Full spine AP make sure the patient is in the middle



Full spine AP make sure the patient is in the middle. Find the 2nd sacral tubercle to line them up left to right.

 

Dr. Montgomery leaves ear rings in since they are not in the way of the spine so that people can believe what they see and know what they are looking at. Also take the X-ray with the mouth open and breath in.

Breath in out and a half a breath in.

(if you are pregnant please let us know - SIGN up in room)

 

Go over: with patient

• The innominates

• Femur heads

• Ribcage

• Clavicle

 

Patient has a big gut, there is a band that attaches to the bucky that will mimck them laying down. The band is radio lucent.

 

Where does the beam go? Where it goes is where the xray is exposed. (1 inch below the gluteal fold or 2 inches below the top of the greater trochanter) (below the eye is where the top goes.

 

For children use a 14 by 17 if possible

 

1 full spine

4 - 14 by 17

5 - 8 by 10

2 - 10 by 12

 

Tube to film is 72 inches

 

If the patient normally wears shoes then the 1st time you take the film have the patient wear shoes.

 

Collimate, do not expose lens of the eye, if a marked scoliosis you want to watch your filters.

 

Lower Kvp by 16% and double MAS for elderly patients

 

Full spine lateral, patient should hold onto something to avoid counter balance

 

4:2:1 ratio

• To raise the L5 vertebra 1mm you have to raise the leg 4 mm

• Women sacrum has a pedistool (can be 8 to 10 mm high)

• 88 - 89.3% of women with scoliosis have an asymmetrical pedistool

• The 2mm is dependent on the sacrum

 

Ferguson's angle is the last one (L5, S1 spot shot)

(take this at 37 inches since there is such a large angle)

 

HANDOUT FROM GATTERMAN

 

Coccyx should go with the sacral curve

 

Adjustment could be made with hand on the sacrum and pisiform on the coccyx

 

Or you will have to go from the inside and lift out

• Use glove

 

Symptoms

• Cannot lean back (pain)

• Standing up from the sitting position (pain)

• Blurry vision

• Base headaches

• Mental confusion

 

 

Clinical Case #4

Sally Walker

• Chronic Recurring low back pain on right side

• Fallen from cheerleader accident

• Sciatica Grade 3 on right

• Pain up back to lower rib cage

• Posterior thigh pain on left side

• Headaches and stiff neck on right side

• ***repetitive stiff necks…red flag for scoliosis***

• At the time of consultation she is at a grade 1 sciatica

• Computer technician

• BP !!4/78

• Spasm of erector spinae

• Dimpling on left side (piriformis spasm)

• High right occiput

• High R crest

• High left shoulder

• 3 curves expected

• Distortion 3 or 4

• Hypertonicity R sided neck muscels

• 50lbs R 75lbs L

• Butterfly tattoo on back

• Moderate foot flare on left

• Tenderness in R SI joint

 

When you are looking the patient you are looking at a complex thing and you are trying to eliminiate the things that could not be wrong with them. Make the best guess that you can. This is called Diff Dx. This is why you have a practice when you get out of school.

 

There are different techniques for evaluating x-ray. Gonstead looks at the subluxation

 

In a rotary scoliosis we expect to see the body of the LFMV to be rotated down hill.

 

Where does the unleveling come from

• Anatomical short leg

• Wedged vertebra anywhere in the spine

• Open wedge (where the disc itself is shifted

 

Distortions are developed on typical spines that distort

 

When we look at a case, see how things are getting worse.

The longer the subluxation the more the body tries to correct itself and then throws the rest of the spine out. In Basic, the first 4 distortions are all the same person

• Dist. 1 is the step in the hole

• Dist. 2 for a few years

• Dist 3, the patient has ahd it for many years

• Dist 4, the person has aquired an anatomical short leg after a very long time of being subluxated

• Hyperlordosis - can gain weight easily with Low BMR, However it is hard to lose weight

• Hypolordosis - can eat as much as they want and is hard to keep the weight on, with a High BMR. They have a very unstable back while standing, and then when they bend over there back gives out

• Scoliosis does not cause pain, but causes a weakness and allows things to happen in the spine that should not happen. So when you are putting together a treatment plan for the patient you put together 2 treatment plans

• Short term - what are you doing today

• Long term - get rid of subluxation and make sure that it does not come back

• Logan Basic Method (LBM) chiropractors are structural chiropractors. LBM chiropractors look from the ground up

• So in the long term goal this works well, and possibly better than the segmentally orientated doctors.

• Basic should be used on the appropriate patients

▪ No sacral subluxation and no distortion (do not use, logan basic, LB)

▪ Shoulder problem unrelated to spine (do not us LB)

▪ Related to the spine, shoulder problem…use LB

• Pace - tight piriformis

• Batti sign - patient toes out and you pull out on it…have them resist against you bringing it in

• ROM - can't move in all ranges

• Full length Mirror in room

 

Wed Guest Lecture

Dr. Hutti

 

Word problems for FINAL

• Some questions on anatomy (LB)

• Sacrum

• Ligaments

• Muscles

• Sacral unlock…what is changing

• Distortional analysis

• Just injured back …never been to office before

• Acute AI sacrum

▪ Pelvis - high crest..no

• Tight erectors and piriformis…no rotation of L5 yet

▪ Tight AI sacrum

▪ High shoulder same side as subluxation

• Chronic AI w/ secondary scoliosis (R. AI)

▪ Shoulder low - R side

• Pregnant women

▪ Perineal contact at 5 months

▪ Explain to them where you will make the contact (perineum)

▪ Straight thumb

▪ To belly button

▪ On side

• Hot low back bent to left

▪ Pain on right side

▪ Acute disc protocal

▪ Apex on R first, then Left

• Wash hands after Apex…

• Questions about X ray

▪ PA = pelvic anteriority

▪ AI = anterior inferior

• Where on thumb

▪ Lateral 1/3

• End of apex

▪ Patient breath in and out…thrust to set adjustment

• HB Logan

• List presidents of college

▪ HB logan

▪ Vinton

▪ Coggins

▪ Morter - invetor of BEST

▪ B Hagen

▪ Goodman

• What year school founded

▪ 1935

 

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