wrist abduction
20-30 degrees
Elbow extension
0 to -5 degrees
Knee extension
0 degrees
Whats cauda equina syndrome?
-Clinically, buzzwords are saddle anesthesia + bowel/bladder incontinence -Can happen from edema of canal -SURGICAL EMERGENCY
Hip external rotation
40-60 degrees
Whats a meningomyelocele?
Most common type of spina bifida -Unfused portion of spinal column allows spinal cord to protrude
What are the muscle groups that are involved with type 1 mechanics of the lumbar spine?
Long restrictors
What is the second fryette principle?
In flexion or extension, rotation and sidebending in same direction
What is the general steps to treat low back pain?
Address cause --> OMT ---> drugs (NSAIDS > tylenol, random trivia) --> surgical management
What is the third principle?
-Actually not a fryette principle bc it was put forth by a dude named Nelson. -It basically says that movement in one plane affects motion in other planes. -So like, if you are rotated right and flexed, you'll notice that sidebending left is harder than sidebending right. That just proves its coupled motion and not independant of each other
How do the lumbar and sacrum interact mechanically?
they flex and extend in opposite directions. Lumbar flex = sacral extend
Hip internal rotation
30-40 degrees
Calcaneal/subtalar eversion/inversion
<5 degrees
How do you chart a somatic dysfunction?
Segment. Position. Rotation. Sidebending. Ex. T1-3 N RrSl L4 E RrSr
Anterior chapman's tender points
Periumbilical: Adrenals, kidney, and bladder. 5th ICS: Stomach and liver 6th: Stomach, liver/gallbladder 7th: Spleen, pancreas
This may seem like unnecessary semantics but it's definitely an easy question to trip people up...... How do you name lumbar dysfunctions for charting purposes?
Level of dysfunction Then neutral or flex/extend IF TYPE 1, then sidebend first, then rotation, IF TYPE 2, then rotate first, then sidebend. Ex. L4-5 N Sr Rl L4 F Rr Sr
wrist adduction
30-40 degrees
Tell me about the red flags of low back pain
-Major trauma mechanism -Age > 50 or < 20 -Hx cancer -Cauda equina syndrome (think saddle anesthesia + incontinence) -constitutional symptoms
Wrist extension
70 degrees
Wrist Flexion
80-90 degrees
What vertebra are kyphotic? Lordotic?
Kyphosis: Thorax and sacrum Lordosis: Cervical and lumbar
Hip adduction
20 degrees
What are the mechanics of the cervical spine?
OA - Type 1 like AA - Just rotates. Typical - type 2 like *Problems elsewhere can lead to compensatory changes in typical cervical and make them look type 1 like*
Who is the doctor who described the normal physiological motion of the spine?
Fryette.
What are the muscle groups that are involved with type 2 dysfunctions of lumbar spine?
Short restrictors
What about the patient's history might tell you about a type 2 dysfunction?
-Rapid onset
Elbow Flexion
140-150 degrees
You just pressed on the right side of someones L4 segment and it doesn't go as far as it should, what is their dysfunction?
L4, rotated right Pushing on the right makes them rotate left and they don't like that
Hip extension
15-30 degrees
Ankle eversion
10-20 degrees
Hip flexion with knee bent
120-135 degrees
Forearm supination/pronation
90 degrees
Ankle plantarflexion
55-65 degrees
Arm external and internal rotation
90 degrees
Hip abduction
45-50 degrees
Whats a meningocele?
Meninges forced between vertebral spaces
Section 5
(26 cards)