Chiro Methods Exam 2

Patella (Anatomy & Attachments)

Largest sesamoid bone. Located in quadriceps tendon; superiorly attaches to quadriceps tendon, inferiorly to patellar ligament.

Trochlear Groove (Anatomy & Function)

Anterior distal femur groove where the patella glides; stabilizes patellar tracking during flexion/extension.

Lateral Femoral Condyle (Anatomy & Function)

Rounded lateral distal femur prominence; articulates with lateral tibial plateau and provides ligament attachments.

Adductor tubercle — attachment?

Small bump on superior aspect of medial femoral condyle. Attachment site for hamstring portion of adductor magnus.

Patellar Ligament (Origin & Insertion)

Origin: Apex of patella. Insertion: Tibial tuberosity. Function: Extends the knee.

Tibial tuberosity — attachment?

Bony prominence on anterior proximal tibia. Attachment site for patellar ligament; transfers quadriceps force.

Medial plateau — general info?

Superior surface of medial tibia. Articulates with medial femoral condyle; weight-bearing surface.

Lateral plateau — general info?

Superior surface of lateral tibia. Articulates with lateral femoral condyle; weight-bearing surface.

Gerdy's tubercle — attachment?

Bony prominence on lateral proximal tibia. Attachment site for iliotibial (IT) tract.

Fibular head — attachments?

Proximal end of fibula. Attachment for biceps femoris tendon and lateral collateral ligament (LCL).

Sternoclavicular (SC) Joint

The only true bony connection between the upper limb and the axial skeleton.

Acromioclavicular (AC) Joint

Joint between acromion and clavicle; allows scapular movement during shoulder motion.

Coracoid process — attachments?

Hook-like projection of scapula. Muscles: Pectoralis minor, biceps short head, coracobrachialis. Ligaments: Coracoacromial, coracoclavicular.

Greater tubercle — attachments?

Large lateral projection of proximal humerus. Attachment site for rotator cuff muscles: Supraspinatus, Infraspinatus, Teres minor.

Lesser tubercle — attachment?

Smaller anterior projection of proximal humerus. Attachment site for subscapularis.

Medial epicondyle — attachments?

Projection on medial distal humerus. Attachment site for forearm flexors; ulnar nerve passes posteriorly.

Lateral epicondyle — attachments?

Projection on lateral distal humerus. Attachment site for forearm extensor muscles.

Olecranon — attachment?

Posterior projection of ulna forming elbow point. Insertion site of triceps brachii tendon.

Radial head — general info?

Proximal end of radius. Articulates with capitulum of humerus; rotates during pronation and supination.

Biceps Brachii (Origin & Insertion)

Origin: Long head (supraglenoid tubercle), short head (coracoid). Insertion: Radial tuberosity and bicipital aponeurosis.

Triceps Brachii (Origin & Insertion)

Origin: Long (infraglenoid), lateral (above radial groove), medial (below groove). Insertion: Olecranon.

Deltoid — origin and insertion?

Shoulder abductor. Origin: Lateral clavicle, acromion, spine of scapula. Insertion: Deltoid tuberosity of humerus.

Wrist flexors — general origin?

Flex wrist/fingers. Most originate from medial epicondyle of humerus (common flexor tendon). Examples: FCR, FCU, palmaris longus.

Wrist extensors — general origin?

Extend wrist/fingers. Most originate from lateral epicondyle of humerus (common extensor tendon). Examples: ECRL/B, ECU.

Memory Hook: Medial vs. Lateral Epicondyle?

Medial = Flexors ("Medial = Move fingers in"). Lateral = Extensors ("Lateral = Lift wrist").

Memory Hook: Greater vs. Lesser Tubercle?

Greater tubercle = 3 rotator cuff muscles (SITS except subscapularis). Lesser tubercle = Subscapularis alone.

Memory Hook: Gerdy & Olecranon?

Gerdy gets the IT band. Olecranon = Triceps pull point (push-up muscle).

Neck pain that causes shooting pains into the arms or legs; or an extremely rigid neck when bending forward is a sign that the client MIGHT BE experiencing meningitis or cervical disk herniation. (T/F)

True

You palpate a pulsating mass in the abdomen of a patient with Low back pain. Is this an emergent Referral?

Yes

Client comes in for back pain.

Signs and Symptoms:

-flank pain

-fever and chills

-Murphy's punch test is positive

What system of the body are we working with?

And will this be an emergent referral?

Visceral, yes

Estimates of risk are based on measuring the relationship between the presence of possible risk factors and

Subsequent incidence of particular conditions

To demonstrate causation one must show both correlation and _________________.

A reasonable physiologic mechanism through which this occurs

The most significant risk factors are found in the nature of the client's presenting complaints.

True

The 5 D's of Vertebrobasilar Insufficiency / Stroke

Dizziness, Dysarthria, Drop attacks, Diplopia, Dysphagia.

Heart rates below ______ and above _________ without symptoms are cause for an urgent referral.

35; 140

A scaphoid fracture with poor apposition. Should be:

Stabilized and seen within 48 hours

Stroke or Vertebrobasilar Insufficiency has vital signs that a chiropractor must be aware of.

The 2Ns associated with Stroke are:

Nausea

Numbness

_________________ is a condition that shows up as low back pain, urinary retention/incontinence, sexual dysfunction, and a numbness between the legs.

Cauda Equina syndrome

Considering posture, it is imperative to understand that structural changes lead to functional compensation and functional changes will not alter the structural integrity of the human body.

False

In forward head posture the weight of the head is increased by ___ pounds per inch that the head is forward from the neutral position

10

Lower cross syndrome is associated with:

Hyperlordosis

Flexion and extension of the spine happen inside which plane of the body?

Sagittal

Upper Cross syndrome is a compensation due to a repetitive stress on the body.

True

Rotation of the spine happens in what plane of the body?

Transverse

Assessing posture in the lateral view includes which landmark(s)?

External acoustic meatus

Acromion

Lateral flexion occurs in what plane of the body?

Frontal

What are good screen-time recommendations for clients?

Take a break every 30-45 minutes and keep screen brightness comfortable to avoid squinting.

Lower crossed syndrome is a postural compensation presenting with:

Inhibited: Abdominals, Gluteus Min./Med./Max

Facilitated: Thoraco-lumbar extensors, rectus femoris/iliopsoas

Which of the following are involved in upper cross syndrome?

Inhibited: Deep cervical flexors, lower trap/serratus anterior

Facilitated: upper trap/levator scapula, SCM/pectoralis

Artho means:

Joint

Which cervical vertebrae does not have a spinous process?

C1

What is the evaluation of a person's body position and/or structure in standing?

posture

From which views do you assess standing posture?

Anterior, posterior, left lateral, and right lateral.

How can you learn a bit more about a patient's posture?

Prone and supine positions on the table

Where should the clinician stand during a postural assessment?

Close enough to support the client if they experience balance issues.

What instruction should you give a patient to observe their natural standing posture?

"I would like to observe how you normally stand."

To neutralize patients "normal stance" have them

close their eyes, march in place, shake it out, then open their eyes

How do you observe patient's posture after neutralizing their normal stance?

From the feet up toward the head

Postural assessment is best observed in

shorts or clothing that is form fitting

If patient has orthodics observe:

with them in and with them out

Doctor should walk around the patient during observation while

the patient stands still

Human center of gravity while standing is

Just anterior of S2

Most stable posture is in ages

20-60

Over 60 years of age stability decreases by_____ with eyes closed

50%

What are the long-term benefits of correcting posture habits?

Increased ROM, stability, muscle strength/endurance, and improved neuromuscular programming.

Methods of analysis

Visual

Posture grid with plumb line

Bilateral Scales

Applications- iphone, ipad or others

The postural muscles are

Neck extensors and flexors

Spinal extensors and flexors

Gluteus maximus

Hamstrings and quads

Gastroc and soleus

tibialis anterior

Antigravity muscles that maintain erect posture

postural muscles

Group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms

Syndrome

What are the two types of postural syndromes?

Lower and upper cross syndrome

Upper and lower cross syndromes

weakness in the front and back

Tightness in the front and back

Imbalance of muscle patterns

In Upper Cross Syndrome Which Muscles are inhibited (weak)

Deep Cervical flexors

lower trap and serratus anterior

In upper cross syndrome which muscles are facilitated ( tight)

SCM/Pectoralis

Upper Trap/ Levator Scapula

In lower cross syndrome, which muscles are inhibited (weak)?

Abdominals, gluteus minimus, medius, and maximus

In lower cross syndrome, which muscles are facilitated (tight)?

Rectus femoris, iliopsoas, and thoracolumbar extensors

Common postural variations

Kyphotic-lordotic, flat back (military spine), and swayback

An applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely

Ergonomics

Key ergonomic guidelines for screen time

Break every 30-45 mins; 90-90-90-90 angles; screen perpendicular to windows; eyes at top 1/3

Contact points of the contact or indifferent hand

Pisiform, hypothenar, metacarpal/knife edge, digital, DIP, PIP, MCP/index web, thumb, calcaneal, palmar

Client palpation positions

Seated, supine, prone, side-lying, and standing

Doctor stance and table positions

HOT, SOT, FOT, fencer/lung/staggered stance, and square/straight-on stance

Which joints can become highly unstable if not supported?

Elbow and knee

How should unstable joints be supported?

Using hands, another part of the doctor's body, or the table

Correct table height for doctor longevity

Fingers/knuckles brush table top with relaxed arms; base of patella level with table top

Adjust posture and biomechanics according to

body part being treated and technique applied

Doctors should keep shoulders relaxed (t/f)

True

How to avoid whipping or snapping wrists during rapid light/moderate applications

Keep elbows flexed and wrists relaxed

stand with feet ______, place feet in the direction of______, knees and hips should be slightly______, back is _______, shoulders are ________

shoulder width apart, movement, flexed, straight, relaxed

algesia-

sensitivity to pain

Eu-

good

dys-

bad, difficult

Myelo-

spinal cord

dactyl

finger, toe

-penia

lack of

-algia

pain

primary palpating contact points for finding landmarks:

tips of fingers, pads of fingers, flat multiple finger contact

the harder you press the less you will ______

feel

a light pressure will __________ the beds of the fingernail

blanch and whiten

a hard pressure is uncomfortable on

your closed eyeballs

What are the two methods of palpation for vertebre?

2 Finger slide

Spider walk