Diagnosing cranial somatic dysfunction
Notes
Osteopathic Cranial Manipulative Medicine
Diagnosing cranial somatic dysfunction
DIAGNOSIS OF CRANIAL SOMATIC DYSFUNCTION BEGINS WITH THE VAULT HOLD
With the patient supine, you place your hands on the lateral aspects of the cranium, using the following landmarks:
- First fingers meet in the center of the frontal bone
- Second fingers over the greater wing of the sphenoid bone
- Third fingers over the zygomatic process
- Fourth fingers on the mastoid process
- Fifth fingers along the squamous portion of the occiput
Figure 1. A depiction of the vault hold with landmarks highlighted in red.
TYPES OF CRANIAL SOMATIC DYSFUNCTION
DYSFUNCTION: FLEXION | ||
| SPHENOID & OCCIPUT | Rotate in opposite directions around two transverse axes | |
| DIAGNOSIS | Body spends more time in flexion phase of motion | |
| EXAMPLE IN VAULT HOLD | Fingers spread apart and move inferiorly | |
| CAUSES | N/A | |
Figure 2. Flexion: the sphenoid and occiput rotate in opposite directions around two transverse axes.
DYSFUNCTION: EXTENSION | ||
| SPHENOID & OCCIPUT | Rotate in opposite directions around two transverse axes | |
| DIAGNOSIS | Body spends more time in extension phase of motion | |
| EXAMPLE IN VAULT HOLD | Fingers shift closer together and move superiorly | |
| CAUSES | N/A | |
Figure 3. Extension: the sphenoid and occiput rotate in opposite directions around two transverse axes.
DYSFUNCTION: TORSION | ||
| SPHENOID & OCCIPUT | Rotate in opposite directions around one anterior-posterior (AP) axis | |
| DIAGNOSIS | Named according to side with more superior greater wing of sphenoid (left or right) | |
| EXAMPLE IN VAULT HOLD | Left 2nd finger moves cephalad and left 5th finger moves caudad (left torsion) | |
| CAUSES |
| |
Figure 4. Torsion: the sphenoid and occiput rotate in opposite directions around one anterior-posterior (AP) axis.
DYSFUNCTION: VERTICAL STRAIN | ||
| SPHENOID & OCCIPUT | Rotate in sam direction around two transverse axes | |
| DIAGNOSIS | Named according to direction in which sphenoid base moves (superior or inferior) | |
| EXAMPLE IN VAULT HOLD | Bilateral 2nd fingers move caudad and bilateral 5th fingers move cephalad (superior strain) | |
| CAUSES |
| |
Figure 5. Vertical strain: the sphenoid and occiput rotate in the same direction around two transverse axes.
DYSFUNCTION: LATERAL STRAIN | ||
| SPHENOID & OCCIPUT | Rotate in same direction around two vertical axes | |
| DIAGNOSIS | Named according to direction in which sphenoid base moves (left or right) | |
| EXAMPLE IN VAULT HOLD | Bilateral 2nd fingers move to right and bilateral 5th fingers move to left (left lateral strain) | |
| CAUSES |
| |
Figure 6. Lateral strain: the sphenoid and occiput rotate in the same direction around two vertical axes.
DYSFUNCTION: SIDE BENDING-ROTATION | ||
| SPHENOID & OCCIPUT | Rotate in opposite directions around two vertical axes (side bending) and same direction around one AP axis (rotation) | |
| DIAGNOSIS | Named according to side of convexity (side that moves inferiorly) | |
| EXAMPLE IN VAULT HOLD | Right hand feels more full (fingers spread apart) and moves inferiorly (right side bending-rotation) | |
| CAUSES |
| |
Figure 7. Side bending-rotation: the sphenoid and occiput rotate in opposite directions around two vertical axes (side bending) and the same direction around one AP axis (rotation).
DYSFUNCTION: COMPRESSION | ||
| SPHENOID & OCCIPUT | Compressed through one AP axis | |
| DIAGNOSIS | Lack of movement and cranium feels heavy | |
| EXAMPLE IN VAULT HOLD | No movement is palpated | |
| CAUSES |
| |
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