Today’s OMM question involves a 45-year-old man with chronic head and neck pain, attributed to a previous whiplash injury and well-controlled hypertension, seeks medical attention. Physical and osteopathic examinations reveal specific somatic dysfunction at the occipitoatlantal joint. To address this, the patient is instructed to move his head in a particular way using muscle energy techniques. But how exactly should he move his head to alleviate this discomfort and improve his condition?
A 45-year-old man presents to the office with several months of intermittent pain in his head and upper neck. He characterizes it as a dull ache of moderate severity. He sustained a whiplash injury one year ago during a flag football game but did not suffer a concussion. CT without contrast of his head and cervical spine one year ago was normal. He has hypertension which is well-controlled with lisinopril 5 mg daily. His vital signs are within normal limits. Physical exam shows moderate tenderness to palpation along his suboccipital region. Osteopathic structural exam shows a deep right sulcus which evens out completely with the left sulcus while placing him in extension at the occipitoatlantal joint. How would you instruct the patient to move his head during treatment of his occipitoatlantal somatic dysfunction with muscle energy?
A. Ask the patient to extend, sidebend left and rotate right
B. Ask the patient to flex, sidebend right and rotate left
C. Ask the patient to extend, sidebend right and rotate left
D. Ask the patient to flex, sidebend left and rotate right
E. Ask the patient to extend, sidebend left and rotate left
Scroll down for the correct answer!
The correct answer to today’s OMM® Question is…
A. Ask the patient to extend, sidebend left and rotate right
Before we get to the Main Explanation, let’s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!
Incorrect answer explanations
B. Ask the patient to flex, sidebend right and rotate left
Incorrect: This is the patient’s barrier and is the direction you would move him during muscle energy. He should move opposite this direction in order to return toward neutral.
C. Ask the patient to extend, sidebend right and rotate left
Incorrect: While he should be extending to return toward neutral, he should also be sidebending left and rotating right rather than sidebending right and rotating left.
D. Ask the patient to flex, sidebend left and rotate right
Incorrect: While he should be sidebending left and rotating right to return toward neutral, he should be extending rather than flexing.
E. Ask the patient to extend, sidebend left and rotate left
Incorrect: While he should be extending and sidebending left to return toward neutral, he should als be rotating right. Remember that sidebending and rotation are usually opposite at the OA joint.
Main Explanation
Rotation and sidebending always go in opposite directions at the OA joint, so you can diagnose both of these motions by only testing one of them. Use the depth of the sulci to determine the rotation (the deeper sulcus is the side of rotation), and the translation of the joint to determine sidebending (e.g. easier leftward translation means sidebent right). Flexion/extension (or neutral) is determined by which motion causes the sulci to even out.
For muscle energy, place the patient in the exact opposite direction of their somatic dysfunction and gently engage their barrier for 3-5 seconds while the patient resists by gently trying to move that body part back to neutral. After 3-5 seconds, ask the patient to stop and rest for 2 seconds while you slowly engage a new barrier. Remember to place the patient exactly opposite of their somatic dysfunction as they move toward neutral by moving in the direction of their somatic dysfunction (their motion of ease). This patient is extended, sidebent left and rotated right, so you should position him in flexion, right sidebending and left rotation, and ask him to return to neutral (via extension, left sidebending and right rotation).
Major Takeaway
Once you have established the rotation (side of deep sulcus), sidebending (opposite of easier translation) and flexion/extension (motion which evens out the sulci), you can treat somatic dysfunction easily with muscle energy. Place the patient in the exact opposite direction of their somatic dysfunction and ask them to return to neutral during the 3-5 seconds of treatment by moving their head toward the direction of their somatic dysfunction.
________________________
Want more OMM Questions as well as practice questions for USMLE® Step 1 and Step 2 CK? Try Osmosis today! Access your free trial and find out why millions of current and future clinicians and caregivers love learning with us.
Leave a Reply