Diagnostic skills

Somatic dysfunction is a restriction or impaired function that can occur in bones, joints, muscles, and fascia, resulting in decreased range of motion, pain, and improper nerve functioning (increased or decreased autonomic nervous activity). Blood supply and lymphatics may also be altered, which results in impaired healing and immunity, and lymphatic congestion.

DIAGNOSTIC CRITERIA FOR SOMATIC DYSFUNCTION (TART)
TISSUE TEXTURE CHANGES	Surrounding tissue may be edematous, tender, fibrotic, atrophied, or hypertonic
ASYMMETRY	Bones, muscles, or joints may feel asymmetric to the surrounding structures (e.g., more posterior spinous process, more superior ischial tuberosity)
RESTRICTION	Joints with somatic dysfunction are restricted in motion. Under normal physiologic conditions, a joint has two barriers: Physiologic barrier: the maximum active range of motion of any given joint (e.g., patient abducting their shoulder to 150 degrees) Anatomic barrier: the point at which a joint reaches its maximum passive range of motion (e.g., physician rotating a patient’s neck to 90 degrees) The restrictive barrier in somatic dysfunctions is pathologic; it lies before the physiologic barrier and prevents full range of motion
TENDERNESS	Painful sensation reproducible during palpation of tissues

Figure 1. The normal ranges of motion and barriers of a vertebral body.

ACUTE VS. CHRONIC SOMATIC DYSFUNCTION
FINDINGS	ACUTE	CHRONIC
TISSUE TEXTURE CHANGES	Edematous, erythematous, boggy; hypertonic muscles	Edematous (less than an acute somatic dysfunction), no erythema, cool dry skin, fibrotic; ropy muscles
ASYMMETRY	Present	Present with compensation in other areas of the body
RESTRICTION	Painful restriction with movement	Restriction with less or no pain
TENDERNESS	Severe, sharp	Mild / moderate, dull / achy

Author: Arman Israelyan, OMS-III

Editor: Matt Lipinski, DO

Illustrator: Aileen Lin, MScBMC

Editor: Robyn Hughes, MScBMC

Diagnostic skills

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