P&P Analysis Exam

Why should static palpation be done in a seated posture?

Get better correlation of findings

What does static palpation allow for?

To suggest vertebral positional characteriestics

What is acute stage of skin turgidity(skin bounce)?

Turgidity of the skin is changed by the edema present at the damaged tissue site

Edema usually unilateral and palpates as a well-circumscribed spot

What is the chronic stage of skin turgidity?

Edema has resolved and tissue damaged site has fibrous tissue with less resiliency

Edema is usually bilateral and feels like a depression

May not feel as firm as the surrounding tissue

What is the acute stage of skin texture?

Noted over boney prominences (like a spinous), will feel wetter or greasy

What is the chronic stage of skin texture?

will feel drier over the spinous

often referred to as "skin drag"

What is the acute stage of point tenderness?

more superficial pain and more sensitive to touch

What is the chronic stage of point tenderness?

unaware until spot is palpated

usually deeper and dull

What is positional characteristics?

helps formulate the listing system for adjusting purposes

palpate for the side of articular prominence - more prominent side is side of posterior body rotation, less prominent side is side of spinous laterality

How many interspinous spaces are the cervical laminae?

1 above

How many interspinous spaces are the T1-4 TVPs?

1 above

How many interspinous spaces are the T5-9 TVPs?

2 above

How many interspinous spaces are the T10-12 TVPs?

1 above

How many interspinous spaces are the Lumbar mammillary processes?

1 above

How many interspinous spaces is the break level?

1 above

What spinous is the tip of the scapula at when one is standing?

T7

What is the first palpable "bump" below the EOP?

C2 spinous

What is the VP 60-70% of the time?

C7

What is most prominent thoracic vertebra(typically)?

T4

What is the first blade like spinous?

L1

Which thoracic spinouses are typically closest together?

T9/10

What is the VP 30-40% of the time?

T1

What spinous is the tip of the scapula with the patient is prone?

T6

What spinous is most often at the level of the iliac crest with a patient standing?

L4

What is the last freely movable cervical segment on extension?

C6

What levels is the thoracic imbrication area usually?

T5-9

What is typically the smallest lumbar spinous?

L5

What is the most prominent lumbar spinous?

L4

What is motion palpation?

start assessing quality not just quantity of motion

What is aberrant motion usually associated?

Acute problems

What does end feel associated with?

Chronic problems

Where do you find tissue prominence for occiput listings?

Lateral mass of atlas

If there is a PLS-M listing, what does the curve look like when the patient's left shoulder is pushed down?

Smooth curve

If there is a PLS-M listing, what does the curve look like when the patient's right shoulder is pushed down?

Stacking curve

What does circumduction give you in the listing?

P and S/I

What is emphasized with circumduction at levels T3-12?

Rotation and lateral bend

What is limited in circumduction at levels T3-12?

extension due to coronal facets

What is emphasized with circumduction at levels L1-4?

extension and lateral bend due to sagittal facets

What are the reasons to use instrumentation?

1. Patient Management

2. Limit the number of segments adjusted

3. When to start and where (sometimes)

4. When to stop

What is Break Analysis?

1. Conceptually the oldest system of instrumentation

2. System used by full spine chiropractors

3. Used to suggest probably levels of subluxations

4. Refined by Dr. Gonstead in the early 1950's

5. It is the most widely used system

How is a break defined?

rapid deflection of the needle over the distance of a single spinal segment or sensory/dermatomal field - repeatable finding

How is a heat swing defined?

slow deflection of the needle which occurs over a multi-segmental area

Broad, sweeping movement of the needle whereas the needle movement over the area of the break is a sharp, well-defined movement

Where is the break in relation to the spinous at Occiput-C2?

Occur very close together

A condyle or atlas subluxation create a differential at any location between occiput-C2

Where is the break in relation to the spinous at C2-T3?

Inferior to the spinous process

Where is the break in relation to the spinous at T4?

At the same level of the SP

Where is the break in relation to the spinous at T5-9?

1 interspinous space above the SP

Where is the break in relation to the spinous at T10-12?

At the level of the SP

Where is the break in relation to the spinous at L1-5?

At the level of the lower 1/4th of the SP

What is the Pattern Analysis?

There is a display of a static and repeatable pattern of heat distribution that is observed on 3 separate readings, spaced as widely as possible and generally over a 24 hour period

What is Chiroterm?

Single probe heat thermometer

Placement is angled I-S and A-P at the styloid fossa

What is the Dermathermagraph?

Single probed, infrared heat sensing instrument designed to read skin temp

Difference of DT25 from Dual Probe

1. Single probes rather than two

2. Reads absolute temp on one side, not bilateral comparisons

3. No contact with skin, reads heat radiating off of skin

4. Analysis employed - neither break nor pattern - provides objective input

4. Bilateral atlas fossa reading is employed as a routine portion os the analysis

5. Graph component with a hand held scanner

What is the repeatability of the Tytron dependent upon?

Operator's ability to maintain a consistent starting and termination point of the scan

What are the environmental controls?

Temperature of the office around 70 degrees

No direct heating or cooling vents drafts should bear on the scanner

Scanner not in the direct sunlight

Scanner holder should be placed away from the computer monitor and CPU

Why is spinography the chiropractic art of analyzing x-rays?

1. Finding potential subluxations

2. Understanding the anatomy to give the most appropriate adjustment

3. Developing the most appropriate management plan for the patient

What are heel lifts?

1. Body usually adapts well up to 6mm of actual deficiency

2. Last lumbar body rotation to the low leg side

3. Lumbar curve convexity on the low leg side

4. patient must have no hip, knee, or ankle pathology

5. patient not holding the adjustment

What is the lumbar disc angle btw L1 and L2?

3-10

What is the lumbar disc angle btw L2 and L3?

4-13

What is the lumbar disc angle btw L3 and L4?

6-14

What is the lumbar disc angle btw L4 and L5?

7-15

What is the lumbar disc angle btw L5 and S1?

8-16

What do you need next if there is spurring on the lateral cervical?

Oblique X-rays to see IVFs

What do you need next is there is a spondylo?

Oblique X-rays to look at the Pars

What do you need next if there is visible posteriority/stairstepping on the lateral cervical?

Flexion/extension X-rays to see ligament laxity