Copyright ©2016, Kansas City University of Medicine & Biosciences (KCUMB). This presentation is intended for KCUMB educational use only. No part of this presentation may be distributed or reproduced without the expressed written consent from the author or KCUMB OMM Department Chairperson. This includes electronic distribution through uploading or posting on any Internet web site.

Introductory Concepts: Somatic Dysfunction, TART & OMT

Kelley Joy, DO

Associate Professor

OMM Department Chair - Joplin

Copyright ©2018, Kansas City University of Medicine & Biosciences (KCU). This presentation is intended for KCU educational use only. No part of this presentation may be distributed or reproduced without the expressed written consent from the author or KCU OMM Department Chairperson. This includes electronic distribution through uploading or posting on any Internet web site.

Disclosure InformationOsteopathic Manipulative Treatment Refresher and Introductory Training for Supervisors of DO Students & Residents

• I have no financial relationships to disclose.

• I will not discuss off label use and/or investigational use in my presentation.

Objectives

Identify, describe, and define

• Achieve & Demonstratea foundational understanding in core concepts of Osteopathic Physical Exam skills and TART (tissue texture abnormality, asymmetry, restricted motion, tenderness) to enable application of Osteopathic Manipulative Treatment (OMT)

• Practice the skills necessary for the supervision of students and residents in the performance of OMT.

• Perform the skills necessary to integrate OMT into a physician’s routine clinical practice.

Diagnostic Criteria for Somatic Dysfunction

T.A.R.T.

Tissue texture abnormalities

Asymmetry of structure

Restriction of motion

Tenderness

4

Any one of which must be present for the diagnosis of somatic dysfunction

Somatic Dysfunction Tissue Texture Abnormalities

Acute

• Red

• Hot

• Swollen

• Edematous

• Boggy

Chronic• Cool

• Blanching

• Ropy

• Thickened

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–Layer palpation of forearm

• Skin

• Subcutaneous tissues, fascia, vessels

• Muscles & Tendons

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Lab 1 – Introduction to Soft Tissue Layer Palpation

Superficial to Deep

Lab 2 – Bony and Joint Layer Palpation and Palpation of Motion

– Layer palpation of

forearm

• Bones and Joints

– Motion of the Forearm

and hand

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Normal Physiologic Motion Active Range of Motion

Passive Range of MotionAROM – patient initiated ROM, examiner visually observes

PROM – examiner initiated ROM with passive patient

PROM > AROM because pt. muscles are relaxed

Terminology is in reference to patient’s activity level.

Somatic Dysfunction Alters ROM

AROM – patient initiated ROM, examiner visually observes

PROM – examiner initiated ROM with passive patient

PROM > AROM because pt. muscles are relaxedTerminology is in reference to patient’s activity level.

A) Layer palpation of shawl area.

B) Palpation of hypertonic fourth-layer muscle.

BogginessThickeningStringinessRopinessFirmness (hardening)Temperature changeMoisture change

Lab 3 – Layer Palpation of Paraspinals

• Have patient seated:

– Ask the patient to bend forward, gently induce more flexion

– Ask the patient to lean backward, gently induce more extension

– Ask the patient to lean to the right then the left, gently add more motion in each direction

– Ask the patient to turn to the right then the left, gently add more motion in each direction

• What do you notice?

Lab 4 – AROM & PROM Observation

Sy

mp

ath

etic

In

ner

va

tio

nHead/Neck T1-4

Heart/Lungs T1-6

Upper GI T5-9

Small Intestine & R Colon T10-11

Appendix T12

L Colon/Pelvis T12-L2

Adrenal T10-11

GU tract T10-L2

Ureter – Upper/Lower T10-11/T12-L2

Bladder T12-L2

Extremities – Upper/Lower T2-8/T11-L2

Recommended Readings

• Atlas: Ch 1 – Topics: Osteopathic Principles, Structural components, Somatic

Dysfunction. Ch 3 Spinal ROM, Ch 6 –Topics: Direct and Indirect technique, Somatic

Dysfunction, Contraindications, Osteopathic Manipulative Treatment prescription (pg

3-4, 14-27, 75-78)

• FOM: Ch 45 –Topics: Diagnosis and Somatic Dysfunction, Barrier Mechanics (pg

670)