AMP 3

Prévia do material em texto

WORKSHEET (Supplemental to Lecture)
  
PRIVATE "TYPE=PICT;ALT=Muscle layers"ATLAS
R.C.P. Minor 
Purpose - Used to confirm atlas laterality as the R.C.P. Minor is active on the opposing side. 
Location - Found posterior to the atlas (slightly above). 
O.C. Superior 
Purpose - Active during atlas anteriority and laterality. 
Location - Posterior to the t.p.s of atlas. 
First Branch Levator Scapula 
Purpose - Tension is palpable upon Atlas laterality. 
Location - Posterior and inferior to the atlas t.p.s 
S.C.M. - (Used only as muscle of confirmation) 
Purpose - Working upon mastoid posteriority. 
Location - The tip of the mastoid process and Inf. 
O.C. INF. 
Purpose - Active when atlas t.p. is ant. (unless axis is misaligned) 
Location - Posterior t.p. of atlas and slightly inferior. 
  
  
�
AXIS
R.C.P. Major 
Purpose - Splints spinous deviation to the posterior right or left. 
Location - Superior and lateral to the axis spinous. 
Second Branch Levator 
Purpose - Working tension is involved with axis rotation as the t.p. misaligns anterior. 
Location - Inferior and slightly posterior to the t.p.s of axis. 
First Branch Scalenus Medius 
Purpose - used to distinguish the posterior rotation of the axis transverse process. 
Location - Inferior and slightly anterior to the t.p.s of axis. 
C3 - T12
Multifidus 
Purpose - Active during the misalignment on the side opposite spinous rotation. 
Location - Lateral to the spinous process, running oblique and inferior to the transvere processes of a vertabra below. 
Intertransversari - (when present and palpable) 
Purpose - Working upon the inferior t.p. from above and the superior t.p. from below. 
Location - Between the transverse processes.
C-1 through C-6 are palpated as the patient is lying supine and with his/her head resting on the Doctor's hands.  The patient's head should be slightly and passively elevated by the Doctor.  The patient's legs should also remain uncrossed. 
�
PELVIS AND SACRUM
Gluteus Maximus 
Purpose - Active when thee sacrum is misaligned; upon the opposite side of apex deviation. 
Location - Inferior and lateral to the apex of Sacrum. 
Posterior Sacro-Illiac Ligament 
Palpation - tightened when the Sacral base misaligns anterior or the Illium misaligns posterior. 
Location - Medial to the posterior superior spines of the Illia. 
Erector Spinae 
Purpose - Used to distinguish the inferior position of the misaligned Sacrum or Illium. 
Location - Superior to the base of the Sacrum and crest of the Illium. 
Piriformis 
Purpose - Active upon posterior misalignment of the Sacrum. 
Location - Lateral to the 3rd and 4th Sacral segments. 
Gluteus Medius and Gluteus Minimus 
Purpose - Working tension is involved to splint the Illium as it moves anterior upon misalignment. 
Location - Lateral to posterior superior spines of the Illia.  
�
RECTUS CAPITIS POSTERIOR MINOR
PRIVATE "TYPE=PICT;ALT=Lateral view of suboccipital muscles"Origin: The posterior tubercle of atlas’ posterior arch. 
Insertion: The medial portion of the inferior nuchal line and the surface between it and the foramen magnum (broadening as it ascends upwards). 
Located: To be found in the midline of the spine, superior to the spinous process of axis vertebra, just inferior to the external occipital protuberance, at the base of the skull.  In close approximation with the occiput. 
Listing Involvement: Rectus capitis posterior minor corrects the superiority of the anterior atlas subluxation and is involved in correcting atlas laterality (on the side opposite of laterality). 
Working Sensation: Upon palpation of the rectus capitis posterior minor "working" tension of the minor must first be distinguished from the sensation inherent to the normal muscle tone relative to the surrounding muscle tissues.  The tissue of the working rectus capitis posterior minor will not "give way" to finger pressure and indicates obvious contraction upon a light probing touch. PRIVATE "TYPE=PICT;ALT=Rectus capitis posterior minor"
 (Often confused with the larger bellies of rectus capitis posterior major which is located immediately lateral and inferior to the rectus capitis posterior minor.) 
Non-Working Sensation: The sensation of the rectus capitis posterior minor can be deceptive to the novice.  Experience jumps to no conclusions in palpation.  The rectus capitis posterior minor may at first touch suggest a working tension but upon further comparison to the surrounding muscle tissues, found to be only the characteristic tone of the individual's muscle. 
�
 OBLIQUUS CAPITIS SUPERIOR
PRIVATE "TYPE=PICT;ALT=Obliquus capitis superior"Origin: The superior surface of the atlas trasverse process. 
Insertion: Between the superior and inferior nuchal lines of the occiput (running obliquely up and medialward toward its insertion). 
Located: The palpable portion of the muscle is found directly posterior to the insertion of the sternocleidomastoid and in intimate contact with the occiput.  Its bands are not to be confused with those of the sternocleidomastoid which again is directly anterior.  The obliquus capitis superior is palpable closer to its (own) insertion.  To find the obliquus capitis superior, gently raise the patient’s head, while he is in the supine position, rotate the head contralaterally (or opposite the side to be palpated), then as the surrounding muscles are stretched and tightened, a small depression is formed behind the sternocleidomastoid, and this is where the obliquus capitis superior is palpable – but return the patient’s head to the relaxed supine position before palpation. PRIVATE "TYPE=PICT;ALT=Obliquus capitis superior"
�
Listing Involvement:  The obliquus capitis superior is in a synergistic complex with the first branch of the levatores (of the opposite side) when working for atlas correction.  It is palpable upon atlas laterality to the opposite side. PRIVATE "TYPE=PICT;ALT=Posterior view"
�
Working Sensation:  Upon palpation of the obliquus capitis superior, tension can be interpreted most often only to a notable, and occasionally to a relatively firm, degree.  It is palpated as a small consolidation of muscle mass when working and can demonstrate a fleshy resistant consistency only notable when simultaneously compared to the opposing obliquus capitis superior.  
�
�
FIRST BRANCH OF THE LEVATOR
PRIVATE "TYPE=PICT;ALT=ASL"
Origin: The transverse process of the atlas vertebra. 
Insertion: The medial border of the scapula at its superior angle. 
Located: Palpable within the sternocleidomastoid (though actually beneath or sometimes posterior to the sternocleidomastoid) and is easily confused with these bands.  A sliding (or rolling the finger pads over levator gently) of the index or the Chiropractic index fingers is used across the posterior aspect of the sternocleidomastoid, below the transverse process of atlas and above the transverse process of axis vertebra.  The levator can be differentiated from the sternocleidomastoid as a band never reaching the base of the occiput, instead this branch can be found to dip below the sternocleidomastoid angling in the direction of the atlas transverse processes.  Also seemingly disappears as the sternocleidomastoid approaches the mastoid process. 
Listing Involvement: The first branch of the levatores is synergistic with that of the obliquus capitis superior, though it works on the opposing side upon atlas laterality; these two muscles work to correct the lateral plane displacement together.  The levator works on the same side as atlas laterality. 
Working Sensation: Upon palpation of the first branch, tension can be interpreted to any of the three degrees, but is often notableor firm. The levatores are tendonous slips of  muscle, closely comparable to a thin, fleshy ribbon drawn muscle, relatively taut, and also compared to having that of a firm "rubber band" effect.  The working levator is distinguishable as a muscle band and fairly obvious (as working) when not complicated by the surrounding tissue or other related branches. 
PRIVATE "TYPE=PICT;ALT=First branch of the levator"
�
Non-Working Sensation: It is necessary to emphasize that there is "often to always" an inherent definitive tone to the levator muscle branches.  This can be mistaken for working sensation and therefore required to be palpated simultaneously with the opposing branch.  It is also essential to consider the entire atlas complex before resolving to a lateral listing because the first branch is related and subject to the influence of the second branch of the levatores.  
�
 �
RECTUS CAPITIS POSTERIOR MAJOR
PRIVATE "TYPE=PICT;ALT=Rectus capitis posterior major"
Origin: The spinous process of the axis vertebra. 
Insertion - The lateral portion of the inferior nuchal line of the occiput and the surface area below the line. (Broadening as it ascends.) 
Location: The rectus capitis posterior majors are readily accessible for palpation because of their broadening insertion.  The index fingers are placed above the spinous process of axis (on either side of its apex) and then running the fingers lateral, in each direction and slightly cranialward, these bellies are located deep to the origin of the trapezius (though actually separated from the trapezius by the semispinalis capitis). PRIVATE "TYPE=PICT;ALT=Axis PR"
Listing Involvement: Rectus capitis posterior major works on the opposite side of axis spinous deviation.
PRIVATE "TYPE=PICT;ALT=Base posterior view"
�
Working Sensation: The rectus capitis posterior majors are palpable to a firm or rigid degree when found working.  The muscle may be well defined or seem only to blend with overlying muscle that runs relatively in the same direction to its fibers.  In either situation the rectus capitis posterior major gives a "raised effect" as its fibers are traced over the atlas posterior arch.  This slightly elevated tension is characterized by depth of touch and stalwart pliancy upon palpation.  
�
 
� PAGE �1�