OPP Flashcards
Ribs 2-5 move….
in sagittal plane anteriorly to change AP diameter; PUMP HANDLE
Ribs 6-10 move…
in coronal plane laterally to change transverse diameter; BUCKET HANDLE
Ribs 11 and 12 move…
posterolaterally and anteromedially since they’re floating; CALIPER
Inhaled rib has restriction in _________ so it is stuck _____ and will not move ______ making the key rib the _______ of the group dysfunction.
exhalation; up; down; bottom
Exhaled rib has restriction in _________ so it is stuck _____ and will not move _____ making the key rib the _____ of the group dysfunction
inhalation; down; up; top
Right side most often _______
Exhaled
Left side most often _____
Inhaled
Posterior ribs 2-10 CS
Lean patient toward TP to elevate rib and sidebend away (so if on left side, lean left and sidebend right)
Anterior ribs 3-10 CS
Lean patient away to depress rib and sidebend toward TP (so if left, lean right, sidebend left)
Posterior rib 1 CS
flex arm on same side of TP and rest on examiner’s knee
Anterior ribs 1-2 CS
rotate and flex neck towards same side of TP
Indirect MFR for subluxed or key rib
- Hold entire rib and compress front to back
- Pull compressed rib laterally into POE
- Follow tissue give until done
- Recheck
Direct MFR for subluxed or key rib
- Pull subluxed or key rib angle superior and maintain pull
- Move arm into restrictions (abduct internally rotated, abduct or adduct externally rotated)
- Repeatedly compress the shoulder toward the rib angle
- Retest
Costochondritis
- Inflammation @ costochondral junction
- gradual
- tenderness on chest wall w/o swelling
- pain @ costochondral junction, at rest or during movement, hours to days, can be pleuritic
Rib tip syndrome
- Sharp pain @ end of costal cartilage/rib tip and radiates to abdomen or pelvis/groin
- Intermittent pain, worse with truncal motion
- Usually ribs 10-12
- may have clicking
Scapulocostal syndrome
- Gradual onset of pain in superior/posterior scapula that radiates to shoulder girdle, neck, and chest wall
- Caused by trigger points in chest wall, medial and deep to scapula
- Can contribute to shoulder impingement
- Associated with: stress, overuse, postural strain, prolonged immobilization of shoulder
Zoster
- reactivation of chicken pox (Shingles)
- dermatomal rash
- maculopapular
- NO midline
Sympathetics involve
- Tissue texture change, rotation testing, redness, heat, moisture
- Chapman points evidence of organ dysfunction or disease
Parasympathetics involve
- Suboccipital/OA - head, chest, UGI, UE
- Sacrum - LGI, pelvis, LE
OMT for sympathetics
- Indirect for type II
- Rib raising (thoracolumbar inhibition for lower GI or pelvic problems)
- Chapman point inhibition
- Abdominal plexus inhibition
OMT for normalization of parasympathetics
- Suboccipital inhibition or specific treatment for most problems
- Sacral rocking or specific treatment for colon and pelvic problems
Celiac plexus
UGI
Superior mesenteric plexus
Small intestines, right colon
Inferior mesenteric plexus
Left colon
Diagnosing abdominal plexus dysfunction
Tension over area of plexus
Chapman points are…
tender nodules that suggest specific visceral dysfunction
Anterior chapman points
- Esophagus, bronchus, thyroid, myocardium - between ribs 2-3 (2nd intercostal space)
- Upper lung - between ribs 3-4 (3rd intercostal space)
- Lower lung - between ribs 4-5 (4th intercostal space)
- Stomach acidity (left) and liver (right) - 5th space
- Stomach peristalsis (left) and liver, gall bladder (right) - 6th space
- Spleen (left) and pancreas (right) - 7th space
Posterior chapman points
Esophagus - T2 Liver - T5/6 Stomach acidity - left T5 Gall bladder - right T6 Pancreas - right T7 Spleen - left T7 Sm intestine - T8-10 Pyloris - T9 Intestine peristalsis - between T10/11 Colon - L2-4
Thoracic inlet tension/cervicothoracic junction limits drainage from…..
entire body
Thoracic outlet/thoracolumbar junction limits drainage from….
abdomen, pelvis, and LE
Diaphragm can limit drainage from _____ ______ when restricted because it is a _______ pressure pump
entire body; negative
Pelvic diaphragm/lumbosacral junction limits drainage from…
LE
Treat thoracic outlet/inlet with lymphatics for….
entire body
Treat pelvic diaphragm with lymphatics for…
LE edema
Treat occipitoatlantal junction with lymphatics for…
Craniofacial edema or congestion
Treat restricted diaphragms in with…
Indirect and/or direct MFR
Lymphatic pumps
- Thoracic pump (pectoral traction if contraindicated)
- pedal pump for pelvic or LE edema
- effleurage/petrissage (soft tissue techniques) for extremity edema
Visceral treatments
Ventral techniques (abdominal sphincter release, mesenteric lifts, liver/spleen lymphatic pumps) or visceral manipulation (Barral)
Pyloric sphincter abdominal sphincter release (MFR) treats…
Gastroesophageal reflux
Hepatopancreatic duct MFR treats…
Cholestasis
Ileocecal valve MFR treats…
Constipation
How do mesenteric lifts improve venous and lymphatic drainage?
Lymphatics and nerves follow blood vessels in mesentery in between the section of colon and umbilicus and shortening the mesentery relieves tension on vessels and nerves
Large intestine lift (contra)indications and procedure
I: constipation, IBS, hernia
C: peritonitis, obstruction, recent abdominal surgery
P: distal-proximal in descending, transverse, ascending order
Liver/spleen pump (contra)indications and procedure
I: cholestasis, chronic hepatitis, immune stimulation
C: peritonitis, acute hepatitis/cholecystitis, undiagnosed hepatomegaly, splenomegaly
P: exhalation pump, inhalation recoil, repeat 3-5
Visceral mobility
Movement of viscera in response to voluntary movement, or to movement of diaphragm
Visceral motility
Inherent motion of viscera themselves
