Lymphatics Flashcards
Normal Lymph Node Characteristics
Pea sized Round Spongy Non-tender Mobile Baseline
Thoracic Inlet MFR
Position:
-patient supine, doctor seated at head of the table OR patient seated with physician standing behind patient
Hand Placement:
-hands palms down over shoulder, at cervicothoracic junction
-thumbs over posterior first rib, index fingers superior to clavicles at SC joints, middle fingers inferior to clavicles at SC joints
Technique:
-press toward patient’s feet and twist hands to feel for restriction of motion
-assess for motion: flexion/extension, rotation, sidebending
-apply principles of direct or indirect myofascial release
-release enhancing mechanisms
Doming the Diaphragm
Position:
-patient with hips and knees flexed, physician at patients side facing cephalad
Hand Placement:
-place thumbs inferior to xiphoid process with thumbs pointing cephalad
Technique:
-instruct patient 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
Position:
-patient prone, physician at side of table facing cephalad
Hand Placement:
-place thumbs medial to ischial tuberosities bilaterally
Technique:
-apply cephalad and lateral force
-increase force during exhalation, maintain on inhalation
Pectoral Traction
Position:
-patient supine with hips and knees flexed, physician standing at head of table
Hand Placement:
-grasp inferior to patient’s clavicle at anterior axillary fold
Technique:
-extend arms and lean back to apply cephalad traction bilaterally
-pull when patient inhales and resist on exhale
-repeat 5-7 times
Rib Raising (Supine)
Position:
-patient supine, physician sitting on side to treat
Hand Placement:
-grasp ipsilateral posterior/inferior rib angles (lateral TPs) by flexing fingers
Technique:
-starting eith T12, apply anterolateral traction by rocking backward/leaning elbows on table
-continue up ribs
Rib Raising (Seated)
Position:
-patient seated with arms crossed, physician standing facing patient
-patient crosses arms and leans forward toward physician
Hand Placement:
-grasp bilateral posterior/inferior rib angles lateral to TPs
Technique:
-starting with T12, pull superiorly and toward the physician
-continue up ribs
Tapotement
Position:
-patient prone, physician at patients side
Technique:
-apply rhythmic forces to thoracic region
-hacking = karate chop
-cupping = hands in c shape
-slapping = palmar surface of hand
Thoracic Pump: Repetitive/Oscillatory
Position:
-patient supine with hips and knees flexed
Hand Placement:
-place thenar eminence of each hand inferior to clavicles with fingers spread over upper rib cage OR over the sternum
Technique:
-have the patient take a deep breath and exhale fully
-at the end of exhalation, apply rhythmic posterior inferior pumping (120x/min)
-continue for several minutes
Thoracic Pump: Vacuum/Atelectasis Modification
Position:
-patient supine with hips and knees flexed, physician at head of table
Hand Placement:
-place thenar eminence of each hand inferior to clavicles with fingers spread over upper rib cage OR over sternum
Technique:
-have patient take a deep breath and fully exhale
-as patient exhales, apply a 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
Position:
-patient supine, physician at patients side facing cephalad
Hand Placement:
-place palms on abdomen with fingers towards patient’s head, thumbs side by side
Technique:
-pump posteriorly in a rhythmic manner (20-30x/minute)
Sacral Rocking
Position:
-patient prone, physician at patient side
Hand Placement:
-place heal of cephalad hand on sacral base with fingers pointing towards the coccyx
-caudal hand on top, pointing in cephalad direction
Technique:
-exert a gentle pressure downwards to gap SI joint
-alternate directions following respiration
-inhalation = sacral apex anterior (extension)
-exhalation = sacral base anterior (flexion)
-repeat 10 times until no further RB
Pedal Pump
Position: -patient supine, physician at foot of table Hand Placement: -contact plantar portion of feet Technique: -dorsiflex patients feet -apply on/off rhythmic cephalad force (120x/min) -continue 1-2 minutes
Effleurage and Petrissage
Position:
-patient supine, physician on side to treat
Technique:
-raise patient’s arm or leg to treat
Effleurage: induce stroking forced distally to proximally
Petrissage: induce kneading/twisting force distally to proximally
IT Band Effleuarge
Position:
-patient lateral recumbent with affect side up, physician facing patient
Hand Placement:
-place cephalad hand on patient’s greater trochanter for stabilization
-with caudal hand, make C shape and contact patient’s IT band
Technique:
-start halfway between greater trochanter and knee, stroking distal to proximal with gentle pressure
-after some congestion frees, start just superior to knee and continue stroking in a distal to proximal fashion
-continue 1-2 minutes
GLIDES OVER SKIN
Auricular Drainage
Position:
-patient supine, physician at patient’s side
Hand Placement:
-using caudad hand, place 3rd and 4th fingers in front of and behind ear
-use cephalad hand to stabilize patient’s head
Technique:
-apply a clockwise and counterclockwise motion
-continue for 2 minutes
Mandibular Drainage
Position:
-patient supine, rotate head toward doctor
-patient standing opposite side to treat
Hand Placement:
-place fingers of caudal hand along posterior ramus of mandible, place hypothenar eminence along body of mandible
-stabilize patient’s head with cephalad hand
Technique:
-apply slow, repetitive downward and midline traction on mandible (DO NOT SLIDE OVER SKIN)
-continue for 2 minutes, repeat on other side
Submandibular Drainage
Position:
-patient supine, physician at head
Hand Placement:
-place fingertips below inferior rim of mandible
Technique:
-direct fingers superiorly and evaluate for ease/restriction of motion
-apply principles of myofascial release, may use direct or indirect treatment
Cervical Chain Drainage
Position:
-patient supine, physician at head of table
Hand Placement:
-using caudal hand, place palmar aspect of fingers over SCM near angle of mandible
-use cephalad hand to stabilize
Technique:
-gently roll along muscles in a milking fashion, working caudally
-treat one side at a time to prevent pressing carotid sinuses bilaterally
Cervical Stroking
Position:
-patient supine, physician at head of table
Hand Placement:
-place hands along cervical paravertebral muscles
Technique:
-slowly stroke the region in a cephalad to caudal direction
Lymphatic Considerations
1) ALWAYS open thoracic inlet first
2) all lymph from diaphragm should be directed to appropriate lymphatic duct
3) all lymph from below the diaphragm should be directed to cisterna chyli
