Friday, December 24, 2010

AHP @ Abnormal Head Posture

Before we discuss further,

Let us remember this diagram:
 and 3 component of AHP:
1) Face turn
2) Head Tilt
3) Chin elevation/depression

As well as purpose of AHP:
--> Avoid diplopia & gain BSV.

What muscles will involve (u/a & o/a) when:
1)Face turn to the Left?
2)Head tilt to the Right?




3)Chin depressed?




4)Face turn to the left, head tilt to the right and chin depressed? please state the affected eye as well.

let's discuss together... :)

61 comments:

  1. Tq so much Rohaila for this post...Helo class, let's discuss our 2nd trigger for SC. Deadline before 12am this Tuesday.

    ReplyDelete
  2. Salam..

    1)face turn to left
    -affected muscle: u/a LLR
    -muscle sequelae: -o/a RMR, o/a LMR, u/a RLR

    2)head tilt to right
    -affected muscle: u/a LSO
    *http://emedicine.medscape.com/article/1200187-treatment
    -muscle sequelae: o/a IR, o/a LSR, u/a IO

    3)chin depressed
    -affected muscle: u/a double depressor
    - o/a double elevator

    enlighten me if i'm wrong..

    ReplyDelete
  3. 1)face turn to left,
    -u/a: LLR
    -o/a: LMR
    so, LE is the affected eye.

    2)head tilt to right
    -u/a: LSO
    -o/a: RIO, LSR
    So, LE is the affected eye.

    3)chin depressed
    -u/a: double depressor [like c.nur said ;)]
    -o/a: the elevator muscles.

    pls, correct me if i'm wrong..

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  4. @rohaila

    I've one question.

    Your patient has left face turn, chin up and right head tilt...which muscle is affected?

    ReplyDelete
  5. Left face turn (right gaze):
    the u/a muscles : LLR and RMR.


    Right head tilt :
    RE intortion, LE extortion
    RE: o/a of RSR and RSO, u/a RIO and RIR
    LE: o/a of LIO and LIR, u/a LSR and LSO

    chin depression :
    u/a of the deppressor muscles of BE
    RIR and LIR.

    Left face turn(right gaze), right head tilt, chin down:
    affected muscle: LSO

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  6. I'm not sure, sir...

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  7. anyone please correct me...

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  8. A) Face turn left:
    Possible cause of face turn:
    1) LLR palsy, or
    2) RMR palsy, or
    Muscles involved:
    1) u/a of LLR and o/a LMR ----- LLR palsy
    2) u/a of RMR and o/a RLR ----- RMR palsy

    B) Right head tilt
    Possible cause of head tilt
    1) RIR palsy, or
    2) LSO palsy, or
    Muscles involved:
    1) If the case is RIR palsy --- u/a of RIR, u/a of LSR, o/a of RSO and o/a of RIO
    2) If the case is LSO palsy --- u/a of LSO, u/a of RIO, o/a of LIR and o/a of RSR

    C) Chin depression
    Possible cause of chin depression
    1) RIR palsy, or
    2) LIR palsy, or
    3) both
    Muscles involved:
    1) if case of RIR palsy ----- u/a of RIR and o/a of RSR
    2) if case of LIR palsy ----- u/a of LIR and o/a of LSR


    answer for no.4 i'll post later. need to do 'park 3 test first'..hehe..

    ReplyDelete
  9. ok sorry, some correction on my first post/comment

    A) 2)RMR palsy, or ------> pls remove the word 'or'.
    B) 2)LSO palsy, or ------> pls remove the word 'or'.

    tq

    ReplyDelete
  10. 1) Face Turn to LEFT
    o/a- RMR
    o/a- LMR
    u/a- RLR

    2) Head Tilt to RIGHT (RE HYPO)
    affected muscle RIO
    o/a- LSR
    o/a- RIR
    u/a- RSO

    2) Head Tilt to RIGHT (LE HYPER)
    affected muscle LSO
    o/a- RIR
    o/a- LSR
    u/a- RIO


    3) Chin DEPRESSED
    Depressor muscles BE SR & BE IO

    If patient has left face turn, chin up and right head tilt

    1) Face Turn to LEFT
    o/a- RMR
    o/a- LMR
    u/a- RLR

    2) Head Tilt to RIGHT (RE HYPO)
    affected muscle RIO
    o/a- LSR
    o/a- RIR
    u/a- RSO

    2) Head Tilt to RIGHT (LE HYPER)
    affected muscle LSO
    o/a- RIR
    o/a- LSR
    u/a- RIO

    3) Chin UP
    Elevator muscles BE SO & BE IR

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  11. left face turn, chin up, right head tilt:

    u/a:LLR,LSO,IR for BE.
    o/a:LMR,RIR,SR for BE.

    this is my opinion... :)

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  12. @rohaila

    ela if you don't mind, can u explain more on your answer?

    *the answer can vary right?

    ReplyDelete
  13. SAYA PENING .....TOLONG SAYA :(

    ReplyDelete
  14. sorry, this is the right order..

    left face turn, right head tilt and chin up:

    u/a:LLR,LSO,IR for BE.
    o/a:LMR,RIR,SR for BE.

    ReplyDelete
  15. answering for question sir,

    -left face turn: u/a LLR, RLR
    o/a LMR, RMR

    -chin up: affected of double elevator

    -right head tilt: muscle affected is LSO

    ReplyDelete
  16. tibe-tibe lost..i dont know which questions need to be answer first... ~x(

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  17. assalamualaikum...

    wahh, lots of answers... :-o

    1] face turn to the left:
    ~ the affected muscle come from left eye
    ~ so, the affected muscle : LLR
    ~ o/a : RMR, LMR,
    ~ u/a : RLR

    2] head tilt to the right :
    ~ the affected muscle come from left eye
    ~ so, the affected muscle : LSO
    ~ o/a : RIR, LSR
    ~ u/a : RIO

    3] chin depressed :
    ~ the affected muscles come from BE depressor muscles (SO & IR)
    ~ o/a : BE (IO & SR)
    ~ u/a : BE (SO & IR)

    4] face turnto the left, head tilt to the right, chin depressed :
    ~ the affected eye : LE
    ~ u/a : LLR, LSO , BE(SO & IR)
    ~ o/a : LMR, LSR , BE(IO & SR)

    for this case (question no 4), can BE depressor muscles (SO & IR) be the affected muscles or just either one......correct me if i'm wrong... :D

    ReplyDelete
  18. hmmm..i think the answer can vary, azuwan.

    for my answer, how should i explain ye...mmmm, left face turn u can understand right??coz face turn always involve 2 horizontal muscles.

    for tilting i think it mostly involve SO/IO while depression/elevation mostly contributed by either SR or IR coz their primary action is torsional and up/down movement respectively.

    that's why i juz give the simple answer..but, there are many possibilities.

    sir, pls enlighten me~

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  19. @M.Sobri
    try answer the latest question from sir..

    ReplyDelete
  20. i agreed with atikah for question 1,2 and 3..hoho..she s my beloved groupmate though.ngeh3

    i would like to answer question no 4, the affected muscle is right eye. but for the u/a and o/a muscle i am still thinking for the right answer.hehe

    ReplyDelete
  21. Makin byk sy bca, makin sy pening....

    ReplyDelete
  22. huhuk..juz pegang konsep dye jer.. (pandai2 jer..:p)

    ReplyDelete
  23. aslmkm everyone..



    1)left face turn:
    -possible affected muscle is LLR
    -for muscle sequele...
    i) o/a contralateral synergist - O/a LMR
    ii) o/a ipsilateral antagonist - o/a RMR
    iii) u/a contralateral synergist - u/a LLR

    right head tilt:
    - possible affected muscle is LSO
    - for muscle sequele..
    i)o/a contralateral synergist - o/a RIR
    ii) o/a ipsilateral antagonist - o/a LSR
    iii) u/a contralateral synergist - u/a RIO

    chin depressed/down:
    -possible affected muscles are BE depressor muscles


    agree with che nur..grab the concept..=)

    ReplyDelete
  24. my answer for first problem..ela's question...

    no.1 face turn to the left
    -equal to face turn to the palsy muscle (left side)
    -the plasy muscle/affected muscle would be LLR
    -thus, the o/a muscles would be RMR & LMR
    -and the u/a would be RLR



    no.2 head tilt to the right
    - head tilt to right palsy muscle(LSO)
    - thus, the o/a muscles would be RIR & LSR
    - and u/a muscle would be RIO

    no.3 chin depress
    - face look down and the eyes will be elevated up
    - the o/a muscles would be RSR & LSR
    - and the u/a muscles would be RIR & LIR

    ReplyDelete
  25. @rohaila

    Perhaps everyone can comment more on question no. 4. like Eli said the problematic eye is RE, which result left turn, right tilt n chin depress.

    Eli, why do you think the RE causing such adaptation?

    Sob, you can give some opinion here as well.

    What I hv to my mind just now, the faulty muscle is the oblique muscle of RE which has 3 action: depression, intorsion, abduction.
    so, probable faulty muscle is RSO.
    this muscle has those 3 actions.

    since we already know the faulty muscle, so we can easily apply the formula given by Sir Muziman. 'Z' and 'S' formula.

    Any comment or correction?

    ReplyDelete
  26. and for the second problems (sir question)...

    no.1 left face turn
    - answers are same with the first problem

    no2. chin up
    - face look up & down gaze
    - the o/a muscles are RIR & LIR
    - the u/a muscles are RSR & LSR

    no.3 right head tilt
    - answers are same with the first problem

    ReplyDelete
  27. @azuwanmusa

    yes for the head tilt i did use the "z" formula...but for the chin up/down and face turn i just follow the 3 rules from hering and sherington's laws...

    ReplyDelete
  28. sory, late comers..hehehe

    i'll try answer Q4 which are:
    Left face turn, Right head tilt and Chin up

    the possible
    u/a:LLR,LSO,LIR,RIR.
    o/a:LMR,RIR,LSR,RSR.

    -correct me if i'm wrong...phening2 lalat..8-}

    ReplyDelete
  29. @azuwanmusa

    this answer is actually referring to the RE as the problematic eyes.

    From answer given by many friends: aida, ela, nisah, hanan, the problematic eye is LE. Meaning to say, left face turn, right tilt and chin depress are due to LSO palsy (u/a).

    let us relate this. if we perform park 3 test on patient with LSO palsy, does the result show left face turn, right head tilt and chin depression?

    ReplyDelete
  30. @azuwanmusa

    this answer is referring to the RE as the problematic eye (Eli said so. RSO under action/palsy may be the probable cause of face turn, heat tilt to right and chin depression.

    Since most frends (aida. ela, nisah, hanan) answer LSO as the u/a muscle, so the problematic eye now is LE. I'm I right?

    So, LSO palsy ---- causing those three adaptation. Moreover SO involves in intorsion, depression and abduction.

    Let say. If we are about to perform park 3 step test on patient with LSO palsy, does the end result showing patient has face turn left, right head tilt and chin depression?

    Do you get what i'm trying to say?

    ReplyDelete
  31. @azuwanmusa

    @azuwanmusa

    this answer is referring to the RE as the problematic eye (Eli said so. RSO under action/palsy may be the probable cause of face turn, heat tilt to right and chin depression.
    Since most frends (aida. ela, nisah, hanan) answer LSO as the u/a muscle, so the problematic eye now is LE. I'm I right?
    So, LSO palsy ---- causing those three adaptation. Moreover SO involves in intorsion, depression and abduction.
    Let say. If we are about to perform park 3 step test on patient with LSO palsy, does the end result showing patient has face turn left, right head tilt and chin depression?

    Do you get what i'm trying to say?

    ReplyDelete
  32. @azuwanmusa

    this answer is referring to the RE as the problematic eye (Eli said so. RSO under action/palsy may be the probable cause of face turn, heat tilt to right and chin depression.

    Since most frends (aida. ela, nisah, hanan) answer LSO as the u/a muscle, so the problematic eye now is LE. I'm I right?

    So, LSO palsy ---- causing those three adaptation. Moreover SO involves in intorsion, depression and abduction.

    Let say. If we are about to perform park 3 step test on patient with LSO palsy, does the end result showing patient has face turn left, right head tilt and chin depression?

    Do you get what i'm trying to say?

    ReplyDelete
  33. @azuwanmusa

    this answer is referring to the RE as the problematic eye (Eli said so. RSO under action/palsy may be the probable cause of face turn, heat tilt to right and chin depression.

    Since most frends (aida. ela, nisah, hanan) answer LSO as the u/a muscle, so the problematic eye now is LE. I'm I right?

    So, LSO palsy ---- causing those three adaptation. Moreover SO involves in intorsion, depression and abduction.

    ReplyDelete
  34. Let say. If we are about to perform park 3 step test on patient with LSO palsy, does the end result showing patient has face turn left, right head tilt and chin depression?

    Do you get what i'm trying to say?

    ReplyDelete
  35. Askum everyone...
    I think i agree with azuwan... if we look at each position individually will will get a variety of u/a muscles and o/c muscle. And I go all the way from up and i can say that i agree with c.nur and dayah on the muscles involved. But if we consider all of this happening on the same muscle and eye, the faulty muscle would be on the RE and the SO muscle considering the AHP involved. So i agree with eli on this one..

    ReplyDelete
  36. Sorry i missed the train. Will comment on quest no 1, 2 n 3 1st.

    1. Left face turn
    U/A: LLR
    sequeale: O/A: RMR, LMR, U/A: RLR

    2. Right head tilt
    U/A: LSO
    sequeale: O/A LSR, RIR, U/A: RIO

    3. Chin depression
    U/A: BE SO, IR, O/A: BE SR, IO

    Will update on quest no4 soon, insyaAllah

    ReplyDelete
  37. Zahirah could you plz enlighten me on how it about he RSO being the faulty muscle?:D
    From the info that we have (left face turn, right head tilt and depressed chin), we can only shorlist the possible faulty muscle as what have been listed above.
    But to rule out a single faulty muscle, we have to perform park 3 step test.
    This is what we have discussed during last paediatric case, which was also discussed in this blog.
    Or if there's a method to rule out single faulty muscle from the information we have, plz let me know....

    ReplyDelete
  38. @nazaryna marzuki

    To answer this question, all of you must remember muscle sequeale lecture..

    O/A contra synergist
    O/A ipsi antagonist
    U/A contra antagonist

    or just remember the z or s pattern

    from , the MS..we can know which muscle is affected.

    Same to AHP...from AHP position, we can relate with muscle the MS involved..from that, we can know which muscle is affected.:D




    Park Three step test only for vertical muscle.

    ReplyDelete
  39. varies answers from u guys...
    the affected muscle is the verticle muscle...
    some said LSO n some said RSO...

    so,which one is the affected muscle?.. =((

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  40. based on the face turned to the left, right head tilt and chin dpressed.. i think this is a Duane's syndrome.

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  41. and the affected muscle probably would be RSO and LIR.

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  42. @eli aimi

    duane syndrome? how did you get that answer? do you have any link to share here?

    ReplyDelete
  43. hi everyone.

    1)left face turn
    u/a muscle is LLR. the affected eye is LE

    -when LR is palsy, pt sometimes adopt a face turn towards the side of the affected eye. Thus, Left face turn signify LLR palsy


    2)Right head tilt
    u/s muscle is LSO. The affected eye is LE

    - when SO muscle is palsy, the head will usually tilt apposite to the affected eye.


    3)chin down
    u/a muscles of depressor muscles.
    u/a of RIR & LIR, RSO & LSO

    4))Left Face Turn, Right head tilt and chin down
    u/a of LIR, affecting the LE

    ReplyDelete
  44. salam. here is my answer:

    1)u/a of LLR. affecting LE.

    -when LR is palsy, face will usually turn towards affected side. As it is LEFT face turn, LLR is the one being under action.


    2)u/a muscle is LSO. affecting LE.

    - when SO is palsy, the head will tilt to the opposite side. as it is RIGHT head tilt, LSO is the one being under action.


    3) u/a of depressor muscles. (RIR & LIR, RSO & LSO)


    4)LEFT face turn, RIGHT head tilt, Chin down
    u/a muscle is LIR. affected LE

    ReplyDelete
  45. salam. here is my answer:

    1)u/a of LLR. affecting LE.

    -when LR is palsy, face will usually turn towards affected side. As it is LEFT face turn, LLR is the one being under action.


    2)u/a muscle is LSO. affecting LE.

    - when SO is palsy, the head will tilt to the opposite side. as it is RIGHT head tilt, LSO is the one being under action.


    3) u/a of depressor muscles. (RIR & LIR, RSO & LSO)


    4)LEFT face turn, RIGHT head tilt, Chin down
    u/a muscle is LIR. affected LE

    ReplyDelete
  46. salam...the answer for above questions are:

    1)left face turn:
    - affected muscle is LLR
    -o/a RMR
    -o/a LMR
    -u/a RLR

    2)head tilt to the right:
    - affected muscle are:RSR,RSO,LIO,LIR

    3)Chin depression:
    - u/a depressor muscle: RIR,RSO,LIR,LSO

    4) Left face turn,right head tilt,chin down:
    - o/a: RMR,LMR,RIR,LSO,RSO,LIR
    - u/a: elevator muscle:RSR,LIO,RIO,LSR
    :-/ not sure the answer for the question 4

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  47. the question no.4 is from group 2 and 3 paed case on first week...

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  48. what is the final answer so that we can conclude this case??????????????? BLURRED..

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  49. i dont know if my answer is right but u can refer this ;
    http://www.cybersight.org/bins/content_page.asp?cid=1-2897-3877-3878

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  50. @azuwan

    here ;
    http://www.cybersight.org/bins/content_page.asp?cid=1-2897-3877-3878

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  51. LEFT FACE TURN, CHIN UP, RIGHT HEAD TILT

    =THE AFFECTED MUSCLE IS RIO

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  52. @bahjah

    Left Face turn, Right head tilt, Chin down=

    the answer is RIR

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  53. sir, I think the correct answer is LIR

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  54. yeaaa...the answer is LIR..based on Syah's diagram! heheee

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  55. This comment has been removed by a blog administrator.

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