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Copyright 2002 Steven L. Simmons, DO. All Rights Reserved. Internet Download Copy.
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CHAPTER 2-NEUROLOGIC
Autonomic Nervous System
Table 6: Sympathetic Innervation
T5-T9 Greater splanchnic nerve Celiac ganglion Upper GI (T5R gall bladder, T6R ducts,
T7R pancreas, T7L spleen)
T10-T11 Lesser splanchnic nerve Superior mesenteric Lower GI (small intestine, right colon,
ganglion gonads, adrenals, upper ureter)
T10-T12 Kidney
T12-L2 Least and lumbar Inferior mesenteric Left colon, lower ureter, bladder, uterus/
splanchnic nerves ganglion prostate, genitals
T2-T8 Arms
T11-L2 Legs
CN10 (Vagus) Dorsal vagal Superior and inferior All structures in the head, neck,
vagal heart, lungs, kidneys, upper ure-
ters, entire GI tract down to the
mid-transverse colon.
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Nerve Roots
Table 8: Upper Extremity and Brachial Plexus Nerve Roots
Level of Exit
Nerve Root Sensory Reflex Motor
(Disc)
C5 Root C4-C5 (C4 disc) Lateral arm Biceps Abduction of shoulder, elbow
flexion
C6 Root C5-C6 (C5 disc) Lateral forearm, Brachioradialis Elbow flexion, wrist extension
thumb, index finger (most common herniation)
C7 Root C6-C7 (C6 disc) Middle finger Triceps Elbow extension, wrist flexion
Origin (Partial
Nerve Function Injury Commonly Results in...
Origin)
Median (C5) C6-T1 Innervates flexors of the forearm & Thenar eminence atrophy
hand. Sensory to the palmar surface
(including fingernails) of digits 1-3
& part of 4
Radial C5-C8 (T1) Innervates forearm extensors. Sen- Wrist drop, diminished triceps
sory to back of forearm, hand, digits reflex
1-3 and part of 4
Ulnar (C7) C8-T1 Innervates some flexors of the hand. Hypothenar eminence atrophy
Sensory to medial hand and part of
digit 4, all of digit 5
Level of Exit
Nerve Root Sensory Reflex Motor
(Disc)
L4 Root L3-L4 (L3 disc) Medial leg & foot Patellar Foot inversion
L5 Root L4-L5 (L4 disc) Dorsal surface of the None Dorsiflexion of the toes, foot drop
lower leg & foot if injured
S1 Root L5-S1 (L5 disc) Lateral side of the Achilles Eversion of the foot
foot (most common herniation)
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Femoral L2-L4 Innervates quads, sensory to medial & Diminished knee jerk reflex
middle thigh and medial lower leg
Tibial L4-S3 Innervates muscles of posterior leg, Diminished ankle jerk reflex
sensory to lateral posterior leg
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Table 6-14: Motion and Positional Findings for OA Tri-axial Somatic Dysfunction
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Table 15: Motion and Positional Findings For Typical Cervical Tri-axial Somatic Dysfunctions
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Table 18: Tests of the Upper Extremity Forward Bending (Flexion) Dysfunction
Positional findings:
Test Purpose There is a slight separation of the spinous process
from the segment below.
Empty Can Detect Tears of the Supraspinatus
There is a slight approximation of the spinous pro-
Test Tendon or Muscle
cess to the one above.
Finkelsteins DeQuervains Tenosynovitis There is usually tenderness of the supraspinous lig-
Test (Abductor Pollicis Longus & ament.
Extensor Pollicis Brevis Tendons) Motion findings:
Rotation is restricted bilaterally.
Load & Shift Shoulder Instability, Anterior or Side-bending is usually restricted bilaterally.
Test Posterior The segment forward bends easily and is restricted
in backward bending.
Phalens Test Carpal Tunnel Syndrome
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Non-Neutral Somatic Dysfunction Table 23: Muscles Used for Inhalation Rib
Positional findings (R XSX): Somatic Dysfunction
Approximation of the transverse processes on side
X, caused by side-bending toward side X. Muscle Acts Upon
Separation of the transverse processes on side Y.
Posterior transverse process on side X, caused by Quadratus Lumborum Rib 12 Directly
rotation to side X.
Intercostales Forced Exhalation
Anterior transverse process on side Y.
The spinous process may be shifted slightly to side
Y. CHAPTER 11-THE INNOMINATES
These dysfunctions are generally very painful and AND PUBES
may present with a significant amount of paraverte-
bral muscle spasm. The standing flexion test will be positive on the side
Motion findings: of the dysfunction in both innominate and pubic
With motion testing, the segment will move in the direc- dysfunctions..
tion of somatic dysfunction and it will be restricted in
the direction opposite of the somatic dysfunction. Table 24: Innominate Dysfunction
Dysfunction Findings
Table 21: Non-Neutral Positional Diagnosis
Anterior Rotation ASIS inferior, PSIS superior
Transverse Transverse Posterior Rotation ASIS superior, PSIS inferior
Process Process
Dysfunction
Position in Position in Superior Shear ASIS superior, PSIS superior
Extension Flexion
Inferior Shear ASIS inferior, PSIS inferior
FRS Left Posterior Left Symmetrical
Innominate Inflare ASIS closer to the umbilicus
FRS Right Posterior Right Symmetrical
Innominate ASIS further from the
ERS Left Symmetrical Posterior Left Outflare umbilicus
Dysfunction Findings
Table 22: Muscles Used for Exhalation Rib Superior Shear Pubic tubercle superior
Somatic Dysfunction Inferior Shear Pubic tubercle inferior
Muscle Acts Upon Pubic Adduction Distance between the
pubic tubercles is
Scalenes Ribs 1-2 decreased
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L on LOA Positive right Negative More Right anterior Left posterior &
symmetrical inferior
R on LOA Positive right Positive Less Right posterior Left anterior &
symmetrical superior
L on ROA Positive left Positive Less Left posterior Right anterior &
symmetrical superior
Left Unilateral Positive left Negative More Left anterior Left posterior &
Sacral Flexion symmetrical markedly
inferior
Right Unilateral Positive right Negative More Right anterior Right posterior
Sacral Flexion symmetrical & markedly
inferior
Left Unilateral Positive left Positive Less Left posterior Left anterior &
Sacral Extension symmetrical probably
superior
Right Unilateral Positive right Positive Less Right posterior Right anterior &
Sacral Extension symmetrical probably
superior
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Copyright 2002 Steven L. Simmons, DO. All Rights Reserved. Internet Download Copy. WWW.DRSIMMONS.NET