OMM Semester 1 Savarese Practice Comlex
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A 13 YO male comes to the ED w/ a R wrist & elbow pain following a fall. He states that
he fell forward on his outstretched arm.
On examination, there is no evidence of deformity of the forearm or wrist. Upon
palpation he has exquisite pain between the extensor longus & abductor pollicis longus
tenduons at the radiocarpal joint. There is mild edema at the radiocarpal joint. He has
decreased flexion & extension at the wrist as well as decreased forearm supination.
There is a tender point located at the musculotendonous insetion of the lateral
epicondyle. X-Rays of the wrist & elbow are normal w/out evidence of fracture.
Which of the following techniques is contraindicated in this Pt?
A. ME to the upper extremity to increase supination
B. Counterstrain to the tenderpoint
C. Thoracic inlet releasee
D. HVLA to the R wrist to improve ROM
E. Posterior axillary fold technique - CORRECT ANSWER: Correct: Answer D: The
anatomic snuff box is located at the radiocarpal join & is bordered by the extensor
pollicis longus & abductor pollicis longus tendons. Since the Pt has pain at the anatomic
snuff box w/ some edema & decreased ROM at the wrist, he may have a fracture of the
scaphoid bone. HVLa is contraindicated in areas of the fracture.
Answer A: ME to the upper extremity to increase supination is not contraindicated
because this technique can be modified so that no stress is applied to the radiocarpal
joint. A cross extensor reflex ME could also be used. This would require treating the L
upper extremity in order to achieve a therapeutic effect in the R upper extremity.
,Answer B: Counterstrain is not contraindicated because this technique can also be
modified so that no stress is applied to the radiocarpal joint.
Answer C & E: Thoracic inlet release & posterior axillary fold techniques are indicated in
this scenario because both techniques will help open lymphatic channels & help
decrease the edema in this Pt's R upper extremity.
A 13 YO male comes to the ED w/ a R wrist & elbow pain following a fall. He states that
he fell forward on his outstretched arm.
Based on the Hx, what is the most likely Dx at the elbow?
A. Adducted ulna
B. Posterior radial head
C. Abducted ulna
D. Cubital tunnel syndrome
E. Medial epicondylitis - CORRECT ANSWER: Correct: Answer B: A posterior radial
head may present as a sharp pain at the wrist or elbow & may result from a fall on an
outstretched arm. On examination, the posterior radial head will resist anterior glide at
the elbow & the forearm will be restricted w/ supination.
Answer A, C, D, & E: The other answers listed are possible, however none are
associated specifically w/ a fall on an outstretched arm.
A 13 YO male comes to the ED w/ a R wrist & elbow pain following a fall. He states that
he fell forward on his outstretched arm.
On examination, there is no evidence of deformity of the forearm or wrist. Upon
palpation he has exquisite pain between the extensor longus & abductor pollicis longus
tenduons at the radiocarpal joint. There is mild edema at the radiocarpal joint. He has
decreased flexion & extension at the wrist as well as decreased forearm supination.
There is a tender point located at the musculotendonous insetion of the lateral
epicondyle. X-Rays of the wrist & elbow are normal w/out evidence of fracture.
,The Pt's wrist is splinted & he is told to follow up in 3 weeks. At the next follow up visit,
the Pt's pain has not improved. Which of the following would be the appropriate course
of action?
A. Prescribe a more effective pain med & have the child follow up in a week.
B. Order a bone scan
C. Imm - CORRECT ANSWER: Correct: Answer B: Since the Pt had pain at the
anatomic snuff box & symptoms have not improved in 3 weeks time, the Dx of fracture
should be considered. Although X-Rays of the wrist are normal, the Pt may still have a
small non-displaced scaphoid fracture. The scaphoid bone is the most common bone
fractured in the wrist & often presents w/ pain in the anatomic snuff box. X-Rays may be
normal for a week or longer. If a fracture is suspected, the practicioner may obtain a
second set of X-Rays, or a bone scan can be ordered. A bone scan will accurately ID a
fractured scaphoid.
Answer A: Putting the child on a pain med's w/out immobilizing the wrist is ill advised,
especially w/ the likelihood of a fracture.
Answer C: Appropriate management for a scaphoid wrist fracture is immobilization of
the wrist for 3 months. Due to the lack of a rich blood supply, the healing of a fractured
scaphoid is characteristically slow. Immobilizing the wrist for 2 weeks will not allow the
fracture to fully heal.
Answer D: Wrist sprains typically improve w/in a week's time. If the swellling & pain are
increased, the Dx of a fracture should be considered.
A 16 YO female is experiencing low, midline, wave-like cramping pelvic pain that occurs
w/ menses. The pain has been present for 3 months & has been getting progressively
worse. Pain frequently radiates to her L-Spine & is associated w/ frequent nausea. In
addition to appropriate oral medications, which OMM technique will most effectively
decrease the Pt's symptoms by altering sympathetic tone?
, A. Rib raising & paraspinal inhibition to the thoraco-lumbar junction
B. Celiac ganglion release
C. Pelvic diaphragm release
D. Muscle energy to T10
E. Sacral inhibition - CORRECT ANSWER: Correct: Answer A: The Pt has signs &
symptoms of dysmenorrhea. Pain is produced by uterine vasoconstriction, anoxia &
sustained contractions mediated by prostaglandins. The uterus receives sympathetic
innervation from T10 - L2 segments. Rib raising & paraspinal inhibition will decrease
sympathetic tone, therefore these techniques will most effectively enhance blood flow &
relax the uterus, thus decreasing pain
Answer B: The purpose of the celiac ganglion release is to calm sympathetics from T5-
T9. This technique will not affect autonomic tone to the uterus.
Answer C: The pelvic diaphragm release will not effectively normalize sympathetic tone
in the uterus.
Answer D: Although manipulative techniques at vertebral levels could alter autonomic
Fx, muscle energy at T10 will not greatly affect sympathetic tone in the uterus because
Tx of one segment is less likely to be as effective as compared to Tx of a few levels.
Answer E: Parasympathetic flow to the uterus originates in the pelvic splanchnic nerves
(S2 - S4). Tx directed at the sacrum will influence parasympathetic tone, not
sympathetic tone.
A 17 YO female complains of anterior knee pain that gets worse when she runs, jumps
or climbs stairs. PE reveals pain is reproducible on squatting & when the knee is flexed.
There is point tenderness on the undersurface of the patella & there is some patellar
crepitus.
Decreasing myofascial restrictions in which muscle would most likely result in greatest
reduction in this Pt's symptoms?
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