Lymphatics Flashcards
How do you evaluate central myofascial pathways?
look for compensated vs uncompensated patterns
compensated = L/R/L/R, etc
uncompensated patterns can further contribute to lymphatic congestion
What are the 4 junctions should you evaluate before doing lymph treatments?
Cranial-cervical
Cervical-Thoracic
Thoraco-lumbar
Lumbo-Pelvic
How do you evaluate the cervical-thoracic junction?
observe symmetry of the inlet
examine supraclavicular and infraclavicular areas for TART
place palms on scapula and fingers rest w/ pads infraclavicularly to introduce rotation to the right and left
How do you evaluate the thoracolumbar junction?
Observe symmetry of the rib cage
palpate lower-most ribs w/ entire hand and examine for tenderness, texture abnormality, and asymmetry
place palms on lateral aspects of lower ribs to introduce rotation to left and right
How do you evaluate the lumbopelvic junction?
palpate the ASIS and iliac crests
place pads of hands on posterolateral aspects of innominates to induce rotation to the right and left
TART
What are the 3 fluid pumps?
thoracic inlet
thoracic diaphragm
pelvic diaphragm
What is the zink test?
warmth provocative test
warmer areas may be a site of SD
What are the 5 principles of diagnosis?
evaluate for indications/risk-benefit ratio evaluate central myofascial pathways evaluate fluid pumps evaluate for spinal involvement evaluate peripheral/regional pathways
What do you feel for when palpating lymph nodes? (6)
size shape consistency tenderness mobility overlying skin
What are the regional collection sites (6)?
supraclavicular space epigastric region posterior axillary fold inguinal region popliteal space achilles region
What are the 4 principles of lymph treatment?
- open pathways to remove restriction to flow
- maximize diaphragmatic functions
- increase pressure differentials or transmit motion
- mobilize targeted tissue fluids
Thoracic inlet MFR
pt supine w/ physician at head of table
hands palms down over shoulders, at cervicothoracic jxn
thumbs over posterior first rib, fingers at SC joint
Assess for motion, apply MFR principles
Doming the diaphragm
pt supine w/ hips and knees flexed
thumbs inferior to xiphoid process w/ thumbs pointing cephalad
instruct pt to take a deep breath and exhale
on exhalation, press thumbs posteriorly and superiorly
push further on exhalation, resist on inhalation
repeat 3-5 times
Ischiorectal fossa release: Doming the pelvic diaphragm
pt prone, physician at side of table facing cephalad
thumbs medial to ischial tuberosities bilaterally
apply cephalad and lateral force
increase force during exhalation, maintain on inhalation
Pectoral traction
pt supine w/ hips and knees flexed, physician at head of table
grasp inferior to pt’s clavicles at anterior axillary fold
apply cephalad traction bilaterally
pull when pt inhales and resist on exhale
repeat 5-7 times
Rib raising (supine)
Pt supine, physician sitting on side to treat
grasp ipsilateral posterior/inferior rib angles by flexing fingers
starting w T12, apply anterolateral traction by rocking backward/leaning elbows into the table; continue up ribs
Rib raising (seated)
Pt seated w/ arms crossed, physician faces pt and pt leans forward toward dr
dr grasps bilateral posterior rib angles
starting w/ T12, pull superiorly and toward Dr. continue up ribs
Thoracic pump: repetitive/oscillatory
pt supine w/ hips and knees flexed
place thenar eminence of each hand inferior to clavicles (offer woman a pillow or place their hands under yours)
have pt take a deep breath and exhale fully
at the end of exhalation, apply rhythmic posterior inferior pumping
120x/min for several minutes
Thoracic Pump: (vacuum/atelectasis modification)
Pt supine w/ hips and knees flexed
thenar eminence inferior to clavicles and hands on chest
have pt take a deep breath and exhale fully
as pt exhales, apply compressive force downward and resist during inhalation. continue for 4-5 breaths
at beginning of last inhalation, briskly remove hands to allow for rapid, deep inhalation
Abdominal pump
Pt supine, physician at pt’s side
place palms on abdomen w/ fingers toward pt’s head, thumbs side by side
pump posteriorly in a rhythmic manner 20-30 times a min
Sacral rocking
Pt prone
place heal of cephalad hand on sacral base w fingers pointing toward coccyx, other hand on top pointing cephalad
exert gentle pressure downwards to gap SI joint
inhalation = sacral apex anterior (extension)
exhalation = sacral base anterior (flexion)
Pedal pump
pt supine, physician at head of table
contact plantar portion of feet
dorsiflex pt’s feet
on and off rhythmic cephalad force 120x/min for 1-2 min
Tapotement
pt prone, physician at pt's side apply rhythmic forces to thoracic region hacking = karate chop cupping/clopping = cup hands into slight C shape slapping = use palmar surface of hands
Effleurage and Petrissage
pt supine, physician on side to treat
raise pt’s arm or leg to treat
effleurage: stroke distally to proximally
petrissage: kneading/twisting distally to proximally
