1
Q
Movement of occiput, sphenoid, ethmoid and vomer
A
- rotate about a transverse axis
- flexion is paired with inhalation
- extension is paired with exhalation
2
Q
SBS extension is paired with inhalation or exhalation?
A
exhalation
3
Q
SBS flexion is paired with? Moves?
A
- inhalation
- SBS moves superiorly with increased angle inferiorly
4
Q
Paired bones of the cranial vault and the temporals
A
- frontals, parietals, temporals
- rotate externally during cranial flexion
5
Q
Paired bones of the face
A
- maxilla, palatines and zygomae
- rotate externally during cranial flexion
6
Q
Parietal bone articulates with 5 other bones what are they?
A
- occiput
- frontal
- sphenoid
- temporal
- opposite parietal (paired!)
- only bone that contacts all 4 fontanelles
7
Q
Parietal bone outer surface
A
- upper temporal ridge (attachment of the temporal fascia)
- lower temporal ridge (origin of the temporalis muscle)
- temporalis fossae (filled by the temporal muscle)
8
Q
Parietal Bone Inner surface
A
- sagittal sulcus: a groove along the sagittal sutures in which the sagittal sinus runs
- groove of the middle meningeal artery
- the bevel changes along the coronal and lambdoidal articulations
- lateral part of the groove for the transverse sinus–carries the marginal insertion of the tentorium cerebelli
9
Q
Parietals axis of motion
A
- bevel change midway along sagittal and lambdoidal sutures creates a hinge for the AP axis of motion (coronal plane)
- external rotation of the parietals occurs with SBS flexion
- inferior borders move laterally
- superior borders move medially and inferiorly
- pterion, asterion and squamous sutures move laterally
- sagittal sutures move slightly inferiorly
10
Q
Parietal bone External rotation
A
- sagittal articulation moves inferiorly
- temporal articulation moves laterally
- cranium widens laterally
11
Q
Parietal bone internal rotation
A
- sagittal articulation moves superiorly
- temporal articulation moves medially
- cranium narrows laterally
12
Q
Mechanical joint related pain associated with parietal bone SD
A
- cranial synostosis: premature closure of the sutures (coronal, sagittal, lambdoidal)
- head pain: pain along a suture
- OM and asterion often involved in tension headaches
- pterion often involved in temporal headaches
- parietosquamous
13
Q
organ/myofascial dysfunction related to parietal bone SD
A
- middle meningeal artery trauma: giant cell arteritis–diagnosed by contrast-enhanced, high resolution MRI
- Head, face and tooth pain–temporal SD
14
Q
Sagittal syntosis
A
- most common form
- premature fusion of the sagittal sutures restricts the transverse growth of the skull
15
Q
Lambdoid synostosis
A
- form of synostosis most commonly mistaken for posterior positional deformational plagiocephaly and must be closely evaluated
- unilateral lambdoid synostosis results in flatterning of the back of the head on the affected side as well as compensatory growth of the mastoid process on the same side (ipsilateral mastoid blue)
- leads to a characteristic and unique “tilt” in the cranial base
- differentiates it from positional/deformational plagiocephaly
- The ear on the affected side is often deviated back and toward the fused suture
- one of the rarest types
16
Q
Temporal Bone Squamous Portion contains
A
-zygomatic process–facial injury affects temporal bone
17
Q
Temporal Bone Petrous portion contains
A
- otovestibular organ
- eustachian tube exit is between the sphenoid and the temporal bones
- border of foramen lacerum (with sphenoid)–greater superficial parietal nerve; lacrimation via the pterygopalatine ganglion
- attachment of the tantrum
- encloses the internal carotid artery
- lateral part of the jugular foramen
- styloid process
18
Q
Newborn skull temporal bone
A
-lacks a mastoid process
19
Q
Eustachian tube
A
- exits the petrous portion and becomes the medial wall of the middle ear (the sphenoid is the lateral wall)
- internal rotation of the temporals will place pressure on the Eustachian tube–high pitched tinnitus
- external rotation will often produce a low roaring sound or low pitched tinnitus
20
Q
Temporal bone external rotation
A
- with SBS flexion
- squamous portion moves laterally
- MP moves medially
21
Q
Temporal Bone internal rotation
A
- with SBS extension
- squamous portion moves medially
- MP moves laterally
22
Q
Temporal bone motion is driven by the
A
occiput through the OM articulation
23
Q
Mechanical/Pain Symptoms of Temporal bone SD
A
- TMJ pain
- Head pain along a suture
- OM and asterion often involved in tension headaches
- Pterion often involved in temporal headaches
- parietosquamous
- Neck pain–SCM and other muscle SD
24
Q
Organ/Nerve/Muscle symptoms of temporal bone SD
A
- dizziness
- ear infections
- swallowing and chewing–stylohyoid, stylomandibular (TMJ) and styloglossus
- Tinnitus and eustachian tube dysfunction–internally rotated temporal associated with high pitched tinnitus; externally rotated temporal bone associated with low roaring tinnitus
- Bells palsy
25
Frontal bone anatomic considerations
- considered paired only because in infancy it is two structures
- metopic suture (remains in 10% of adults)
- forms roof of orbits
- superior border of anterior nasal fossa
26
Frontal bone articulations
-parietals; sphenoid; ehtmoid; lacrimals; maxillae; nasals; zygoma
27
Frontal bone axis
- metopic has hinge like action
- coronal plane motion
- moves from center of orbital roof through frontal eminence
28
Frontal bone external rotation
- during SBS flexion
| - lateral side moves anterior/lateral and slightly inferior, glabella moves posteriorly
29
Frontal bone internal rotation
- during SBS extension
| - lateral side moves posterior/medial and slightly superior, glabella moves anteriorly
30
Mechanical/Pain symptoms of Frontal Bone SD
- head pain along a suture
- coronal often involved in tension headaches
- pterion often involved in temporal headaches
- head pain from diminished primary respiration and CSF flow due to increased dural tension at the cribiform plate
31
Organ/Nerve/Muscle symptoms of frontal bone SD
- sinusitis (allergic or infectious)
- visual problems (double vision)
- anosmia--frontal influences cribiform plate
- frontalis muscle TrP/TP
32
Bicronal Synostosis
- fusion of both coronal sutures leads to a head shape called brachycephaly
- causes restriction of growth of the anterior fossa resulting in a shorter and wider than normal skull
- compensatory vertical growth also occurs, which is called turricephaly
- Bicronal syostosis is often seen in patients with associated syndromes such as Crouton, Apert, Saethre-Chtotzen, Muenke and Pfeiffer syndromes
- can also have additional sutures that are prematurely closed
33
Unicoronal syostosis
- premature fusion of a single coronal suture leads to a head shape called anterior plagiocephaly
- results in restricted anterior growth of the skull, involving the top of the skull as well as the cranial base
- causes deformities of the face, ear, nose and forehead
- affected forehead is flat with the contralateral side more forward
- the affected side ear is also more forward
- face always has a characteristic C shaped deformity or facial twist
- characterized by the base of the nose drawn towards the affected side and the tip of the nose pointing away
- associated facial deformity is the key method of differentiated anterior plagiocephaly from positional/deformational plagiocephaly, which is NOT the result of syostosis
34
Parietal lift
- Both forearms resting on the table, establishing a fulcrum
- place fingertips on both parietal bones just superior to the parieto-squamous sutures
- crosses thumbs above the sagittal but thumbs not to touch the patient
- physician presses one thumb against the other which creates a fulcrum and approximates other fingertips
- inducing internal rotation of the parietal bones at the parietal-squamous sutures
- while maintaining this light pressure, traction superiorly until fullness is felt over fingertips
- fullness is the parietal bones externally rotating
- physician gently releases head
- reacess for ROM and PRM rate and rhythm
35
Frontal lift
- both forearms resting on table, establishing fulcrum
- position hypothenal eminences on lateral angles of frontal bones and the thenar eminence on the lateral aspects of the frontal anterior to the coronal suture
- interlace fingers above metopic suture
- using interlaced fingers as a hinge, apply gentle compressive force medially to disengage the frontals from the parietals (internally rotates the frontal bones)
- while maintaining the gently compression force, apply a gentle anterior force through your frontal bone contacts to disengage the suture restrictions
- hold the traction until you feel softening and/or expansion of the frontal bone--frontal bone moving into external rotation
- then gently release the patient's head
- reassess for ROM and PRM rate and rhythm
36
5-finger temporal hold
- can be done unilaterally or bilaterally
- place middle finger gently on patients external auditory canal
- using a pincer grasp of your thumb and index finger contact the patient's superior and inferior border of their zygomatic arch
- place the pads of your 4th and 5th digits on the mastoid process
- if done unilaterally, the opposite hand cradles the occipital squama, medial to the occipitomastoid sutures
37
Temporal rocking
- assess temporal motion using bilateral 5 finger temporal hold
- encourage free directions of motion (indirect)
- to encourage internal rotation: thumb and index finger move superiorly and laterally while the 4th and 5th digits move inferomedial
- to encourage external rotation, thumb and index finger move inferomedial while 4th and 5th digits ride along thee superolateral motion
- simultaneous ER/IR motions are encouraged in a back andd forth manner until bones achieve an asynchronous motion--then just monitor allowing physiologic motion to return
- if physiologic synchronous motion does not return, then gently begin to resist the motions to induce a STILL point
- leaving the temporal bones in asynchronous motion will often result in vertigo or other temporal bone problems
38
CV4
- thenar eminences are inferior to the superior nuchal line and medial to patient's OM sutures
- compression lateral to suture can cause an OM suture compression or ER of b/l temporals
- after tuning into flexion and extension motions through occiput, gently encourage extension by leaning back causing occiput to favor a superior direction (extension) and resisting its inferior (flexion) motion
- the motion will seemingly diminish to the point where you question if it has disappeared. This is called the still point. there is often a softening and or warming of the occipital contact
- after still point, the motion will slowly, yet powerfully, resume. Allow this to happen and reassess
39
Directing the tide
- The tide is directed gently by the touch of a finger. you direct the tide from one point on the skull to another point on the other side
- place the palpating fingers over the suture contacting the 2 components with a V-spread
- balance tension across this area
- direct the tide from the other hand using the greatest contralateral diameter of the head
- the change in quality of response shows that change is occurring in the area of strain
40
V spread
- commonly used as asterion, pterion, and occipitomastoid sutures
- fingerpads of contactng hand are usually on the longest contralateral diameter
- pressure is used to follow and just slightly encourage the PRM to create a lateral fluctuant flow between the opposite contacts
- softening will occur at the formerly compressed suture, along with more vitality in the perceived motion
41
Common ooposing joints useful for directng the tide
- parietal eminence--petrobasilar
- lateral vertex--petrojugular
- frontal eminence--occipitomastoid
- pterion--parietomastoid
- asterion--pterion
- parietal eminence--sphenosquamous pivot
- frontal eminence--sphenopetrous
