Podcast
Questions and Answers
Which of the following best describes how spinal somatic dysfunction is diagnosed?
Which of the following best describes how spinal somatic dysfunction is diagnosed?
- Understand normal spinal mechanics, assess range of motion, identify the spinal level, and determine the cause of dysfunction.
- Identify the spinal level, name the dysfunction, assess the patient's pain level, and understand normal spinal mechanics.
- Assess TART changes, understand normal spinal mechanics, identify specific spinal levels, and name the dysfunction. (correct)
- Assess TART changes, understand pathological spinal mechanics, identify specific spinal levels, and treat the dysfunction.
A patient presents with a thoracic somatic dysfunction. Palpation reveals a restricted range of motion during flexion. How should this restriction influence the naming of the dysfunction?
A patient presents with a thoracic somatic dysfunction. Palpation reveals a restricted range of motion during flexion. How should this restriction influence the naming of the dysfunction?
- The dysfunction is named based on motion preference.
- The dysfunction is named based on tissue texture changes.
- The dysfunction is named based on which direction has the greatest ease of motion. (correct)
- The dysfunction is named based on the direction of greatest restriction.
What is the primary purpose of the vertebral column?
What is the primary purpose of the vertebral column?
- To coordinate endocrine function with the nervous system.
- To facilitate nutrient distribution throughout the body.
- To enable rapid exchange of gases during respiration.
- To protect the spinal cord and support the upper body. (correct)
When describing vertebral motion, what serves as the key reference point on an individual vertebra?
When describing vertebral motion, what serves as the key reference point on an individual vertebra?
In right rotation of a vertebra, what is the movement of the spinous process in relation to its initial position?
In right rotation of a vertebra, what is the movement of the spinous process in relation to its initial position?
During left sidebending of a vertebra, where does the point of reference tilt in relation to its original position?
During left sidebending of a vertebra, where does the point of reference tilt in relation to its original position?
As a vertebra moves into flexion, how does the spinous process move in relation to its initial position?
As a vertebra moves into flexion, how does the spinous process move in relation to its initial position?
If the LEFT transverse process of T5 moves posteriorly, what motion is occurring at the T5 vertebra?
If the LEFT transverse process of T5 moves posteriorly, what motion is occurring at the T5 vertebra?
What is the relationship between rotation and sidebending in the C2-C7 spinal region, according to cervical spine mechanics?
What is the relationship between rotation and sidebending in the C2-C7 spinal region, according to cervical spine mechanics?
The facets of the lumbar spine are oriented primarily in which direction?
The facets of the lumbar spine are oriented primarily in which direction?
The facets of the cervical spine are oriented primarily in which direction?
The facets of the cervical spine are oriented primarily in which direction?
Where is the T1 spinous process located in relation to the T1 transverse processes?
Where is the T1 spinous process located in relation to the T1 transverse processes?
You locate a spinous process that is approximately halfway between the T5 and T6 transverse processes. Which vertebral segment does the spinous process likely belong to?
You locate a spinous process that is approximately halfway between the T5 and T6 transverse processes. Which vertebral segment does the spinous process likely belong to?
The spinous process of T9 moves inferiorly with which motion of the T9 vertebra
The spinous process of T9 moves inferiorly with which motion of the T9 vertebra
Three adjacent vertebrae present with asymmetry in neutral, and sidebending to one side causes rotation to the opposite side. Which type of Fryette's principle is illustrated?
Three adjacent vertebrae present with asymmetry in neutral, and sidebending to one side causes rotation to the opposite side. Which type of Fryette's principle is illustrated?
A single vertebra demonstrates asymmetry that worsens with flexion or extension, and sidebending induces rotation to the same side. Which Fryette's principle is being illustrated?
A single vertebra demonstrates asymmetry that worsens with flexion or extension, and sidebending induces rotation to the same side. Which Fryette's principle is being illustrated?
Which best describes Fryette's 3rd Law?
Which best describes Fryette's 3rd Law?
What term best describes somatic dysfunction?
What term best describes somatic dysfunction?
The components of TART are useful for what?
The components of TART are useful for what?
A paraspinal valley feels more shallow on the right and a transverse process feels more posterior. What rotational dysfunction can we predict?
A paraspinal valley feels more shallow on the right and a transverse process feels more posterior. What rotational dysfunction can we predict?
A patient's paraspinal valley on the left is more shallow, the transverse process on the left feels more posterior, and this presentation does NOT improve in neutral. How will this dysfunction feel in flexion?
A patient's paraspinal valley on the left is more shallow, the transverse process on the left feels more posterior, and this presentation does NOT improve in neutral. How will this dysfunction feel in flexion?
A patient's paraspinal valleys on the right feel more shallow, and the transverse processes on the right feel more posterior throughout the thoracic spine. How would you expect this to present in the neutral position?
A patient's paraspinal valleys on the right feel more shallow, and the transverse processes on the right feel more posterior throughout the thoracic spine. How would you expect this to present in the neutral position?
A patient's paraspinal valleys on the right feel more shallow throughout the thoracic spine. Which sidebending preference would you expect?
A patient's paraspinal valleys on the right feel more shallow throughout the thoracic spine. Which sidebending preference would you expect?
The side of ease is used to ___ the dysfunction.
The side of ease is used to ___ the dysfunction.
How do you notate a spinal dysfunction involving T4-T6, in neutral, rotated right and sidebent left?
How do you notate a spinal dysfunction involving T4-T6, in neutral, rotated right and sidebent left?
Using shorthand notation, what is the equivalent of T2 ELRL?
Using shorthand notation, what is the equivalent of T2 ELRL?
Which structures play a role in guiding spinal ROM?
Which structures play a role in guiding spinal ROM?
What is a reason that scoliosis could cause somatic dysfunction?
What is a reason that scoliosis could cause somatic dysfunction?
A vertebra with a posterior transverse process on the right is rotated ___.
A vertebra with a posterior transverse process on the right is rotated ___.
Three adjacent vertebra haves posterior transverse process on the left, and they exhibit worse asymmetry in flexion and extension. What type of dysfunction are they?
Three adjacent vertebra haves posterior transverse process on the left, and they exhibit worse asymmetry in flexion and extension. What type of dysfunction are they?
Three adjacent vertebra have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. Which way are they rotated?
Three adjacent vertebra have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. Which way are they rotated?
Three adjacent vertebra have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. Which way are they sidebent?
Three adjacent vertebra have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. Which way are they sidebent?
On examination of your patient's L2, you note that it prefers to rotate to the left. Asymmetry is worse in Neutral and Extension. Sidebending preference cannot be discerned. What is the diagnosis?
On examination of your patient's L2, you note that it prefers to rotate to the left. Asymmetry is worse in Neutral and Extension. Sidebending preference cannot be discerned. What is the diagnosis?
A vertebra is found to have restricted motion in flexion, sidebending right, and rotation left. Which motion will be freer?
A vertebra is found to have restricted motion in flexion, sidebending right, and rotation left. Which motion will be freer?
When sidebending is introduced from neutral, what is the behavior that the Type II Somatic Dysfunction will exhibit
When sidebending is introduced from neutral, what is the behavior that the Type II Somatic Dysfunction will exhibit
During flexion, what direction does the spinous process of a given vertebrae move?
During flexion, what direction does the spinous process of a given vertebrae move?
During left rotation of T3, to which side will the point of reference move?
During left rotation of T3, to which side will the point of reference move?
The transverse processes resist anterior pressure when the vertebral rotates
The transverse processes resist anterior pressure when the vertebral rotates
What plane of motion does rotation occur in?
What plane of motion does rotation occur in?
Which of the following are part of TART changes
Which of the following are part of TART changes
Besides protecting the spinal cord, what is another major function of the vertebral column?
Besides protecting the spinal cord, what is another major function of the vertebral column?
Which of the following is NOT considered a primary motion of the spine?
Which of the following is NOT considered a primary motion of the spine?
What is the first step in diagnosing spinal somatic dysfunction?
What is the first step in diagnosing spinal somatic dysfunction?
When assessing vertebral motion, which specific anatomical landmark serves as the primary reference point?
When assessing vertebral motion, which specific anatomical landmark serves as the primary reference point?
During right rotation, how would the anterior-superiormost point move in relation to its original position?
During right rotation, how would the anterior-superiormost point move in relation to its original position?
With left sidebending, what happens to the point of reference in relation to its initial position?
With left sidebending, what happens to the point of reference in relation to its initial position?
In flexion, what direction does the point of reference move in relation to its initial position?
In flexion, what direction does the point of reference move in relation to its initial position?
How does the point of reference move during spinal extension?
How does the point of reference move during spinal extension?
In the context of spinal motion, which plane is associated with rotation?
In the context of spinal motion, which plane is associated with rotation?
What axis of motion is associated with sidebending of the spine?
What axis of motion is associated with sidebending of the spine?
Which plane of motion does flexion and extension occur in?
Which plane of motion does flexion and extension occur in?
The transverse axis is associated with which spinal motion
The transverse axis is associated with which spinal motion
What is the anatomical term that describes the inward curvature of a structure, such as within the spinal column?
What is the anatomical term that describes the inward curvature of a structure, such as within the spinal column?
Which term describes an outward curvature of the spine?
Which term describes an outward curvature of the spine?
According to the 'Rule of Threes,' where is the spinous process of T2 typically located relative to its transverse process?
According to the 'Rule of Threes,' where is the spinous process of T2 typically located relative to its transverse process?
According to the 'Rule of Threes,' how does the location of the T5 spinous process relate to its transverse process?
According to the 'Rule of Threes,' how does the location of the T5 spinous process relate to its transverse process?
If a spinous process is located approximately at the level of the transverse process of the vertebra below, which vertebral level is it most likely to be?
If a spinous process is located approximately at the level of the transverse process of the vertebra below, which vertebral level is it most likely to be?
Which spinous process is located at the halfway point between the transverse processes of T5 and T6?
Which spinous process is located at the halfway point between the transverse processes of T5 and T6?
According to Fryette's principles, what typically occurs when sidebending is initiated in a neutral position in the lumbar spine?
According to Fryette's principles, what typically occurs when sidebending is initiated in a neutral position in the lumbar spine?
In the context of Fryette's principles, what is the characteristic motion coupling observed when a single lumbar vertebra is in a non-neutral position (flexion or extension)?
In the context of Fryette's principles, what is the characteristic motion coupling observed when a single lumbar vertebra is in a non-neutral position (flexion or extension)?
What does Fryette's third law primarily address regarding spinal motion?
What does Fryette's third law primarily address regarding spinal motion?
In the context of spinal assessment, what does the acronym 'TART' primarily refer to:
In the context of spinal assessment, what does the acronym 'TART' primarily refer to:
Upon palpation, you find that the right transverse process of a vertebra feels more posterior and the paraspinal valley on the right feels more shallow compared to the left. Which rotational dysfunction is most likely?
Upon palpation, you find that the right transverse process of a vertebra feels more posterior and the paraspinal valley on the right feels more shallow compared to the left. Which rotational dysfunction is most likely?
If a patient has a shallow left paraspinal valley with the left transverse process feeling more posterior that does NOT improve with flexion, which is most likely its behavior in flexion?
If a patient has a shallow left paraspinal valley with the left transverse process feeling more posterior that does NOT improve with flexion, which is most likely its behavior in flexion?
A patient exhibits shallower paraspinal valleys on the right throughout the thoracic spine. What sidebending preference would you anticipate?
A patient exhibits shallower paraspinal valleys on the right throughout the thoracic spine. What sidebending preference would you anticipate?
In describing somatic dysfunction using shorthand notation, what does naming the dysfunction for the 'side of ease' indicate?
In describing somatic dysfunction using shorthand notation, what does naming the dysfunction for the 'side of ease' indicate?
If a vertebra is found to have a posterior transverse process on the right, what is its rotational status?
If a vertebra is found to have a posterior transverse process on the right, what is its rotational status?
Three adjacent vertebrae have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. What type of somatic dysfunction are they?
Three adjacent vertebrae have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. What type of somatic dysfunction are they?
Three adjacent vertebrae have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. Which direction are they rotated?
Three adjacent vertebrae have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. Which direction are they rotated?
Three adjacent vertebrae have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. Which direction are they sidebent?
Three adjacent vertebrae have posterior transverse processes on the left, and they exhibit worse asymmetry in flexion and extension. Which direction are they sidebent?
If L2 prefers to rotate to the left, and this asymmetry worsens in neutral and extension, what is the appropriate notation?
If L2 prefers to rotate to the left, and this asymmetry worsens in neutral and extension, what is the appropriate notation?
In a Type II somatic dysfunction at L4 where the vertebra is restricted in flexion, sidebending left, and rotation right, which motion will be the freest?
In a Type II somatic dysfunction at L4 where the vertebra is restricted in flexion, sidebending left, and rotation right, which motion will be the freest?
What is the effect of scoliosis on spine mechanics?
What is the effect of scoliosis on spine mechanics?
Besides Accumulated trauma, degeneration, wear/tear. What is another thing that can guide spinal ROM?
Besides Accumulated trauma, degeneration, wear/tear. What is another thing that can guide spinal ROM?
What best describes primary determinants of spinal ROM?
What best describes primary determinants of spinal ROM?
Flashcards
Why do we have a spine?
Why do we have a spine?
Protect the spinal cord and provide support for the upper half of the body.
Motions of the spine?
Motions of the spine?
Flexion, extension, sidebending (lateral flexion), and rotation.
Diagnosing spinal somatic dysfunction?
Diagnosing spinal somatic dysfunction?
Understand normal mechanics, identify spinal levels, assess TART, and name the dysfunction.
Right Rotation
Right Rotation
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Left Rotation
Left Rotation
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Left Sidebending
Left Sidebending
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Right Sidebending
Right Sidebending
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Flexion
Flexion
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Extension
Extension
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Rule of Threes
Rule of Threes
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Somatic Dysfunction
Somatic Dysfunction
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TART
TART
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Fryette's Laws
Fryette's Laws
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Type I Somatic Dysfunction
Type I Somatic Dysfunction
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Type II Somatic Dysfunction
Type II Somatic Dysfunction
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Fryette Law III
Fryette Law III
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CO-C1 joint mechanics
CO-C1 joint mechanics
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C1-C2 joint mechanics
C1-C2 joint mechanics
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Palpation of Right Rotation
Palpation of Right Rotation
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Naming spinal somatic dysfunction
Naming spinal somatic dysfunction
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Study Notes
Lecture Objectives
- The goal is to understand how somatic dysfunction impacts spinal movement.
- Learning how tissue changes relate to somatic dysfunction is important.
- TART is important for understanding tissue changes in somatic dysfunction.
- Understanding the Rule of Threes is important.
- Learning the principles and limits of Fryette's 3 principles is needed.
- Knowing the role of vertebral facets in controlling motion is necessary.
- There is a need to learn how to diagnose general dysfunctional motions of the spine.
Why the Spine Exists
- It protects the spinal cord.
- It helps support the upper half of the body.
Spinal Motions
- The spine allows for flexion.
- The spine allows for extension.
- The spine allows for sidebending, also known as lateral flexion.
- The spine allows for rotation.
Diagnosing Spinal Somatic Dysfunction
- Requires understanding normal spinal mechanics.
- Requires the ability to identify specific spinal levels.
- Involves assessing TART, which stands for Tenderness, Asymmetry, Restriction of motion, and Tissue texture changes.
- Finally, the dysfunction is named.
Reference of Vertebrae Motion
- The reference point for motion in an individual vertebra is the anterior-superiormost point of the vertebral body.
Vertebral Rotation
- Right Rotation: The reference point rotates to the right of its initial position; the spinous process moves left.
- Left Rotation: The reference point rotates to the left of its initial position; the spinous process moves right.
Vertebral Sidebending
- Left Sidebending: The reference point tilts toward the left side; the spinous process tilts left.
- Right Sidebending: The reference point tilts toward the right side; the spinous process tilts right.
Vertebral Flexion
- The reference point moves inferiorly from its initial position with flexion.
- The spinous process moves superiorly from its initial position with flexion.
Vertebral Extension
- The point of reference moves superiorly from its initial position during extension.
- The spinous process moves inferiorly from its initial position during extension.
Planes and Axes of Motion
- Rotation occurs in the transverse plane around a vertical axis.
- Sidebending occurs in the coronal plane around an anterior-posterior axis.
- Flexion occurs in the sagittal plane around a transverse axis.
- Extension occurs in the sagittal plane around a transverse axis.
Spinal Curves
- Spinal curves provide convexity and concavity; these are used to describe the direction of a curve.
Rule of Threes
- Used for the thoracic spine, and helps identify where the spinous process tip falls relative to the vertebra's transverse process.
- T1-T3: Spinous process is at same level as transverse process.
- T4-T6: Spinous process is about one-half segment below the transverse process.
- T7-T9: Spinous process is about one segment below the transverse process.
- T10: Usually one segment below, but can vary.
- T11: About one-half segment below.
- T12: Spinous process is at the same level as the transverse process.
Fryette’s Laws
- These are principles, not hard and fast laws.
- Used to determine thoracic and lumbar spinal mechanics/patterns of dysfunction.
- Applicable to the cervical spine, but modified.
- They hold true generally for spinal somatic dysfunction.
Fryette Type I Spinal Mechanics
- Described as "group curve" or "neutral mechanics."
- Occurs when spine is in neutral, not favoring flexion or extension
- Inducing sidebending to one side will result in rotation to the opposite side.
- Type I Somatic Dysfunction: Group of vertebrae asymmetrical in neutral, sidebending, and rotation to opposite sides.
- The apex is the segment exhibiting the most rotation relative to anatomical position.
- The apex is often in the middle of the group curve.
Fryette Type II Spinal Mechanics
- Involves single segment mechanics, also known as "non-neutral mechanics."
- Occurs in hyperflexion or hyperextension.
- Inducing sidebending while in hyperflexion or hyperextension of a single vertebra results in rotation to the same side.
- Type II Somatic Dysfunction: A single vertebra exhibiting asymmetry in flexion or extension with sidebending and rotation to the same sides.
Fryette Law III
- C.R. Nelson, D.O. proposed it; it was not proposed by Harrison Fryette, D.O.
- Proposed in 1948.
- Initiating motion at any vertebral segment in any one plane of motion will modify that segments mobility in the other two planes of motion.
Cervical Spine Mechanics
- C0-C1 Joint (Occipitoatlantal): Sidebending and rotation always occur in opposite directions.
- C1-C2 Joint (Atlantoaxial): Only rotation occurs.
- C2-C7 Joints: Rotation and sidebending occur to the same side due to cervical anatomy, including uncovertebral joints (joints of Luschka).
Summary of Spinal Mechanics
- Type I Thoracic/Lumbar: Occurs in neutral, involves 3+ vertebrae, and rotation/sidebending are opposite.
- Type II Thoracic/Lumbar: Occurs in flexion/extension, involves one or two vertebrae, and rotation/sidebending are the same.
- C0-C1: Occurs in flexion/extension, involves the C0-C1 segment, and rotation/sidebending are opposite.
- C1-C2: Occurs in flexion, involves the C1-C2 segment, and rotation occurs only in this segment.
- C2-C7: Occurs in flexion/extension, involves a single or multiple segments, and rotation/sidebending are the same.
Definition of Somatic Dysfunction
- Impaired/altered function of somatic (body framework) system components: skeletal, arthrodial, and myofascial structures plus related vascular, lymphatic, and neural elements.
- Treatable with osteopathic manipulative treatment.
- Best described using 3 parameters:
- Position of body part determined by palpation.
- Directions in which motion is freer.
- Directions in which motion is restricted.
- See TART and STAR.
Somatic Dysfunction and Spinal Motion
- Indications of include tenderness, asymmetry, and restricted range of motion.
- Tissue texture abnormalities may also be present.
- Other signs are the relative position of vertebrae, freedom of motion, and restrictions of motion.
TART in Spinal Motion
- Palpation may reveal a more posterior transverse process on one side.
- This can aid in determining which paraspinal valley is shallower.
- Motion testing may reveal less vertebral movement when pressing on one transverse process compared to the other.
Palpation with Right Rotation
- The Transverse Process will feel more posterior.
- The Transverse Process will resist anterior pressure (inducing Left rotation).
- The Paraspinal Valley will feel more shallow.
Type II Dysfunction
- A right transverse process will feel more posterior, and the right paraspinal valley will feel shallower in a Type II dysfunction.
- The condition will not improve in neutral but will improve (feel more symmetrical) in flexion or extension.
- Coupled with preference for sidebending to the same side.
Type I Dysfunction
- Right transverse processes of the vertebrae will feel more posterior.
- Right paraspinal valleys will feel shallower.
- It will be most pronounced in neutral (TPs more posterior).
- Will be coupled with preference for LEFT sidebending.
Diagnosis of Vertebral Somatic Dysfunction
- Dysfunction is named for the direction of ease.
- An example is T1-12 N R(right) S(left)
- N references the Preference is Neutral.
- R(right) references the Rotational Preference- Rotated Right.
- S(left) references the Sidebending Preference, Sidebent Left.
Spinal Somatic Dysfunction Notation
- Short hand notation- Spinal Somatic dysfunction is named for the direction of ease of the dysfunctional segment POSITION IN SPACE
- L2 F RR SR = L2 FRSR
- T8 E R(left) SL = T8 E SL R(left)
- T3-5 N RR S(left) = T3-5 NRRSL
Facet Orientation
- Cervical: Facets oriented BUM (Backward, Upward, Medial).
- Thoracic: Facets oriented BUL (Backward, Upward, Lateral).
- Lumbar: Facets oriented BM (Backward, Medial).
Other Factors Guiding Spinal ROM
- Other items guide and impact spinal ROM - Intervertebral Discs and Articulations with other bony structures.
- These bony structures include the Skull, Ribs and Sacrum
- Ligaments, especially the Anterior Longitudinal Ligament contribute.
- Other factors are Associated musculature, Soft tissue, Inherent asymmetries (tropism) of facets) and Accumulated trauma, degeneration, wear/tear.
Somatic Dysfunction and Spinal Motion
- Primary somatic dysfunction is trauma or repetitive microtrauma.
- Secondary somatic dysfunction arises from pathological situations like local arthritis; larger deformities such has scoliosis; and viscerosomatic and somatosomatic reflexes.
- These things will affect the joints, ligaments and muscles restricting overall spinal motion and can cause TART.
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