1b. OMM | Somatic Dysfunction

What is the definition of somatic dysfunction?

An impaired or altered function of the somatic system, including skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements.

What does the mnemonic TART stand for in diagnosing somatic dysfunction?

Tissue texture changes, Asymmetry, Restriction of motion, Tenderness

What is the expanded mnemonic TART?

T: Texture (boggy, edematous, fibrotic), A: Alignment/asymmetry (static and dynamic), R: Range of motion limited, T: Tender to touch

What are tissue texture changes in somatic dysfunction?

Palpable changes in skin, fascia, or muscle such as bogginess, ropiness, or fibrosis.

What does asymmetry refer to in somatic dysfunction?

Unequal landmarks or posture side-to-side (e.g., scoliosis).

What does restriction refer to in somatic dysfunction?

Loss of range of motion, either active or passive.

What does tenderness refer to in somatic dysfunction?

Pain elicited during palpation, often more severe in acute cases.

Compare onset of acute vs chronic somatic dysfunction.

Acute: < 3 months; Chronic: > 3 months.

Compare temperature in acute vs chronic somatic dysfunction.

Acute: Increased (warm, hot); Chronic: Decreased or cool to touch.

Compare tissue texture in acute vs chronic somatic dysfunction.

Acute: Boggy, edematous, soft; Chronic: Ropy, stringy, fibrotic, thin skin.

Compare moisture in acute vs chronic somatic dysfunction.

Acute: Moist (increased skin drag); Chronic: Dry (fingers glide easily).

Compare tension in acute vs chronic somatic dysfunction.

Acute: Rigid, board-like; Chronic: Mildly increased, fibrotic.

Compare tenderness in acute vs chronic somatic dysfunction.

Acute: Severe (9-10/10); Chronic: Dull or reduced.

Compare edema in acute vs chronic somatic dysfunction.

Acute: Likely present; Chronic: Rare.

Compare vascular findings in acute vs chronic somatic dysfunction.

Acute: Venous congestion; Chronic: Neovascularization.

Compare erythema test in acute vs chronic somatic dysfunction.

Acute: Redness persists; Chronic: Redness fades quickly or blanching occurs.

What is the skin drag test and what does it indicate?

Dragging fingers along the skin to assess moisture: sticky in acute, smooth in chronic.

What is the erythema friction rub test and what does it indicate?

Press and observe skin color change: persistent redness in acute, quick fade in chronic.

What is a physiologic barrier?

The limit of active ROM where the patient moves themselves.

What is an anatomic barrier?

The limit of passive ROM where the physician moves the patient with mm. relaxed

What is the elastic barrier?

The region between physiologic and anatomic barriers; slight resistance felt before the endpoint.

What is a restrictive barrier?

A pathologic barrier that limits normal motion, occurring before the physiologic barrier due to dysfunction.

How is a physiologic barrier tested?

Through active range of motion performed by the patient.

How is an anatomic barrier tested?

Through passive range of motion performed by the physician.

How is an elastic barrier tested?

During passive ROM, by sensing slight resistance just before the anatomical limit.

How is a restrictive barrier tested?

Identified by limited active ROM that does not reach physiologic range.

What is the clinical insight for an elastic barrier?

Slight resistance is felt before final stop

What is the clinical insight for a physiologic barrier?

If the patient cannot reach the normal range actively, consider dysfunction.

What is the clinical insight for an anatomic barrier?

Going beyond this barrier risks tissue damage.

What is the clinical insight for a restrictive barrier?

Indicates somatic dysfunction, such as a tight rotator cuff limiting flexion.

Who moves the joint in active ROM and what barrier does it reach?

The patient moves the joint and reaches the physiologic barrier.

Who moves the joint in passive ROM and what barrier does it reach?

The physician moves the joint and reaches the anatomic barrier.

What barrier is associated with motion loss and what does it indicate?

Restrictive barrier; indicates somatic dysfunction.

Why is motion fundamental to life in osteopathic medicine?

Motion supports vital processes such as respiration, circulation, lymphatic flow, and neurologic function. Restrictions in motion can impair these systems.

What are the components examined during an osteopathic structural exam?

Observation, Palpation, and Motion Testing - summarized as Look, Feel, Move.

What is the purpose of the Look, Feel, Move approach?

To sequentially assess for somatic dysfunction by observing asymmetry, palpating for texture and tenderness, and testing range of motion.

Why can't a fracture be considered a somatic dysfunction?

Because it is a structural injury, not a functional impairment. Somatic dysfunction involves impaired motion and tissue function, not bone breaks.

What is the clinical significance of diagnosing somatic dysfunction?

It helps identify the cause of the patient's musculoskeletal complaints and guides appropriate osteopathic manipulative treatment.

When is erythema friction rub considered positive?

When redness persists after pressing on the skin, typically seen in acute somatic dysfunction.

What does persistent asymmetry suggest during structural exam?

It may indicate somatic dysfunction contributing to or resulting from patient complaints.

Why is it important not to push past the anatomic barrier during motion testing?

Going beyond it may result in tissue damage and violate safe clinical practice.

What determines whether somatic dysfunction is clinically relevant?

The dysfunction must correlate with the patient's symptoms and physical exam findings.

What type of motion loss suggests somatic dysfunction?

An observed restriction in active ROM before the physiologic barrier (a restrictive barrier).

While diagnosing the lumbar spine, the physician find that L4 is flexed, rotated to the right, and sidebent to the right. Which of Fryette’s Laws can be used to describe this dysfunction?

A. First law

B. Second law

C. Third law

D. Fourth law

B

The correct answer is Fryette’s second law (B). The second law states that when the spine is in a flexed or extended position, the rotation and sidebending will occur to the same side. In this question, L4 is flexed, meaning that it will exhibit type II mechanics, which is covered under Fryette’s second law. Fryette’s first law (A) states that in a neutral position, a vertebra will be rotated and sidebent to opposite sides, exhibiting type I mechanics. Fryette’s third law (C) states that the motion of a vertebra in one plane will affect the motion in the other two planes. There is no Fryette’s fourth law (D).

Fryette’s first law

In a neutral position, a vertebra will be rotated and sidebent to opposite sides, exhibiting type I mechanics

Fryette’s second law

When the spine is in a flexed or extended position, the rotation and sidebending will occur to the same side, exhibiting type II mechanics

Fryette’s third law

Motion of a vertebra in one plane will affect the motion in the other two planes

During an osteopathic structural exam, you ask a patient to sidebend their trunk to the right. They can only go halfway, but you are able to move them farther when you perform the motion. This finding most specifically indicates the presence of a:

A. Physiologic barrier
B. Elastic barrier
C. Anatomic barrier
D. Restrictive barrier
E. Neurologic lesion

D

Explanation:

• The physiologic barrier is the normal end of active motion.

• In this case, the patient stops short of that = a restriction is present before the physiologic limit = restrictive barrier.

• You're able to go farther passively → means motion is limited by dysfunction, not structure.