amy vagedes, oms v and sarah watson, oms v june 12, 2013 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?Segmenta
l Definition
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
Osteopathic Exam
Segmental Definition Tells you the specific details (the address)
of the dysfunction – Ex: T7 F RrSr ALWAYS written in ease, not resistance
Screen: IS there a problem?
• Gait• PostureLook
• Patient Liste
n• Superficial Muscle
Tone/Gross Regional Motion
Feel
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
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?”
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
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
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
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.
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
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
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)
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
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)
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.
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
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
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
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
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
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
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
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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