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CHAPTER 1-PRINCIPLES
Facet Orientation
Cervical-Backward, Upward, Medial
Thoracic-Backward, Upward, Lateral
Lumbar-Backward, Upward, Medial
Spinal Mechanics
Table 1: Planes and Axes
Motion
Plane
Axis
Rotation
Horizontal
Vertical
Side-bending
Coronal
AP
Sagittal
Sagittal
Horizontal
Table 2: Rotation
Left Transverse
Process
Type I (Neutral)
SXRY or SYRX
Type II (Non-Neutral)
RXSX or RYSY
Right Transverse
Process
Left
Posterior
Anterior
Acute Findings
Right
Anterior
Posterior
Vasodilatation,
Edema,
Tenderness,
Pain,
Contraction,
Skin Warm/Moist,
Muscle Spasm,
Minimal Somatovisceral changes
Table 3: Side-bending
Side of SB
Concave Side
Convex Side
Left
Left
Right
Right
Right
Left
Direction
Somatic Dysfunction
Side of
Rotation
Chronic Findings
Vasoconstriction,
Itching & Fibrosis,
Tenderness,
Paresthesias,
Contracture,
Skin Cool/Pale,
Muscle Flaccid,
Frequent Somatovisceral Changes
Copyright 2002 Steven L. Simmons, DO. All Rights Reserved. Internet Download Copy.
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Osteopathic Manipulative Medicine Review for the Boards- The Cram Pages
CHAPTER 2-NEUROLOGIC
Autonomic Nervous System
Table 6: Sympathetic Innervation
Level
Splanchnic Nerve
T1-4
Collateral Ganglia
Cervicothoracic, middle &
superior cervical ganglia
T1-T6
Organs/Structures Innervated
Head and Neck
Heart and Lungs
T5-T9
Celiac ganglion
T10-T11
Superior mesenteric
ganglion
T10-T12
Kidney
T12
T12-L2
T2-T8
Arms
T11-L2
Legs
Nucleus
Ganglion
Organs Innervates
CN3 (Oculomotor n)
Edinger-Westphal
(accessory oculomotor)
Ciliary
Pupil
CN7 (Facial n)
Superior salivatory
Pterygopalatine...........>
OR
Submandibular...........>
CN9
(Glossopharyngeal n)
Inferior salivatory
Otic
Parotid gland
CN10 (Vagus)
Dorsal vagal
S2-S4 (Pelvic
splanchnic nn)
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Nerve Roots
Table 8: Upper Extremity and Brachial Plexus Nerve Roots
Level of Exit
(Disc)
Nerve Root
Sensory
Reflex
Motor
C5 Root
Lateral arm
Biceps
C6 Root
Lateral forearm,
thumb, index finger
Brachioradialis
C7 Root
Middle finger
Triceps
C8 Root
Medial forearm,
ring & little finger
None
Finger flexion
T1 Root
Medial arm
None
Finger abduction/adduction
Nerve
Function
Long Thoracic
C5-C7
Axillary
C5-C6
Deltoid atrophy
Musculocutaneous
C5-C7
Median
(C5) C6-T1
Radial
C5-C8 (T1)
Ulnar
(C7) C8-T1
Level of Exit
(Disc)
Sensory
Reflex
Motor
L4 Root
Patellar
Foot inversion
L5 Root
None
S1 Root
Achilles
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Origin
Function
Obturator
L2-L4
Femoral
L2-L4
Lateral Femoral
Cutaneous
L2-L3
Meralgia paresthetica
S1-S3
Sciatic
L4-S3
Tibial
L4-S3
Common fibular
L4-S2
Foot drop
Initial
Lift
Increase Every 2
Weeks
Not
treated
N/A
Fragile Patient
(Elderly, Arthritis, Osteoporosis)
1/16 Lift
No More Than
1/16
Flexible Patient
1/8 Lift
No More Than
1/16
Injured Patient
(Where Leg
Length Was Suddenly Shortened)
Full
Amount
N/A
CHAPTER 5-CRANIAL
Flexion:
Extension:
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Occiput
Temporals
Flexion
External Rotation
Bilaterally
Extension
Superior, Posterior,
and Medial Bilaterally
Internal Rotation
Bilaterally
Left
Torsion
Superior on Left,
Inferior on Right
Inferior on Left,
Superior on Right
Right
Torsion
Superior on Right,
Inferior on Left
Inferior on Right,
Superior on Left
Left Sidebending
Rotation
Inferior on Left,
Superior on Right
Inferior on Left,
Superior on Right
Right Sidebending
Rotation
Inferior on Right,
Superior on Left
Inferior on Right,
Superior on Left
Somatic
Restricted
Dysfunction Motion
Translation Terminology
Transverse
Process
Closer to the
Mandible
Transverse
Process
Closer to the
Mastoid
If the Right
Side is Most
Dominant in
Restriction &
Tissue Changes
(F)SLRR
(E)SRRL
Translates Right OR
Restricted in Left Translation During Extension
Right
Left
Anterior
Occiput Left
Posterior
Occiput Right
(E)SLRR
(F)SRRL
Translates Right OR
Restricted in Left Translation During Flexion
Right
Left
Anterior
Occiput Left
Posterior
Occiput Right
(F)SRRL
(E)SLRR
Translates Left OR
Restricted in Right Translation During Extension
Left
Right
Posterior
Occiput Left
Anterior
Occiput Right
(E)SRRL
(F)SLRR
Translates Left OR
Restricted in Right Translation During Flexion
Left
Right
Posterior
Occiput Left
Anterior
Occiput Right
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Osteopathic Manipulative Medicine Review for the Boards- The Cram Pages
Table 15: Motion and Positional Findings For Typical Cervical Tri-axial Somatic Dysfunctions
Somatic
Dysfunction
Restricted
Motion
(E)RRSR or
ERSR
(F)SLRL
(E)RLSL or
ERSL
(F)SRRR
(F)SRRR or
FSRR
(E)RLSL
(F)SLRL or
FSRL
(E)RRSR
Translation
Terminology
May Also
Be Written
as...
Posterior
Articular
Process
Side of Most
Paraspinal mm.
Tightness
Translates Left OR
Restricted in Right Translation During Flexion
Translates
From Right
to Left
Most Prominent
During Flexion
Translates Right OR
Restricted in Left Translation During Flexion
Translates
From Left to
Right
Most Prominent
During Flexion
Translates Left OR
Restricted in Right Translation During Extension
Translates
From Right
to Left
Right
Right
Most Prominent
During Extension
Most Prominent
During Extension
Translates Right OR
Restricted in Left Translation During Extension
Translates
From Left to
Right
Most Prominent
During Extension
Right
Most Prominent
During Flexion
Left
Left
Most Prominent
During Flexion
Left
Left
Most Prominent
During Extension
Right
Restricted
Motions
Most Likely
Mechanism
Radial Head
Anterior
Posterior and
Pronation
Fall Backward on
the Outstretched
Hand
Radial Head
Posterior
Anterior and
Supination
Fall Forward on
the Outstretched
Hand
Carrying
Angle
Increased
Decreased
Wrist
Increased
Adduction
Increased
Abduction
Test
Purpose
Olecranon
Process
Adsons Test
Increased
Medial
Glide
Allens Test
Apleys
Scratch Test
Apprehension
(Crank) Test
Increased
Lateral
Glide
Copyright 2002 Steven L. Simmons, DO. All Rights Reserved. Internet Download Copy. WWW.DRSIMMONS.NET
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Purpose
Empty Can
Test
Finkelsteins
Test
DeQuervains Tenosynovitis
(Abductor Pollicis Longus &
Extensor Pollicis Brevis Tendons)
Phalens Test
Posterior
Apprehension
Test
Speeds Test
Bicipital Tendinitis
Sulcus Sign
Tinels Sign
Yergasons
Test
Bicipital Tendinitis
Transverse
Process Location
in Relation to the
Spinous Process
T1-T3
The Same
Horizontal Plane
T4-T6
T7-T9
About 1 Inch Up
and Lateral
T10-T12
The Same
Horizontal Plane
Vertebrae
Easy Normal
(EN)
(N)SLRR
Right
EN Right or ENR
(N)SRRL
Left
EN Left or ENL
Dysfunction
Copyright 2002 Steven L. Simmons, DO. All Rights Reserved. Internet Download Copy. WWW.DRSIMMONS.NET
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Transverse
Process
Position in
Extension
Dysfunction
Transverse
Process
Position in
Flexion
FRS Left
Posterior Left
Symmetrical
FRS Right
Posterior Right
Symmetrical
ERS Left
Symmetrical
Posterior Left
ERS Right
Symmetrical
Posterior Right
CHAPTER 9-RIBS
Rib 12 Directly
Intercostales
Forced Exhalation
Muscle
Acts Upon
Scalenes
Ribs 1-2
Pectoralis Minor
Ribs 3,4,5,(6)
Serratus Anterior
Ribs 6,7,8,9,10
Latissimus Dorsi
Ribs 9,10,11,12
Quadratus Lumborum
Rib 12 Indirectly
Intercostales
Forced Inhalation
Findings
Anterior Rotation
Posterior Rotation
Superior Shear
Inferior Shear
Innominate Inflare
Innominate
Outflare
Acts Upon
Quadratus Lumborum
Dysfunction
Findings
Superior Shear
Inferior Shear
Pubic Adduction
Pubic Abduction
Copyright 2002 Steven L. Simmons, DO. All Rights Reserved. Internet Download Copy. WWW.DRSIMMONS.NET
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Seated Flexion
Test
Spring
Test
Sphinx Test
Sacral Base
Findings
ILA Findings
L on LOA
Positive right
Negative
More
symmetrical
Right anterior
R on ROA
Positive left
Negative
More
symmetrical
Left anterior
Right posterior
& inferior
R on LOA
Positive right
Positive
Less
symmetrical
Right posterior
L on ROA
Positive left
Positive
Less
symmetrical
Left posterior
Sacral Base
Anterior
Positive bilaterally
(may appear negative)
Negative
N/A
Anterior
bilaterally
Sacral Base
Posterior
Positive bilaterally
(may appear negative)
Positive
N/A
Posterior
bilaterally
Left posterior
Right Sacral
Margin Posterior
Right posterior
Right posterior
& even
Left Unilateral
Sacral Flexion
Positive left
Negative
More
symmetrical
Left anterior
Right Unilateral
Sacral Flexion
Positive right
Negative
More
symmetrical
Right anterior
Right posterior
& markedly
inferior
Left Unilateral
Sacral Extension
Positive left
Positive
Less
symmetrical
Left posterior
Right Unilateral
Sacral Extension
Positive right
Positive
Less
symmetrical
Right posterior
Copyright 2002 Steven L. Simmons, DO. All Rights Reserved. Internet Download Copy. WWW.DRSIMMONS.NET
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Osteopathic Manipulative Medicine Review for the Boards- The Cram Pages
Barlows Test
Hip Stability
Erichsens Test
Sacroiliac Pathology
Homans Sign
Deep Vein
Thrombophlebitis
Lachmans Test
Anterior Cruciate
Ligament
Ludloffs Sign
Traumatic Separation of
the Lesser Trochanter of
the Femur
McMurrays Test
Meniscal Tears
Obers Test
Iliotibial Band/Fascia
Lata Dysfunction
Ortolanis Test
Patricks (FABER or
FABERE) Test
Posterior Cruciate
Ligament
Thomas Test
Contraction of the
Iliopsoas Muscle
Thompsons Test
Ruptured Achilles
Tendon
Trendelenburg Test
Purpose
Purpose
Babinskis
10
Anterior Cruciate
Ligament
Medial (Tibial)
Collateral Ligament
Lateral (Fibular)
Collateral Ligament
Apleys Compression
Test
Knee Ligamentous
Injury
Copyright 2002 Steven L. Simmons, DO. All Rights Reserved. Internet Download Copy. WWW.DRSIMMONS.NET