Somatic dysfunction evaluation

Palpation plays a major roll in the diagnosis of somatic dysfunction. The physician uses the hands to diagnose somatic dysfunction as well as other pathologies of the musculoskeletal system. Observation, motion testing, strength testing, and a variety of special tests are incorporated into the diagnostic evaluation of the patient... 

The physician palpates superficially at first and then more deeply into the tissues. The texture of the tissues is evaluated including bogginess, ropiness, or a change in tone of the muscles. Although the tissues posteriorly are being evaluated for an indication of the presence of somatic dysfunction, the anterior neck tissues should be evaluated as well. The scalene muscles and the sternocleidomastoid muscles can give important clues regarding cervical pain or motion restriction. 

In the evaluation of the cervical spine for somatic dysfunction, the intersegmental motion between vertebrae is extremely important. There are several ways the cervical spine may be tested for individual vertebral motion. For all these methods, the patient will be supine with the physician seated at the head of the table. 

Other types of headaches, including migraines, often have elements of muscle tension and somatic dysfunction. Somatic dysfunction of the upper cervical spine causes pain behind the eyes. Migraine headaches are frequently associated with abnormal motions or restrictions of the temporal bones. Any patient with headache should be evaluated for somatic dysfunctions of the cranium and cervical spine with treatment of any found. 

Other symptoms such as headache, nausea, dizziness, or paresthesias may be present. Because the entire body is involved with the forces that cause the hyperflexion and hyperextension, it is important, to evaluate the entire spine. The sacrum is frequently involved in somatic dysfunction. If the sacral dysfunction is not treated, it tends to maintain disability in cases that fail to respond to treatment. Dysfunctions of the cranium are commonly present after an accelera-tion/deceleration injury. The occiput and sacrum tend to exhibit the same restrictions to motion. The temporal bones are especially vulnerable to the forces transmitted through the sternocleidomastoid muscles. 

Rotoscoliosis testing and intersegmental motion testing are two diagnostic modalities for evaluating somatic dysfunction at a vertebral level. They can be used alone or in conjunction with each other, according to physician preference. 

The patient was seen again in 3 days and reported partial relief of symptoms. Re-evaluation found that the muscle hypertonicity had partially returned in all areas. The lumbar lateral shift had lessened, and the restriction of the left sacroiliac articulation and the extension somatic dysfunction at 1-5—SI had returned. Osteopathic manipulative treatment was repeated, as needed. The bed rest and NSAlDs were continued for an additional week. Mild exercises were prescribed. 

An initial diagnosis of somatic dysfunction may often be made by evaluating the patient s gait The most obvious problems are those relating to low back dysfunction. 

Palpation and visual observation are used during osteopathic examination. Knowledge of the structure and biomechanics of the area under evaluation is integral to this process. Somatic dysfunctions restrict motion of the thoracic cage and its components. The bucket handle and pump handle movements may be limited when examined at the greatest extent of inspiration and expiration. Asymmetric excursion and difficulty in movement imply restriction of the region examined. 

Palpation of the costochondral junction elicits tenderness. There seldom is swelling. It must be differentiated from Tietze syndrome, which is similar in symptomatology. However, Tietze syndrome is generally more localized and swelling is usually present. Costochondritis must also be differentiated from somatic dysfunction, another cause of anterior chest wall pain. Evaluation of rib motion will usually allow a diagnosis however, motion may be restricted in the presence of costochondritis as well. 

Somatic dysfunction of the thorax may occur anteriorly, involving ribs, sternum, or clavicle, or posteriorly, involving costovertebral articulations or the scapulae. Muscle attachments connect the thoracic cage to the cervical spine, the thoracic spine, the lumbar spine, the innominate bones, and the upper extremities. These regions must be evaluated when problems occur in the thoracic cage. 

The lirst rib is probably the rib most commonly involved in somatic dysfunction of all the ribs. It is affected by trauma, stress, and posture as well as by dysfunction ofthe C7-T1 complex. The patient may report "shoulder" pain, stiff neck, upper back or neck pain, and an inability to turn the head while driving. The first rib can impinge the neurovascular bundle as it passes between it and the clavicle through the costoclavicular space. The anterior and middle scalene muscles, which raise the first rib, may likewise compress the brachial plexus when they are in spasm and result in thoracic outlet syndrome symptoms. The patient s symptoms are then described as pain, numbness, or paresthesias ofthe arm or hand on the involved side. The physician needs to be aware that this may cause confusion should the patient demonstrate a herniated cervical disc on magnetic resonance imaging [MRO. The symptoms may be caused by the rib dysfunction rather than the herniated disc, so evaluation ofthe rib for normal motion and treatment of any dysfunction should be performed in these cases. Osteopathic manipulation may save the patient unnecessary surgery. 

The glenohumeral joint can be evaluated during us range of motion testing. Somatic dysfunction is diagnosed if there is no pathology of the joint Arthritis, tendonitis, or other pathology may be treated with appropriate osteopathic manipulation, but most responsive will be true somatic dysfunctions. 

It is important to evaluate the radial head as a somatic dysfunction of the radial head frequently mimics tennis elbow and responds well to osteopathic manipulative treatment. 

There are a number of causes for the creation of psoas dysfunction. Among these are trauma to the lumbar spine, lesser trochanter or pubes, myosistis or psoatic bursitis, or visceral dysfunction in relationship to the psoas muscle, such as an acute appendicitis, renal or urethral dysfunctions, fallopian tube inflammation, and iliac or femoral arteiy phlebitis. Any musculoskeletal condition that causes a low back imbalance and lumbar and pelvic somatic dysfunctions must be evaluated. It is important lhat any and all of the findings be actively treated. 

The bursitis has as its cause trauma to the area, acute or chronic, as well as any dysfunction affecting the ischium or the structurai integrity of the knee joint. The patient reports pain at the medial aspect of the knee, but careful palpation will elicit point tenderness below the knee joint that is very specific and localized in its nature. The pain will be made worse with contraction of the semitendinous, sartorius, and gracilis muscles. An evaluation for somatic dysfunctions of the pelvis, sacrum, and lumbar region, as well as the postural balance of the lower extremity, must be performed. Treatment can be a local injection of a steroid, a prescription for a NS AID, ice, exercises, and osteopathic manipulative treatment (OMT) of all somatic dysfunctions, including knee, hip. and pelvic region. 

A marked dorsi-flexion dysfunction of the ankle joint will create a close-packed joint and create a posterior fibula somatic dysfunction. This posterior fibula somatic dysfunction is easily diagnosed and treated. If the condition chronically reoccurs, the physician must evaluate the postural integrity of the foot Calcaneal valgus is a common cause for chronic sprain of the ankle. 

The musculoskeletal system is intimately involved in tension and migraine headaches. The muscle involvement in tension headache is obvious and includes the muscles of the head and face, the cervical spine, and the upper thorax. Somatic dysfunction of the occipito-atlantal joint, the atlanto-axial joint, and C2 on C3 are frequent sources of headache. The levator scapula, with its attachments to the scapula and the cervical spine, and the trapezius must be considered. Facial muscles may be the major source of head pain. The patient must be evaluated for bruxism, teeth grinding, or jaw clenching, which affects the temporalis and masseter muscles. Bruxism may lead to dysfunction of temporal bone motion or to problems with the temporomandibular joint. 

A complete physical must be performed and any possible organic causes ruled out. Muscle spasms, scoliosis, leg length discrepancies, arches of the feet, craniosacral motion, and somatic dysfunctions must be evaluated. Asymmetries of any postural mechanisms can be reflected at the TMJ. 

Sympathetic innervation to the sinuses arises in the upper thoracic area and passes through the cervical ganglia. The upper thoracic and cervical areas should be evaluated for the presence of somatic dysfunction, and any dysfunction found should be treated. Probably the most con-... 

Somatic dysfunctions are commonly found at the twelfth thoracic, and first two lumbar segments. Chapman s points for the kidney, as well as the cranio-sacral mechanism, must be evaluated. Any dysfunctions found should receive osteopathic manipulative treatment at the time of the acute incident, with a follow-up evaluation and treatment as necessary when the symptom complex has subsided. 

The primary focus of the initial treatment was to perform a full evaluation for primary and secondary sites of somatic dysfunction. Although the primary concern of the patient was the cervical region, it was important to correct any structural problems affecting the other parts of the body. Soft tissue and muscle energy techniques were complemented with moderate velocity-low amplitude (MVLA) techniques except for the cervical spine, where myofascial release techniques were the primary modality used. Trapezius inhibition techniques were performed with a compression myofascial technique to the right trapezius. 

The method of detecting iodine supply levels and the evaluation of the effect of the lack or oversupply (Boyages, 1993) of iodine on the condition of the thyroid gland (its size, function and the impact on the autoimmunity process) and the resulting evaluation of the overall condition of health of an entire population (from the occurrence of endemic cretinism due to significant lack of iodine to mild occurrence of brain dysfunction due to lack of iodine during intrauterine development) problems in the development of the somatic. 

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