LECOM-SH OPP 1001, Fall 2022, Exam 1

Definition of Osteopathic Medicine

a comprehensive system of healthcare based upon a specific philosophy and distinctive art. Our philosophy and principles embrace holistic evaluation and treatment of patients to obtain the best possible outcomes in medical care. Our art is the use of sensitive palpatory diagnostic skills and osteopathic manipulative treatment (OMT) to assist in facilitating the patient's own healing abilities. Hands-on treatment is beneficial not only for a variety of musculoskeletal problems, but also for visceral, lymphatic, autonomic, central and peripheral nervous system disorders. OMT works to balance the body, mind, and spirit of the individual and may influence bioenergetic realms. It is what distinguishes and separates us from the allopathic profession and all other healthcare professionals.

Definition of Osteopathy

a science which consists of such exact exhaustive and variable knowledge of the structure and functions of the human mechanism, anatomy, physiology, psychology, including the chemistry and physics of its known elements...It is a scientific knowledge of anatomy and physiology in the hands of a person of intelligence and skill, who can apply that knowledge to the use of man when sick or wounded by strains, shocks falls, or mechanical derangement or injury of any kind to the body.

What is Tenet #1?

The body is a unit; the person is a unit of body, mind and spirit

(where many illnesses/symptoms star and/or are worsened)

What is Tenet #2?

The body is capable of self-regulation, self-healing, and health maintenance

(Ex: a simple scar after a major injury)

What is Tenet #3?

Structure and function are reciprocally interrelated

(Ex: cardiovascular and respiratory systems work together)

(Ex: support the body and it won't atrophy)

What is Tenet #4?

Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship, of structure and function

(Ex: follow patient's needs)

OPP vs OMT /OMM

OPP = Osteopathic Principles and Practice

OMT/OMM = Osteopathic Manipulative Treatment/Medicine

Definition of OMT/OMM

Therapeutic use of the hands to restore normal Structure (anatomy) and Function (physiology)

What are the 3 osteopathic principles?

1) Holistic emphasis (unity of body, mind, spirit)

2) Care directed toward finding and restoring health (homeostasis; hemodynamics)

3) Comprehensive healthcare

Historical timeline: August 6th, 1828?

birth of A.T. Still

Historical timeline: 1849?

1849 - A. T. Still marries 1st wife, Mary V.

Historical timeline: 1850?

A. T. Still Moves from MO to KS

Historical timeline: 1853?

A. T. Still begins training as physician

Historical timeline: 1859?

Mary V. dies (first wife)

Historical timeline: 1860?

remarried to Mary E. T.

Historical timeline: 1864?

3 children (1 adoptive) died of meningitis and

1 died of pneumonia (3 weeks later)

Historical timeline: What was established in 1847?

AMA

Historical timeline: 1867?

Father Abram dies

Historical timeline: 1870?

A. T. Still searched for answers

Historical timeline: June 22nd, 1874?!?!?!?!

FLUNG the BANNER of OSTEOPATHY and 1st voiced tenets of osteopathy

Historical timeline: 1892

American School of Osteopathy (ASO)

Historical timeline: 1893

ASO first class in October

Historical timeline: 1894

ASO courses changed to 2 years long

Historical timeline: 1897

ASO expand and new DO schools start up

Historical timeline: 1910

Flexner report that closes med schools

A.T. Still's super long, and super important timeline: 1915

closure of many daughter DO schools (only 7 left open)

Historical timeline: December 12th, 1917

A.T. Still DIES @89 yrs

Historical timeline: 1918

Pandemic was treated with osteopaths

Historical timeline: 1929

Pharmacology was added to curricula

Historical timeline: 1940-1969

The second period of osteopathic research

Historical timeline: What merged in 1960?

California Osteopathic Association (COA) and California Medical Association (CME)

- Changed the College of Osteopathic Physicians and Surgeons to the University of California College of Medicine

AOA standards changing (timeline)

1905

1915

1930

1954

1905 - curricula changed to 3 years

1915 - curricula changed to 4 years

1930 - 2 years of undergrad required

1954 - 3 years of undergrad required

How much could a DO pay to get an MD degree?

$65

Historical timeline: 1969 (school)

MSUCOM opened

Historical timeline: 1969 (council)

Education council of Osteopathic Principle (ECOP)

Historical timeline: 1973

D.O. fully licensed in 50 states

Historical timeline: 1993!!!!!

LECOMs FIRST class

Historical timeline: 2014-2020

AOA and ACGME residency merger announced and completed

LECOM timeline

1992

1993

2009

1992 - charter in Dec

1993 - inaugural class matriculation

2009 - LECOM at Seton Hill opened

Scientific Approach 1-6

1) define problem or lack of knowledge

2) research related info

3) formulate hypothesis

4) Devise experiment(s)

5) Analyze data results for significance

6) conclusion

What does S.O.A.P. stand for?

S---subjective

O---Objective

A---Assessment

P---Plan

Medical approach to patients? (SOAP)

1) Collect data (history of prob & necessary diagnostics)

2) Evaluate/Synthesize Data

3) Differential Diagnosis (DDx)

4) Management Plan (OMT?)

5)Re-evaluate at each each visit

6) Find health

Parts of the Osteopathic Medical Evaluation

- Observation

- History

- Physical Exam (Gen. comprehensive or focused; integrated neuromusculoskeletal)

- Palpation

- Motion testing (gross; segmental)

- Special Tests

- Laboratory

- Radiology (MRI, X-ray, CT, PET)

- Other (ECG, EG, Pulse ox, Etc.)

Why focus on the Neuromuscular system (NMS)? 10 common reasons for doctor visits

1. Skin Issues

2. Joint Pain and Osteoarthritis

3. Back Pain

4. High Cholesterol

5. Upper Respiratory Problems

6. Anxiety, Depression, Mental Health Disorders

7. Neurological Disorders

8. High Blood Pressure

9. Headaches and Migraines

10. Diabetes

Why focus on NMS? 10 common NMS complaints?

1. Strains/Sprains

2. Muscle Imbalance (muscle tension headaches, LBP)

3. Myofascial Trigger Points

4. Somatic Dysfunction

5. Viscerosomatic Dysfunction (internal organs, ANS)

6. Trauma (Sports Injuries, Falls, MVAs, Work-related, War)

7. Neurological (migraines, TBI, concussions, HNP, nerve entrapments)

8. Osteoarthritis

9. Rheumatologic Diseases

10. Stress/anxiety/PTSD

Palpatory NMS examination? T.A.R.T

T---tissue texture abnormalities (tension)

A---Asymmetry of tissue/joint motion

R---Restricted ROM of tissue/joint

T---Tenderness

What is somatic Dysfunction? (multiple definitions)

- ALWAYS NAMED FOR ITS FREEDOM OF MOTION

- Somatic Dysfunction is an impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and related vascular, lymphatic, and neural elements.

- a disturbance of the normal function of somatic structures

- possesses characteristics identifiable by means of palpation

- basis of the phenomenon appears to be neurophysiological

- deleterious effects on health when present

- improves with OMT

What does Somatic Dysfunction not include?

Fractures, degenerative processes, and inflammatory processes

What are the 5 classic osteopathic models?

1. Biomechanical-Structural

2. Respiratory-Circulatory

3. Metabolic-Nutritional

4. Neurological

5. Behavioral-Biopsychosocial.

What is the Biomechanical model?

- anatomy of muscles, spine, extremities; posture, motion tensegrity

- OMT normalizes mechanical somatic dysfunction, structural integrity, physiological function, homeostasis

-joint mobilization

- myofascial

- ligaments

- bony

- viscera

What is the neurological model?

- CNS, PNS, ANS that control body functions

- OMT normalizes neurological functioning, balancing the ANS, proprioception, homeostasis

-exercise (stretching, strengthening), surgery, medications

What is the Respiratory-Circulatory Model?

-Pulmonary, circulatory and fluids (lymph and CSF) systems

- OMT normalizes blood and lymph flow, diaphragm function, tissue oxygenation

- medications, surgery, IV fluids, ventilation

What is the Metabolic-Nutritional Model?

- Homeostatic adaptive mechanisms through +/- feedback loops to regulate energy exchange and conservation through metabolic processes

- Neuroendocrine immune system and all internal organs

- OMT lymphatic pump, visceral techniques

- lifestyle changes, nutritional counseling

What is the Behavioral-Biopsychosocial Model?

- Mental, emotional, social and spiritual dimensions related to health and disease

- Depression, anxiety, stress, habits, additions, and other mind-body interaction

- OMT gentle, guided imagery, hypnosis, gentle breathing exercises

- Stress reduction, exercises, psychiatry, psychotherapy, medication, prayer, appropriate medications

What is Biophysics?

an interdisciplinary science using methods of, and theories from, physics to study biological systems. Spans all scales of biological organization, from the molecular to whole organisms to ecosystems.

What is Bioenergentics?

study of how endogenous and exogenous energy sources/forms influence and control living systems and their environment.

What is Bioenergy?

energy produced endogenously by living systems

What is the Bioenergetic Model?

addresses the bioenergetic nature of the human being in health and disease, striving to maintain and/or support the return to homeostasis through the application of biophysics principles in the biofield. It serves as the foundation and integration point for all other osteopathic models of care and this model can be utilized to diagnose and treat all levels of dysfunction.

Definition of Palpation?

The application of variable manual pressures to the surface of the body for the purpose of determining the shape, size, consistency, position, inherent motility and health of tissues beneath

What info is obtained from palpation?

1) Tissues - soft (skin, fascia, muscles, tendons, ligaments, organs, temp, edema, scars) vs hard (bone, joints)

2) Motions - ranges of motion (gross, segmental), barriers, ease, strain patterns

3) Rhythms - Arterial pulse, respiratory, "inherent" tissue motions

What are the 3 Sensory nerve receptors and their received information?

1) mechanoreceptors (touch & proprioception)

2) Thermoreceptors (cooling & heat)

3) Nociceptors (pain, itchc, Tickle, Tingling to stabbing)

what does the Merkel disc detect?

- degree of pressure

- Deformation of skin

- ex: monitoring pulse and sensing 'end point"

What does the Ruffini corpuscle detect?

- stretch of skin

- ex: enlarged lymph nodes, lumps, and bumps

What does the Meissner's corpuscle detect?

- 2 point discrimination

What does the pacinian corpuscle do?

- Vibration

- rapid adapting

- ex: tuning fork & thrill

What part of the hand senses temperature?

Dorsal-lateral side of hand

What are you feeling for during palpation?

- Temp

- Moisture/dryness

- Depth/Thickness

- Texture

- Tissue tension

- Tenderness/irritability

- Swelling

- Elasticity

- Turgor

- Motions

- Barries/Ease

What are the 3 basic phases of sensory palpation?

1) Detection ("feeling")

2) Internal amplification ("seeing")

3) Analysis and interpretation ("thinking and knowing")

Texture Changes: Acute

- History

- Tenderness

- Temp

- texture

- Tension

-edema

- Moisture

- skin color

- Erythema test

History - Recent

Tenderness - Sharp, localized

Temp - Increased warmth

texture - Boggy

Tension - Increased/rigid

edema - present

Moisture - increased

skin color - Erythematous

Erythema test - Redness lasts

Texture Changes: Chronic

- History

- Tenderness

- Temp

- texture

- Tension

-edema

- Moisture

- skin color

- Erythema test

History - Remote

Tenderness - dull, ache, burning

Temp - cool

texture - smooth

Tension - slightly increased (ropey)

edema - absent

Moisture - decreased

skin color - pale

Erythema test - Redness fades

Planes of Motion: Rotation is along what axis and plane?

- Vertical axis

- transverse/horizontal plane

Planes of Motion: Sidebending is along what axis and plane?

- A-P Axis

- Coronal/Frontal Plane

Planes of Motion: Flexion/Extension is along what axis and plane?

- Transverse Axis

- Sagittal plane

Thorax anatomy: included bones?

- 2 clavicles

- Manubrium, sternum. xiphoid process

- 12 sets of ribs

- 12 thoracic Vertebra

4 functions of the thoracic cage

1) Respiration

2) Protection of vital organs

3) Pump for venous and lymphatic return

4) Support structure for the upper extremities

Sternum Motions:

1) compression & decompression -

2) Gliding motion -

3) Rotation around -

4) Torsion around -

1) - Ant./Pos.

2) - Sup./Inf.

3) Transverse & Vertical axis

4) Oblique axis

What are the true ribs?

1-7

What are the false ribs?

8-10

What are the floating ribs?

11-12

What are the typical ribs?

3-9

What are the atypical ribs?

1, 2, 10, 11, 12

What make a rib true?

attach directly to the sternum

What makes a rib false?

attaches via a synchondroses

what makes a rib floating?

do not attach to the sternum

what makes a rib typical?

- head has 2 articulations

- tubercle has 1 articulation

- have a neck, angle, shaft

What makes rib 1 atypical?

articulates only with T1 body & no angle

What makes rib 2 atypical?

large tuberosity on shaft for serratus anterior

what makes rib 10 atypical?

Single facet for costovertebral articulation

What makes ribs 11 and 12 atypical?

articulates only with corresponding vertebral body, has no neck or tubercles

rib articulations - sternochondral (rib 1)

synchondrosis and non-synovial

rib articulations - sternochondral (rib 2-7)

synovial articulation

What are the 3 articulations for a typical Posterior rib articulation?

1) Costotransverse joint

2) Costovertebral joints (sup&inf)

Rib motions at the Costotransverse joint?

Ribs 1-7: rotate

ribs 8-10: glide

ribs 11&12: no articulation with transverse process

Rib motions for 1-5?

A) Bucket handle

B) Pump handle

C) Caliper

Pump handle

Rib motions for 6-10?

A) Bucket handle

B) Pump handle

C) Caliper

Bucket handle

Rib motions for 11&12?

A) Bucket handle

B) Pump handle

C) Caliper

Caliper

Describe the direction of the pump handle motion, motion in which plane and axis, and location of palpation

- ant. ribs move cephalad & pos. ribs move caudad w/ inhalation (opposite for expiration)

- Motion in sagittal plane

- motion in costovertebral-costotransverse axis line

- palpated at mid-clavicular line

Describe the direction of the bucket handle motion, motion in which plane and axis, and location of palpation

- ribs move laterally and increase transverse diameter w/ inhalation

- motion in coronal plane

- axis of motion in Costovertebral-costosternal and A/P line

- palpated mid-axillary line

Describe the direction of the caliper motion, motion in which plane and axis, and location of palpation

- ribs externally rotate with inhalation

- motion in horizontal plane

- axis of motion is vertical line

- palpate 3-5cm lateral to transverse processes

what is the morphology of the 1st rib?

- broadest, shortest, sharpest curve

- Grooves for subclavian a. & v., Brachial plexus, and Phrenic n.

- Tubercle is scalene and anterior