_____ manipulation should occur as an adjunct to the _____ adjustment
What is essential for proper management of an extremity injury & appreciating its affect on the spine?
Understanding of the kinetics of the upper and lower extremity
What are 2 general rules of extremity adjusting?
1.) Get a history of the area & do a visual & palpatory inspection of the area
2.) Analyze for misalignment/subluxation with pre- and post- criteria
What 5 questions should be answered when getting a history & doing a visual & palpatory inspection of the extremity?
1.) Is this a chronic or acute condition?
2.) What tissues are injured?
3.) How severe are the injuries?
4.) Is motion restricted of hypermobile/unstable?
5.) Is this a pre- of post-surgical joint?
What is found at the end of passive ROM?
What is joint play?
The extra "give or spring" that is felt within the joint
What limits joint play?
The integrity of the stabilizing ligaments
What will lack of joint play cause within the joint?
Dysfunction and may cause pain
Joint play is a _____ movement and requires _____ to become adept at determining its presence or absence.
What are 5 methods discussed in class for upper extremity evaluation?
2.) Relative Muscle Testing
3.) MOI - Mechanism of Injury
What is motion palpation?
When the joint is tested for proper motion & joint play
What should be done if there is an absence of proper motion or joint play?
A thrust or impulse is applied to restore proper motion
Extremity muscle testing is based on which theory?
What is the mechanoreceptor theory?
A muscle functioning across a misaligned joint will be inhibited by a reflex signal originating from mechanoreceptors surrounding that joint
What are 3 ways to accomplish the extremity adustment?
1.) Hands only
3.) Mechanically Assisted (drop)
What must be included in the concept of extraspinal management within the chiropractic paradigm?
Integration of the extraspinal area to the spine
What must be considered first when integrating the extremity management to the spine?
The neurological connection
i.e. nerve root levels of innervation
What is considered after the neurological connection when integrating the extremity management to the the spine?
Musculature which crosses the area
Musculature which crosses the injured area must be differetiated into what 2 groups?
1.) Prime movers
What were the last 2 states to put extremity adjusting in the chiropractic scope of practice?
1.) New Jersey
What is the criteria for acute trauma to an extremity?
1.) Check for patient safety
2.) Check for joint stability
3.) Check for subluxation
What does the body innately do for an injury?
Will compensation always have an outward expression?
The more subtle the problem the longer the compensation is present prior to outward expression
The _____ traumatic the injury, the _____ the body will be forced to compensate & the _____ the patient is compensation expressiev
More, Quicker, Quicker
What are 3 reasons for the body to compensate?
1.) Abnormal stress on a normal structure
2.) Normal stress on an abnoral structure
3.) Normal stress on a normal structure that is not at the time prepared to receive the stress
What is one example from class of abnormal stress on a normal structure
Sitting for extended periods of time
What are 3 examples from class of normal stress on an abnormal structure?
1.) Falling arch
3.) Carpal Tunnel
What are 2 examples from class of normal stress on a normal structure that is not, at that time prepared to recieve the stress
(Pre-) Disc Herniation
What are the characteristics of a Grade 1: Ligament Sprain?
No residual laxity
What are the characteristics of a Grade 2: Ligament Sprain?
What are the characteristics of a Grade 3: Ligament Sprain?
Complete rupture of the structure
What is the characteristic of a Grade 1: Muscle/tendon Strain?
No residual weakness
What is the characteristic of a Grade 2: Muscle/tendon Strain?
Partial muscle tear
What is the characteristic of a Grade 3: Muscle/tendon Strain?
What are the most common injuries seen in the office?
Grade 1 or mild Grade 2
Grade 3 injuries will heal without reconstruction
Grade 3 injuries will almost never return to normal _____ and/or _____.
Stability and/or Function
What do serious grade 2 and grade 3 injuries leagally require?
What 2 steps need to be taken is the patient refuses the medical referral?
2.) Have the patient Sign It
What are the 3 factors to be considered in the mechanism of injury?
1.) Joint Position
2.) Forces Involved
3.) Time of Episode
According to the notes, The MOI will often lead to the what 2 things being better?
1.) Understanding of the tissues injured
2.) Potential concerns
What is the only case in which the spine is not considered first?
What is the closed pack position?
The end of travel in a joint where:
- The surfaces are at maximum congruency
- The ligaments are taut
Injuries in the closed pack position causing further movement in that direct of travel will result in what type of injury?
Dislocation and/or Fracture
What is the open packed position?
The position of travel of a joint away from the closed pack position where the capsule and ligaments are not taut
Injuries in the open packed position causing extreme movement in that direct of travel will result in what type of injury?
What is the cause of degenerative changes?
Loss of normal joint mechanics
Degenerative changes lead to what 2 responses?
2.) Fibrotic Response
What is the result of the healing processes involved in degenerative changes?
Altered joint mechanics
Trauma will lead to the occurance of what 5 steps?
2.) Passive Congestion
3.) Consolidation of protein exudate
4.) Reorganization via fibrotic activity/Secretion of collagen
5.) Healing by 1st or 2nd intent
What tissue is involved in healing by 1st intent?
What tissue is involved in healing by 2nd intent?
What are the 10 steps of fibrosis which ultimately result in chronic pain and disability?
3.) Weaker repair
4.) Less elastic
7.) Altered functional capacity
8.) Further fibrosis
10.) Chronic pain and disability
How long is the initial healing time?
How long is the regeneration healing time?
How long is the remodeling healing time?
6 months - 2+ years
What are the 4 questions that need to be answered when planning rehabilitation?
1.) What was the pre-injury status of the patient?
2.) What are the specific goals of the patient and doctor?
3.) What rehabilitation equipment or facilities are available?
4.) What is the likelihood of patient compliance?
Joint play is what type of motion in a joint?
How is joint play detected?
Passive stress to the joint
What is joint play essential for?
Proper joint function
What are the 3 functions of hydrodynamics?
1.) Proper lubrication
2.) Transport of nutrients
3.) Removal of waste material from the articular surfaces
Proper hydrodynamics occur during what 3 activities?
1.) Weight bearing
2.) Intermittent muscle activity
3.) Full ROM of joint and capsule
When can radiographic studies be conducted?
Anytime the doctor chooses
What are 5 reasons from the medical model to conduct x-rays?
4.) Muscle strength loss