Amy Vagedes, OMS V and Sarah Watson, OMS V

June 12, 2013

SCREEN, SCAN, SEGMENTAL DEFINITION

Goals

What is Professional Touch? Introduce the Osteopathic Exam

Screen Scan Segmental Definition

Osteopathic Exam

• Is there a problem?

Screen

• Where is the problem?

Scan• What is the

characteristics/ nature of that problem?Segmenta

l Definition

Osteopathic ExamSegmental Definition (Bullseye!)Scan

Screen

Osteopathic Exam

Screening 2 Tissue Textures

+ 2 Motion Tests Is at least 1 of

each positive? Tells you the

neighborhood – Ex: Thoracic Region

Scanning Local Deep

Pressure + Confirmatory Rotation OR Sidebending

Both if you need a Tiebreaker

Tells you the exact block – Ex: T7

Osteopathic Exam

Segmental Definition Tells you the specific details (the address)

of the dysfunction – Ex: T7 F RrSr ALWAYS written in ease, not resistance

Screen: IS there a problem?

• Gait• PostureLook

• Patient Liste

n• Superficial Muscle

Tone/Gross Regional Motion

Feel

Screen

Focusing on axial spine today cervical spine, thoracic spine, lumbar spine

Screening consists of: Palpation of Tissue

Texture abnormalities Gross Regional Motion

Restriction of motion

Screen: Palpation

RESISTANCE TO PRESSURE: Two tests in each of 8

regions (only doing axial spine today) Reproducibility &

Consistency

Bilateral Structures Compare Side-to-Side

Axial Spine Compares Above with Below

Ask the question, “Is there a difference in tissue resistance from here to here?”

Screen: Palpation

Cervical Upper Cervical Lower Cervical

Thoracic Upper Thoracic Lower Thoracic

Lumbar Upper Lumbar Lower Lumbar

http://www.backpain-guide.com/Chapter_Fig_folders/Ch05_Anatomy_Folder/Ch5_Images/05-4_Overall_Spine.jpg

Screen: Gross Regional Motion RESISTANCE TO INITIAL

MOTION INPUT: Two tests in each of 8

regions Reproducibility &

Consistency

Response of human tissue to a passive motion input (most of the time)

You are NOT using much force to generate motions

Screen: Gross Regional Motion

C-spine Cervical rotation Cervical sidebending

T-spine Thoracic rotation Thoracic sidebending

L-spine Lumbar lordosis**

Flattening or Not Lumbar rotation**

Rotates to the L or R

Screen: Gross Regional Motion Lumbar lordosis

Stand behind patient and palpate lumbar lordosis

Patient *actively* flexes (bends over)

Lordosis should flatten out

Lumbar rotation Stand behind patient and

palpate lumbar lordosis Patient *actively* flexes

(bends over) A notable prominence of left

or right paraspinal tissues is abnormal

These two tests can be combined in one motion for the patient.

Screen: Gross Regional Motion Thoracic rotation

Have patient fold arms While behind patient, place

hands over their shoulder – palms over the head of the humerus.

Apply a slight rotary force to the L and the R

Feel for that initial resistance to motion.

Thoracic sidebending Patient folds arms Stand behind patient and place

hand on top of the shoulder of the patient

Apply a slight downward force using your body weight as leverage

Screen: Gross Regional Motion Cervical rotation

Stand behind patient and place one hand over forehead and the other hand on the back of the head

Apply a slight rotary force to the left/right

Cervical sidebending Stand behind patient Place one hand on the top of

the head and the other at the base of the neck to stabilize the shoulders and trunk

Tell patient to let the head fall to the left/right

Practice

Break into partners

Scan: Where Is the Problem?

Thumb & index or middle finger contact paravertebral muscles that are superficial to transverse processes

Resistance (speed bump) or ease (pothole) comparing segment to segment above vs. below

This can be used in the following areas:

Cervical, Thoracic, Lumbar

Rib Cage (not doing this today)

Scan

• Mark the identified segment

• We will come back to this point to do motion testing

Scan: Confirmatory Motion Scans Passive motion test

Rotation, sidebending, flexion/extension Increased accuracy (reliable and

reproducible) Active motion is too variable

Immediate response, not the end feel!

Listening and Motor Hands

Scan: The Hands

Listening Contacts dysfunctional segment and

“senses” response to motion: restriction No motion input

Motor Consistent introduction of motion Rotation, Sidebending, Flexion/Extension,

(pick two of these motions)

Scan: Rotatory Scan

Physician: Standing behind & to

the Side of the patient Patient Seated:

Arms Crossed Contact the location

being scanned with the finger and thumb of the listening hand

Feeling for immediate ease or resistance upon initiation of the motion

The ‘motor hand’ contacts the patient’s. elbow

Introduces ipsilateral rotation (rotation to the same side)

Lumbars shown here.

Scan: Cervical Sidebending Scan Physician:

Standing behind & to the Side of the patient

Patient Seated: Arms Crossed

Contact the location being scanned with the finger and thumb of the listening hand

Feeling for immediate ease or resistance upon initiation of the motion

The ‘motor hand’ contacts the patient’s. head in the same way cervical sidebending screening was performed

Introduces ipsilateral sidebending

Scan

What if the two scans do not agree?

Use a 3rd Scan to Break the Tie.

Practice

Break into Partners

Segmental Definition: What is the Problem?

We have now identified where the problem is.

Next, we have to identify what the nature of the problem A.k.A. How do we describe the

dysfunctional segment in relation to specific motions?

Ex: T7 F RrSr (written in ease, not resistance)

Resistance may be easier to feel, but all diagnoses in OMM are written in ease

Segmental Definition

Rotatory Flexion/extension Sidebending (right/left) Rotation (right/left)

Translation Cephalad/caudad Right/left Anterior/posterior

Respiration Today, we will focus on the rotatory

motions

Segmental Definition

Active motion: Motion which is

accomplished by the patient

Passive motion: Motion which is

generated by the physician

We will be using passive motion today

Segmental Definition: Rotation of Thoracic Spine

Physician: Standing behind & to

the Side of the patient Patient Seated:

Arms Crossed Contact the identified

segment with the finger and thumb of the listening hand

Feeling for immediate ease or resistance upon initiation of the motion

The ‘motor hand’ contacts the patient’s. elbow

Introduces ipsilateral rotation (rotation to the same side)

No need to compare above and below since we have already identified the dysfunctional segment

Segmental Definition: Flex/Ext of the Thoracic

Spine Physician:

Stands to the side of the patient

Patient Seated: Arms Crossed

Contact the identified vertebra with the finger and thumb of the listening hand

Feeling for immediate ease or resistance upon initiation of the motion

The ‘motor hand’ contacts the patient’s ribcage opposite the side the physician is standing

Introduces flexion by slumping patient’s shoulders forward or extension by arching the patient’s back

Segmental Definition: Sidebending of the Thoracic

Spine Physician:

Standing behind & to the Side of the patient

Patient Seated: Arms Crossed

Contact the identified vertebra with the finger and thumb of the listening hand

Feeling for immediate ease or resistance upon initiation of the motion

The ‘motor hand’ contacts the patient’s shoulder

Introduces ipsilateral sidebending

Segmental Definition

Lumbar spine can be segmentally defined in the seated position as well as prone

Cervical spine can be segmentally defined in the seated or supine position using the head to input the motion There is less gravitational pull to contend

with when the patient is in the supine position

Putting it all together

Screen, Scan and Segmental Definition: Demo

Review of Osteopathic ExamScreenScanSegmental Definition

Questions??

Summary

References

Johnston WL, Friedman HD, Eland DC. Functional Methods: A Manual for Palpatory Development in Osteopathic Examination and Manipulation of Motor Function. 2nd ed. 2005; Indianapolis, IN. American Academy of Osteopathy: 17-79.

Foundations of Osteopathic Medicine, 3rd Ed.