Physiologic Patterns of the SBS: Torsion

Submitted for review OMM 3 #15 September 3, 2003 Wed. 1 pm Dr T. Fotopoulos R. Eason for J. Hurrell Page 1 of 3 Physiologic Patterns of the SBS: Torsion Note: anything that Dr. Fotopoulos said to know/is important is bolded. I. Case presentation A. History & Exam: A fellow student comes to you complaining of a dull constant headache for the past week. No history of trauma, photophobia, nausea, vomiting, blurred vision, or altered taste sensation. Your exam reveals findings that give you the impression that the right side of the sphenoid is in flexion and the left side of the sphenoid is in extension, while the right side of the occiput is in extension and the left side of the occiput is in flexion. He stressed to know this case presentation. B. Differential Dx: Left torsion, tension HA, cluster HA, vascular HA, space occupying lesion, etc. Remember that you may have more than one diagnosis (two or more things going on) II. Torsion A. Definition (know this): 1. Physiological cranial dysfunction 2. is a deviation from the normal SBS flexion and extension—feels different—may feel a restriction. Is not a 3. Diagnosed and described by cranial bone motion—palpate and feel how the bones move. 4. Results from tension or trauma that restricts or diverts the SBS. Movement is not straight up and down. Is like a torquing or twisting motion. B. Etiology: A physiological adaptation to trauma to one quadrant of the head 1. Blow from above or below an anterior quadrant: frontal or cheek. 2. Blow from above or below a posterior quadrant: parietal or occiput. C. Motion 1. Torsion is a twisting at the SBS. 2. It has ONE axis that runs anteriorposterior (AP) from the nasion to the opsithion Slide 8 of the ppts shows this. 3. Sphenoid and occiput rotate in opposite directions about the AP axis. 4. The temporal bones move with the occiput as a functional unit. Rem the occiput influences the temporal bones and the sphenoid influences the frontal bones. III. Physiologic Strain Patterns A .**Named for the high/cephalad/superior greater wing of the sphenoid. B. May result from trauma to the head or other pulls on the body. I.e., the birthing process. C. Motion of the head may alternate between the neutral and strain pattern, or the strain pattern may be present through inhalation and exhalation phases or primary respiration. OMM 3 #15 September 3, 2003 Wed. 1 pm Page 2 of 3 D. Slide 10 or Figure 5-11 shows left torsion. The pt is lying on his/her back with the neck at the bottom of the picture. The figure shows 1 axis with rotation of the bones around it in opposite directions. IV. Findings A. If the occiput is low on one side, then the temporal bone on the same side is in relative external rotation B. If the occiput is high on one side, then the temporal bone on the same side is in relative internal rotation C. Thus left torsion=left temporal externally rotated and right temporal internally rotated. D. And right torsion=right temporal externally rotated and left temporal internally rotated. E. With palpation using the vault hold, one hand seems to rotate posteriorly toward the operator, i.e., left hand in left torsion and right hand in right torsion. F. The index/fourth digit/fore finger moves superior or cephalad G. The little finger/pinky/5th digit moves inferiorly or caudad. H. This happens while the other hand rotates anteriorly with the forefinger going inferiorly and the little finger going superiorly. I. Figures 5-12 and 5-13 (slides 17 and 18) show this motion. V. Gross anatomical features A. Positions are relative B. Anterior quadrant with superior (cephalad) greater wing of sphenoid=external rotation of frontal C. Anterior quadrant with inferior (caudad) greater wing of sphenoid=internal rotation of frontal D. Posterior quadrant with superior (cephalad) occiput=internal rotation of temporal E. Posterior quadrant with inferior (caudad) occiput=external rotation of temporal VI. Specific Findings A. Right torsion 1. Right orbit wide 2. Right globe (eye) protruded 3. Right frontal bone is full due to relative external rotation 4. Right ear moves away from the head 5. Right mastoid tip is posteromedial, due to right temporal bone in relative external rotation B. Left Torsion 1. Left orbit wide 2. Left globe (eye) protruded 3. Left frontal bone is full due to relative external rotation 4. Left ear moves away from the head 5. Left mastoid tip is posteromedial, due to left temporal bone in relative external rotation OMM 3 #15 September 3, 2003 Wed. 1 pm Page 3 of 3 VII. Practice A. First practice the motion in the four contact fingers of the vault hold B. Place a tongue blade or pencil or small wad of paper between the molar teeth on one side (i.e., the left side will then mimic left torsion) C. This will create a twist in the SBS that mimics the torsion pattern.