Diagnosing cranial somatic dysfunction

Diagnosing cranial somatic dysfunction

Chronic Week 1

Chronic Week 1

Down syndrome (Trisomy 21)
Galactosemia
Tay-Sachs disease (NORD)
Mucopolysaccharide storage disease type 1 (Hurler syndrome) (NORD)
Phenylketonuria (NORD)
Phenylketonuria (NORD): Year of the Zebra
Classical homocystinuria (NORD)
Homocystinuria
Glycogen storage disease type II (NORD)
Hypertrophic cardiomyopathy
Abnormal heart sounds
Normal heart sounds
Development of the cardiovascular system
Fetal circulation
Aortic valve disease
Mitral valve disease
Pulmonary valve disease
Tricuspid valve disease
Valvular heart disease: Pathology review
Cyanotic congenital heart defects: Pathology review
Acyanotic congenital heart defects: Pathology review
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
Cardiomyopathies: Pathology review
Approach to cyanosis (newborn): Clinical sciences
Aortic dissections and aneurysms: Pathology review
Peripheral artery disease
Peripheral artery disease: Pathology review
Vasculitis
Vasculitis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Raynaud phenomenon
Fryette laws
Diagnosing cervical somatic dysfunction
Spurling test
Cervical spine counterstrain
Cervical spine facilitated positional release
Cervical spine HVLA
Cervical muscle energy treatment
Cervical spine myofascial release
Other cervical spine treatments
Diagnosing lower limb somatic dysfunction
Special tests for the lower limb
Lower limb counterstrain
Lower limb HVLA
Lower limb muscle energy treatment
Lower limb myofascial release
Other lower limb treatments
Diagnosing lumbar spine somatic dysfunction
Lumbar muscle energy treatment
Lumbar spine counterstrain
Lumbar spine facilitated positional release
Lumbar spine HVLA
Lumbar spine myofascial release
Other lumbar spine treatments
Cranial osteopathy: Cranial nerves
Primary respiratory mechanism
Diagnosing cranial somatic dysfunction
Cranial treatments
Diagnosing pelvis somatic dysfunction
Pelvis counterstrain
Pelvis muscle energy treatment
Other pelvis treatments
Diagnosing rib somatic dysfunction
Rib counterstrain
Rib HVLA
Muscle energy for rib somatic dysfunction
Other rib treatments
Diagnosing sacral somatic dysfunction
Sacrum counterstrain
Sacrum muscle energy treatment
Sacrum myofascial release
Diagnosing thoracic spine somatic dysfunction
Thoracic spine counterstrain
Thoracic spine facilitated positional release
Thoracic spine HVLA
Thoracic muscle energy treatment
Thoracic spine myofascial release
Other thoracic spine treatments
Diagnosing upper limb somatic dysfunction
Special tests for the upper limb
Upper limb counterstrain
Upper limb HVLA
Upper limb muscle energy treatment
Upper limb myofascial release
Other upper limb treatments
Angina pectoris
Stable angina
Coronary artery disease: Clinical sciences
Coronary artery disease: Pathology review
Heart failure
Heart failure: Pathology review
Congestive heart failure: Clinical sciences
Dilated cardiomyopathy
Restrictive cardiomyopathy
ACE inhibitors, ARBs and direct renin inhibitors
Adrenergic antagonists: Beta blockers
Calcium channel blockers
Thiazide and thiazide-like diuretics
Loop diuretics
Potassium sparing diuretics
cGMP mediated smooth muscle vasodilators
Lipid-lowering medications: Statins
Cardiac conduction velocity
Cardiac conduction system
ECG basics
ECG normal sinus rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG rate and rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement

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:
  1. First fingers meet in the center of the frontal bone
  2. Second fingers over the greater wing of the sphenoid bone
  3. Third fingers over the zygomatic process
  4. Fourth fingers on the mastoid process
  5. 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 & OCCIPUTRotate in opposite directions around two transverse axes
DIAGNOSISBody spends more time in flexion phase of motion
EXAMPLE IN VAULT HOLDFingers spread apart and move inferiorly
CAUSESN/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
  • Traumatic force to head (superior or inferior)
  • Dental pathologies or procedures
  • Head / neck surgery
  • Improper sleeping positions
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
  • Traumatic force to vertex of head or below mouth
  • Dental pathologies or procedures
  • Head / neck surgery
  • Improper sleeping positions
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
  • Traumatic force to side of head
  • Dental pathologies or procedures
  • Head / neck surgery
  • Improper sleeping positions
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
  • Traumatic force to side of head (causing convexity to occur on opposite side of head)
  • Dental pathologies or procedures
  • Head / neck surgery
  • Improper sleeping positions
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
  • Traumatic force to head
  • Circumferential compression (e.g. childbirth)
  • Severe depression
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Illustrator: Abbey Richard
Editor: Robyn Hughes, MScBMC