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Amy Vagedes, OMS V and Sarah Watson, OMS V June 12, 2013 SCREEN, SCAN, SEGMENTAL DEFINITION
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Goals What is Professional Touch? Introduce the Osteopathic Exam Screen Scan Segmental Definition
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Osteopathic Exam Is there a problem? Screen Where is the problem? Scan What is the characteristics/ nature of that problem? Segmental Definition
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Osteopathic Exam Segmental Definition (Bullseye!) Scan Screen
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Osteopathic Exam Screening 2 Tissue Textures + 2 Motion Tests Is at least 1 of each positive? Tells you the neighborhood – Ex: Thoracic Region Scanning Local Deep Pressure + Confirmatory Rotation OR Sidebending Both if you need a Tiebreaker Tells you the exact block – Ex: T7
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Osteopathic Exam Segmental Definition Tells you the specific details (the address) of the dysfunction – Ex: T7 F R r S r ALWAYS written in ease, not resistance
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Screen: IS there a problem? Gait Posture Look Patient Listen Superficial Muscle Tone/Gross Regional Motion Feel
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Screen Focusing on axial spine today cervical spine, thoracic spine, lumbar spine Screening consists of: Palpation of Tissue Texture abnormalities Gross Regional Motion Restriction of motion
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Screen: Palpation RESISTANCE TO PRESSURE: Two tests in each of 8 regions (only doing axial spine today) Reproducibility & Consistency Bilateral Structures Compare Side-to-Side Axial Spine Compares Above with Below Ask the question, “Is there a difference in tissue resistance from here to here?”
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Screen: Palpation Cervical Upper Cervical Lower Cervical Thoracic Upper Thoracic Lower Thoracic Lumbar Upper Lumbar Lower Lumbar http://www.backpain-guide.com/Chapter_Fig_folders/Ch05_Anatomy_Folder/Ch5_Images/05-4_Overall_Spine.jpg
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Screen: Gross Regional Motion RESISTANCE TO INITIAL MOTION INPUT : Two tests in each of 8 regions Reproducibility & Consistency Response of human tissue to a passive motion input (most of the time) You are NOT using much force to generate motions
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Screen: Gross Regional Motion C-spine Cervical rotation Cervical sidebending T-spine Thoracic rotation Thoracic sidebending L-spine Lumbar lordosis** Flattening or Not Lumbar rotation** Rotates to the L or R
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Screen: Gross Regional Motion Lumbar lordosis Stand behind patient and palpate lumbar lordosis Patient *actively* flexes (bends over) Lordosis should flatten out Lumbar rotation Stand behind patient and palpate lumbar lordosis Patient *actively* flexes (bends over) A notable prominence of left or right paraspinal tissues is abnormal These two tests can be combined in one motion for the patient.
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Screen: Gross Regional Motion Thoracic rotation Have patient fold arms While behind patient, place hands over their shoulder – palms over the head of the humerus. Apply a slight rotary force to the L and the R Feel for that initial resistance to motion. Thoracic sidebending Patient folds arms Stand behind patient and place hand on top of the shoulder of the patient Apply a slight downward force using your body weight as leverage
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Screen: Gross Regional Motion Cervical rotation Stand behind patient and place one hand over forehead and the other hand on the back of the head Apply a slight rotary force to the left/right Cervical sidebending Stand behind patient Place one hand on the top of the head and the other at the base of the neck to stabilize the shoulders and trunk Tell patient to let the head fall to the left/right
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Practice Break into partners
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Scan: Where Is the Problem? Thumb & index or middle finger contact paravertebral muscles that are superficial to transverse processes Resistance (speed bump) or ease (pothole) comparing segment to segment above vs. below This can be used in the following areas: Cervical, Thoracic, Lumbar Rib Cage (not doing this today)
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Scan Mark the identified segment We will come back to this point to do motion testing
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Scan: Confirmatory Motion Scans Passive motion test Rotation, sidebending, flexion/extension Increased accuracy (reliable and reproducible) Active motion is too variable Immediate response, not the end feel! Listening and Motor Hands
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Scan: The Hands Listening Contacts dysfunctional segment and “senses” response to motion: restriction No motion input Motor Consistent introduction of motion Rotation, Sidebending, Flexion/Extension, (pick two of these motions)
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Scan: Rotatory Scan Physician: Standing behind & to the Side of the patient Patient Seated: Arms Crossed Contact the location being scanned with the finger and thumb of the listening hand Feeling for immediate ease or resistance upon initiation of the motion The ‘motor hand’ contacts the patient’s. elbow Introduces ipsilateral rotation (rotation to the same side) Lumbars shown here.
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Scan: Cervical Sidebending Scan Physician: Standing behind & to the Side of the patient Patient Seated: Arms Crossed Contact the location being scanned with the finger and thumb of the listening hand Feeling for immediate ease or resistance upon initiation of the motion The ‘motor hand’ contacts the patient’s. head in the same way cervical sidebending screening was performed Introduces ipsilateral sidebending
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Scan What if the two scans do not agree? Use a 3 rd Scan to Break the Tie.
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Practice Break into Partners
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Segmental Definition: What is the Problem? We have now identified where the problem is. Next, we have to identify what the nature of the problem A.k.A. How do we describe the dysfunctional segment in relation to specific motions? Ex: T7 F RrSr (written in ease, not resistance) Resistance may be easier to feel, but all diagnoses in OMM are written in ease
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Segmental Definition Rotatory Flexion/extension Sidebending (right/left) Rotation (right/left) Translation Cephalad/caudad Right/left Anterior/posterior Respiration Today, we will focus on the rotatory motions
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Segmental Definition Active motion: Motion which is accomplished by the patient Passive motion: Motion which is generated by the physician We will be using passive motion today
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Segmental Definition: Rotation of Thoracic Spine Physician: Standing behind & to the Side of the patient Patient Seated: Arms Crossed Contact the identified segment with the finger and thumb of the listening hand Feeling for immediate ease or resistance upon initiation of the motion The ‘motor hand’ contacts the patient’s. elbow Introduces ipsilateral rotation (rotation to the same side) No need to compare above and below since we have already identified the dysfunctional segment
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Segmental Definition: Flex/Ext of the Thoracic Spine Physician: Stands to the side of the patient Patient Seated: Arms Crossed Contact the identified vertebra with the finger and thumb of the listening hand Feeling for immediate ease or resistance upon initiation of the motion The ‘motor hand’ contacts the patient’s ribcage opposite the side the physician is standing Introduces flexion by slumping patient’s shoulders forward or extension by arching the patient’s back
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Segmental Definition: Sidebending of the Thoracic Spine Physician: Standing behind & to the Side of the patient Patient Seated: Arms Crossed Contact the identified vertebra with the finger and thumb of the listening hand Feeling for immediate ease or resistance upon initiation of the motion The ‘motor hand’ contacts the patient’s shoulder Introduces ipsilateral sidebending
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Segmental Definition Lumbar spine can be segmentally defined in the seated position as well as prone Cervical spine can be segmentally defined in the seated or supine position using the head to input the motion There is less gravitational pull to contend with when the patient is in the supine position
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Putting it all together Screen, Scan and Segmental Definition: Demo
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Review of Osteopathic Exam Screen Scan Segmental Definition Questions?? Summary
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References Johnston WL, Friedman HD, Eland DC. Functional Methods: A Manual for Palpatory Development in Osteopathic Examination and Manipulation of Motor Function. 2 nd ed. 2005; Indianapolis, IN. American Academy of Osteopathy: 17-79. Foundations of Osteopathic Medicine, 3 rd Ed.
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