By Sebastiaan Bens, MS

Graduate Teaching Assistant

3rd Year Review

Lecture Outline

What Needs to be done TODAY.

Rotation Advice
Shelf Prep
Case Report Dos and Donts (Donts?)
Patient Encounter:
H
&P
Techniques
Bread
Butter
Good Stuff to Know

Work Schedule contact doc TODAY.

Attendings expectations of you.
Demographics needed for patient
log.

PCC if attending out of office. For

reals.
Stuff you might want to
carry
Fold
up clipboard
Maxwells pocket guide
OMT Quick Reference Book
Masons 5 minute OMT book
Pocket Manual of OMT
Pamphlet provided by dept.
Small note pad!!!
Perfect for storing pt demographics for
log shred after use
Shelf Prep

Savarese for questions, also

Comquest/Combank if you have it.
UWORLD is an obvious miss here.
Know your facilitated segments and
Chapmans reflexes cold easy
points.
Understand biomechanics!
Case Report

Try to find an interesting case early.

Best to write on a case with RTC
after tx to discuss benefit, but you
could write on what sort of OMT you
WOULD have done had there been
more visits, had patient RTCd when
asked, etc.
Better have IRB thing done,
otherwise wont get graded =
Incomplete for course. Eeek!
The Patient Encounter

Areas
needing some improvement
based on previous years rotations:
Complete H&P
Tailored ROS
Red flags
Adequate joint exam
Building a differential
Comfort with providing OMT
Patient Encounter

Be able to describe in
layperson terms what
osteopathic manipulative
treatment is as you may have
a new patient with no idea
why theyre seeing us.
History

OLDCARTS like anything else. Be

sure to ask
Past trauma/MVA/Fx
Meds! Know your pharm!
Occupation! desk all day vs. physical
labor
Recurrence back hurting for 2 days
but Ive had this problem on/off for 15
years.
Exercise Yes/No? What?
History

RED FLAGS TO WATCH FOR

Bowel/bladder dysfxn
Saddle anesthesia
Unintentional weight loss
Fevers/chills/night sweats
Hx of cancer
Horrible headache post fall
History

Review of Systems:
Very important to AT LEAST do a limited
ROS tailored towards chief complaint.
Example:
CC: Diffuse joint and muscle pain ask about
f/c/ns/wl, cold intol, brittle hair/nails, etc.
The Physical Exam

Know how to do a proper PE, starting

with the postural exam. Each
attending may have there own
specific requests again its good to
write down how they want things
done so you can be sure to do them
every time.
Proper Physical Exam

OBSERVATION keep an eye on your

patient. Often a big clue.
Palpation be sure to feel stuff before
moving stuff in case theres some
broken stuff.
Range of Motion
Active shows areas with motion loss.
Passive look at passive motion in areas
where AROM was absent. Good for soft tissue
vs joint prob. Provides us our SD diagnoses
Proper Physical Exam

Muscle Strength Testing full

body done very quickly. Know your
scale! 2/5 vs 3/5
Neurovascular Testing DTRs,
proprioception, 2-point, vibratory,
light touch, pulses.
Provocative Testing review
Stockards ppt! Dont forget SLRs.
Making a Differential

Remember:BE A
DOCTOR FIRST.

Dont think OMM

clinic = OMM
lab.
Always look at
PMHx, meds, etc.
Making a Differential

Just like your

other rotations,
remember that
COMMON IS
COMMON.
Try to drop
zebras to the
bottom of your
differential.
My back hurts, doc!
So his back hurts, now
what?
Developing an OMT Tx plan:
Individualize to every patient. Some can
handle direct, some cant.
Start broad, narrow down. My patient is frail,
probably cant handle anything direct, cant
lay down, so he may benefit from a seated
BLT
When in doubt, ST/diaphragm in region in
question.
DONT TREAT UNTIL CONSENT FROM PATIENT
AND ATTENDING
Categories of treatment
modalities:
Direct
ST
ME
HVLA
Indirect
Direct OR Indirect
MFR
JSCS
BLT
Cranial
Other Important
ones
Lymphatic
Visceral
So his back hurts, now
what?
Remember: where the pain is felt
may not be root cause of problem.
This is what history is for!
Could be kidney, pancreas, etc.
Always (at the least) look joint above
and below area in question.
Knee pain often causes and/or results in hip
and ankle somatic dysfunction
Sacrum. Woot.

Get ready. Odds are youll be

diagnosing lots of these.
Standing/Seated flexion is it
sacrum or innominate thats the
problem?
Remember pelvic compression
testing!
Provocative Testing

Head
Spurlings
Shoulder
Adsons/Wrights
Drop arm
Apleys/Lift-off
Cross arm/Active
compression
Speeds/Yergason
s
Provocative Testing
Hips Knees
Trendelenberg/Hi Ant/Post drawer
p Drop Lachmans
FABER
Grind
Thomas test
Varus/valgus
Standing flexion
McMurrays
Sacrum
Apprehension
Seated flexion
Spring
Backward-
SLRs!
bending
Sacral Diagnoses

LOL/ROR with neutral L5

LOR/ROL with F/E L5
Shear
Base flexion/extension

L5is your friend. So is the seated

flexion test.
L5 Rules for the
Sacrum
1. L5 rotation is opposite sacral
rotation

2. L5 side bends in same direction

as an oblique sacral axis.

L5 should be SB Left if you have a

Left sacral axis
ERMAGERD!
Terchnirques!
Diagnose and
practice your
techniques on
each other.
If you have
specific questions
regarding
approach, well
review it
Extra advice

Be sure your table is at a proper

height.
You will tire yourself out if you do ME
all day long.
Large/Tall patients can be a
challenge.
Everyone can benefit from an HEP
and/or PT.
If your preceptor isnt doing OMT,
he/she probably shouldnt be an OMT
Questions?

Be sure to check your email and

Blackboard for information.
Feel free to contact me for rotation
advice, technique review, etc.
Contact Mrs. McTaggart for all other
inquiries.
Good luck!