Cranial Osteology

by Sheldon C. Yao, DO

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    00:01 Also, it is important to note that at birth, the different cranial bones are in different parts So the occiput at birth is in four parts, the sphenoid in three parts, the temporal bone in three parts the maxilla in two parts, there are six fontanels and no mastoid process.

    00:19 So this is important to consider because potentially there might be compressions, strains, forces that might potentially move some of these parts and these bones aren't fully formed yet.

    00:32 and those strains can potentially cause narrowing of different foramina, may compress some different nerves - cranial nerves and so it's important to understand the anatomy of the infant's skull at birth.

    00:46 So OMM can be applied to the cranium to treat cranial somatic dysfunctions.

    00:52 the infant cranium goes through significant strain during development, birth and growth.

    00:58 Even during development in the womb, it's a very tight spot.

    01:02 So based on the infant's development, the lie within the womb, sometimes the head might be compressed and pushed against different parts of the womb.

    01:11 At birth, the cranium undergoes significant forces, whether it's passage through the birth canal, or just pressure against the pelvis.

    01:22 And then during growth, the cranium could potentially receive any blows or trauma from frequent falls, or even just by pressure from how the baby lies to go to sleep.

    01:34 So by gently addressing these different cranial somatic dysfunctions, we could help with removing any restrictions that might be impinging on cranial nerves and to optimize growth and development.

    01:45 Musculoskeletal restrictions could contribute and lead to muscle spasms which then reduces circulation which then could cause pain.

    01:54 And so what we want to do is try to relax hypertonic muscles which then will enhance circulation and improve venous and lymphatic drainage and overall that will help improve our immune responses.

    02:05 So let's take a look at a common pediatric presentation that would really fit in the biomechanical model So here we have X-ray of a patient who demonstrates a spinal curvature.

    02:19 So here this is scoliosis.

    02:21 scoliosis is defined as lateral curvatures of the spine.

    02:25 And here you could see a S-shaped curve with the convexity in the thoracic spine to the right side and in the lumbar spine more to the left side.

    02:36 So we observed this scoliotic curves in the coronal plane.

    02:41 So in order to measure the severity of scoliosis, we use Cobb angles.

    02:46 And so with Cobb angles what you have to do is you have to identify the upper and lower invertebrae and you draw these lines along the vertical borders and where they meet, you measure that angle.

    02:58 That angle will tell you the severity of scoliosis, and based on these different Cobb angles, we could grade the severity of the scoliosis and that in turn then will dictate your potential management.

    03:10 whether it could be conservative management all the way to bracing, or we have to even be needing surgery.

    03:16 So the forward bend test is a special test you could perform to help screen for scoliosis.

    03:21 So usually this is done with the patient standing and you ask them to slowly bend forward to try to touch their toes.

    03:28 And what you're trying to observe for is to see if there is assymetry or a "rib hump" The rib hump is formed if there is a curvature in the spine.

    03:36 So usually, if you have a rib hump on a side, that will be the side of the convexity So remember back to thoracic biomechanics: If the thoracic spine is sidebent to one side, then it will rotate to the opposite side in a neutral spine.

    03:54 So that was Friyette's principle number one .

    03:58 And so if I have a scoliotic curve where my convexity is on the left side, then I'm sidebent right and thus rotate to left so your rib hump will always correspond with the side of the convexity So there's a difference when you find scoliosis to determine whether or not it is structural vs functional So the difference between structural and functional scoliosis is that a structural scoliosis will not change if you try to reduce it.

    04:29 and so generally what I do is I have the patient seated and I try to sidebend them pretty much into their convexity.

    04:37 So if someone was sidebent right and thus convexed left, I would try to sidebend them to the left to see if that scoliotic curve reduces.

    04:46 If it is reducible, then it is more of a functional scoliosis, meaning it's being caused by perhaps muscle spasms, or some other factor.

    04:55 If it's structural, then it will not change.

    04:59 So we could utilize OMM to try to help treat scoliosis.

    05:04 So we described scoliosis as a type 1 curvature and so with that diagnosis, we could utilize OMT to treat any sort of muscle spasm that might be causing and holding that type 1 curve.

    05:17 Also, it's important to look at the whole body.

    05:19 sometimes, patients may have a shorter leg.

    05:22 or a sacral base on leveling, or a pelvis dysfunction which then makes the base of the spine on level and then because the base of the spine is on level, the lumbar and thoracic spine will compensate and thus creating a lateral curvature.

    05:39 OMT could also help structural scoliosis.

    05:41 It may not completely reverse the scoliosis but if they were able to reduce some of the muscle tightness, improve a little bit more joint mobility, that might be able to then help patients feel a little bit more comfortable and slow the progression of the curvature.

    05:58 So torticollis is another pediatric presentation that could be treated with OMM Torticollis is due to spasms of the sternocleidomastoid muscles or better known as the SCM muscle Spasm of the SCM results in sidebending of the head towards and rotation away of the affected muscle.

    06:15 So if I have a spasm of my right SCM muscle, it's going to cause a right sidebending and a left rotation, So OMM could be utilized to treat SCM muscle spasms.

    06:28 What you want to do is to really address the origin-instertion of the sternocleidomastoid muscle.

    06:34 We want to look at the mastoid process which is part of the temporal bone.

    06:38 also looking at the cranial base, upper cervical region and also looking at its insertion on the sternum and the clavicles.

    06:45 So any sort of restrictions around the thoracic inlet could play a part and contribute to SCM spasms.

    06:52 And we also want to look at cranial nerve XI So cranial nerve XI also known as the spinal accesory muscle exits the jugular foramen which is located in between the temporal bone and the occiput.

    07:07 This cranial nerve provides motor innervation to the SCM muscle and the trapezius muscle.

    07:13 Signs of cranial nerve entrapment may include decreased range of motion in head and neck You may also see that the baby's kind of favoring one side a little bit more while feeding Plagiocephaly is another presentation that could potentially be treated with osteopathic manipulation.

    07:33 Plagiocephaly is a flattening or assymetry of the skull And so plagiocephaly actually has been increasing in incidence due to the national campaign to put babies back to sleep.

    07:50 And so when babies are frequently lying just on their back, it may create more pressure on the back of the head and thus create more of a flat head and sometimes if you add torticollis or kids may favor one side than the other, that might put more pressure on one of the right or left sides on the posterior aspect of the head thus creating a head that's a little bit more mishapen.

    08:15 We could utilize osteopathic treatment to address different cranial strain patterns and dural restrictions that might help to free those cranial bones and allow for proper growth and expansion.

    08:25 We also want to treat the cervical and thoracic spine because of all the different muscles that come out from that region attach to the cranium.

    08:32 Try to address any potential nerve compressions and to definitely check the clavicles and upper extremities for dysfunctions too because the muscles attached there can also potentially pull on the neck and like we said before, put undo pressure on the head assymetrically.

    About the Lecture

    The lecture Cranial Osteology by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by Specialty.

    Author of lecture Cranial Osteology

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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