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Diagnosis of Head and Cranial

by Sheldon C. Yao, DO

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    00:01 Cranial somatic dysfunction diagnosis In order to diagnose dysfunctions of the cranium, there are 3 basic hand holds and what we wanna do is to review those hand holds to see if we could get a sense of what's going on with the cranium and if we see any asymmetries or feel any sort of pulse as we're in those positions.

    00:19 So what we wanna do first is to get our hands in a vault hold, vault hold is the most basic hold here, what we want to do is to get our hands on the vault to get a sense of what might be going on at the base.

    00:31 So we're gonna place our pointer finger over the greater wing, our third and fourth fingers are gonna straddle the ear, one in front of the ear and one behind the ear and our pinky finger's gonna come back and try to reach the occiput and we'll do the same thing with the opposite hand We're going to get our thumbs touching but not pushing down on the head and we want to have a nice gentle contact, we don't want to squeeze on the head and now we want to get a sense of what might be going on underneath our fingers.

    01:01 Do we feel assymetry? do we feel flexion and extension? do we feel things kind of expanding and contracting? And in this hold you could appreciate what's going on at the vault to try to get a sense of the diagnosis of the cranial base Another hold that we could utilize is the frontal-occipital hold.

    01:23 so in the fronto-occipital hold, we're gonna get the AP contact, we're gonna place our hands underneath the occiput and so one hand is across with our fingers along the nuchal line and the other hand is going to rest on the frontal bone with my middle finger on glabella and my second and fourth fingers also on the frontal bone.

    01:43 So in this contact, we get a better sense of the anterior-posterior cranium and we could see what we're feeling, and it's almost like getting another view of the cranium so you get a sense of what's going on at the base.

    02:01 There is the posterior occipital hold or also the Becker hold, in this hold, we're focusing a little bit more at the posterior fossa here, we're gonna let our palms rest on the occiput, the rest of our fingers kinda rest gently on the cervical spine and we're gonna let the weight of the head just kinda rest on our palms, and our thumb's gonna come forward and reach the greater wings of the sphenoid.

    02:28 So with this contact, we're getting a better sense of what's going on in the posterior aspect of the cranium with a little bit more focus on the occiput, the temporal bones and my thumbs up here reaching forward to the sphenoid.

    02:43 So through these three hand contacts, we get a better sense of what's going on at the cranium So with our holds, we're trying to get sense of cranial strain patterns The cranial strain patterns are adaptation of the cranium at the vault for what's going on at the base So the first contact that we have -the vault hold is what we're gonna use and with the vault hold, what we're gonna get a sense of our different strain patterns that are combinations at the base - There are three strain patterns that are physiologic.

    03:17 They are flexion and extension, sidebending and rotation, and torsions.

    03:23 so the first physiologic one we'll talk about is flexion and extension, we get our fingers in the vault hold in which we're gonna get a sense of is with flexion, your fingers are going to spread out a little more, and kind of move down towards the feet.

    03:37 And then with extension, your fingers are gonna come closer together and come up to the head, and so again, flexion and a little bit wider in extension, a little bit more narrow and your finger's coming up towards the head.

    03:52 The next pattern we're gonna look at is sidebending rotation, remember sidebending rotation, we're gonna have our fingers spread out on one side that's the side of convexity and then go down and rotate on that AP axis down towards the feet, so here is a right sidebending rotation - my fingers are spread out on the right hand and rotate down towards the feet while the opposite hand - my fingers are gonna come closer together and rotate up towards the head.

    04:18 So that will be a right sidebending rotation.

    04:21 On left sidebending rotation, my fingers are gonna spread out on the left side and my fingers are gonna come closer together on the right side, and my fingers on the left hand are gonna go down towards the feet, my fingers on the right hand wil go up towards the head so this would be the vault hold and this would be a left sidebending rotation.

    04:38 So once again, a right sidebending rotation, and a left sidebending rotation The third physiologic strain pattern is torsion.

    04:49 So remember the torsion, the sphenoid and occiput are rotating in opposite directions in AP axis, so what you're gonna feel is the greater wing's gonna come up along with the rest of the cranium on one side so this would be a right torsion and then this would ba a left torsion, your hands are gonna go in opposite directions in torsion- so right torsion and a left torsion So those are the three physioologic strain patterns, a nonphysiologic strain patterns tend to be secondary to traumas so we have our lateral strains and our superior and inferior shears and compressions, So lateral strain patterns, what you have happening is the sphenoid and the occiput are rotating the same direction on two vertical axes and what you're gonna get is the sphenoid and occiput are gonna shift on each other and shear so this would be a lateral shear with a greater wing to the right and this would be a lateral shear with the greater wing to the left it's almost making a parralellogram with your hand so again, vault hold and this is a lateral shear with the greater wing to the right and here's a lateral strain - greater wing to the left.

    06:01 In superior and inferior shears, we have your sphenoid and occiput rotating in the same direction about two transverse axes so what happens is the sphenoid is going to rotate anteriorly into extension and the occiput is also gonna rotate into extension and then what you have, sorry the occiput's gonna rotate into flexion and so what you have is all your fingers are going to feel like they're going down, so in a superior shear, for a vault hold, all your fingers are gonna feel like they're gonna point down towards the table.

    06:35 In a inferior shear, the sphenoid's gonna rotate posteriorly and the occiput is also gonna rotate posteriorly so everything's gonna feel like they're going up towards the ceiling so in inferior shear, all your finger's gonna kinda rotate up towards the ceiling, and in a superior shear, all your fingers' gonna rotate down towards the floor.

    06:54 Finally in a SPS compression, what we're gonna get a sense of is that, as you put your hands in a vault hold that you're really don't feel much excursion at all, you really can't detect much expansion, the traumatic forces of SPS compression has pushed the sphenoid and occiput and compress at the SPS, that there's really lack of general motion or movement of excursion and you might feel increased density.

    07:18 So those are our three non-physiologic strain patterns.


    About the Lecture

    The lecture Diagnosis of Head and Cranial by Sheldon C. Yao, DO is from the course Osteopathic Diagnosis of the Cranial Region.


    Included Quiz Questions

    1. Vault hold
    2. Fronto-occipital hold
    3. Frontal hold
    4. Becker hold
    5. Posterior-occipital hold
    1. Greater wing of sphenoid
    2. Lesser wing of sphenoid
    3. Temporal bone
    4. Occiput
    5. Parietal bone
    1. Glabella
    2. Greater wing of sphenoid
    3. Temporal bone
    4. Occiput
    5. Parietal bone
    1. Compression
    2. Lateral shear
    3. Vertical shear
    4. Horizontal shear
    5. Sidebending

    Author of lecture Diagnosis of Head and Cranial

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO


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