Somatic dysfunction

In osteopathic medicine and osteopathy, somatic dysfunction is defined as the impaired or altered function of related components of the somatic (bodywork) system including: the skeletal, arthrodial, and myofascial structures, and their related vascular, lymphatic, and neural elements. Somatic dysfunction may be evaluated and treated by osteopaths or osteopathic physicians using osteopathic manual technique (OMT).^[1]

Diagnosis

Somatic dysfunction is diagnosed via physical examination by an osteopathic physician, which is a physician with the Doctor of Osteopathic Medicine degree (D.O.). The osteopathic physician looks for signs and symptoms related to the somatic dysfunction commonly represented by the mnemonic device "TART" (tissue texture change, asymmetry, restriction, and tenderness) or "STAR" (sensitivity, tissue texture change, asymmetry, restriction).^[2] The physician uses techniques such as layer-by-layer palpation and intersegmental range of motion testing to diagnose the somatic dysfunction. Diagnosis usually requires only the use of the physician's hands and fingertips, though instruments such as a goniometer can be used to detect a diminished range of motion.

Signs and symptoms

Tissue texture changes may include edema, fibrosis, atrophy, rigidity, or hypertonicity of musculature.^[2] There may be asymmetry in the bones, muscles, or joints.^[2] There may also be a "restrictive barrier" related to the musculoskeletal structure in question. The language of "barriers" refers to the point at which a structure cannot move farther in a given direction. For example, a natural "physiologic barrier" of the arm represents the farthest that a person can naturally move their arm before it cannot be comfortably moved farther. The "anatomic barrier," describes how far the arm can be pushed or pulled by an outside force before the arm becomes physically injured. A "pathological" or "restrictive" barrier represents the shortened range of motion to which the arm is confined because of an injury, muscle spasm, or some other somatic dysfunction. The goal of treatment is to restore the arm's full range of motion (or that of the structure in question). Of the signs and symptoms associated with somatic dysfunction, tenderness is the only purely subjective finding, while the others are objective findings.^[2]

Types of somatic dysfunction

Other types of somatic dysfunctions may include occlusions or mutilations of vasculature or lymphatic vessels, which can impair cardiovascular or lymphatic circulation. This may also occur secondary to organ pathology, a factor which theoretically allows the detection of visceral dysfunction by examining surface structures. It is by this explanation that Chapman's Points are said to be used in identifying problems with deep tissue structures. A Chapman's Point is an area of bunched tissue or vasculature that is assumed to occur as a result of fluid backup or another dysfunction at a portion of the vasculature more proximal to an organ affected by pathology.^[3] The evidence for these points remains controversial, though some studies suggest modest sensitivity and specificity for their use in diagnosis.^[4]

See also

• Fryette's laws

References

Additional sources

• Ward, Robert (2003). Foundations for Osteopathic Medicine (2nd ed.). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-3497-5. 
• Savarese, Robert G.; Copabianco, John D.; Cox, James J. (2009). OMT review. ISBN 978-0967009018.