OSCE: Lymphatics Flashcards
1
Q
Thoracic Inlet MFR
A
Position:
- Pt supine, doc seated at head of table OR pt seated with physician standing behind patient
Hand placement:
- Hands palms down over shoulders, 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 pt’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 mechanism
2
Q
Doming the Diaphragm
A
Position:
- Patient supine with hips and knees flexed, physician at pt’s side facing cephalad
Hand placement:
- Place hands in the infracostal region, directly below xiphoid process, with fingertips/thumbs pointing cephalad.
Technique:
- 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
3
Q
Ischiorectal Fossa Release: Doming the Pelvic Diaphragm
A
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
4
Q
Pectoral Traction
A
Position:
- Patient supine with hips and knees flexed, physician standing at head of table
Hand placement:
- Grasp inferior to pt’s clavicles at anterior axillary fold
Technique:
- Extend arms and lean back to apply cephalad traction bilaterally
- Pull when pt inhales and resist on exhale
- Repeat 5-7 times
5
Q
Rib Raising (seated)
A
Position:
- Pt seated with arms crossed, physician standing facing pt
- Pt crosses arms and leans forward toward physician
Hand placement:
- Grasp bilateral posterior/inferior rib angles (lateral to transverse processes)
Technique:
- Starting with T12, pull superiorly and toward the physician.
- Continue up ribs.
Helps normalize sympathetic nervous system
6
Q
Rib Raising (supine)
A
Position:
- Pt supine, physician sitting on side to treat
Hand placement:
- Grasp ipsilateral posterior/inferior rib angles (lateral to transverse processes) by flexing fingers
Technique:
- Starting with T12, apply anterolateral traction by rocking backward/leaning elbows into the table.
- Continue up ribs.
Helps normalize sympathetic nervous system
7
Q
Tapotement
A
Position:
- Patient prone, doctor at patient’s side
Technique:
- Apply rhythmic forces to the thoracic region
- Hacking: “karate chop” with ulnar side of hands
- Cupping/Clopping: cup hands into a slight “C” shape
- Slapping: use palmar surface of hands
8
Q
Thoracic Pump (Repetitive/Oscillatory)
A
Position:
- Pt supine, 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 the sternum (offer women a pillow or place their hands under yours).
Technique:
- Have the patient take a deep breath and exhale fully
- At the end of exhalation, apply rhythmic posterior inferior pumping. Rate should be 120x/min (2x/sec).
- Continue for several minutes
9
Q
Thoracic Pump (Vacuum/Atelectasis Modification)
A
Position:
- Patient supine, 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 the sternum (offer women a pillow or place their hands under yours).
Technique:
- Have the patient take a deep breath and exhale fully
- 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 (inflates atelectatic segments).
10
Q
Abdominal Pump
A
Position:
- Patient supine, physician at patient’s side facing cephalad
Hand placement:
- Place palms on abdomen with fingers towards the pt’s head, thumbs side by side
Technique:
- Pump posteriorly in a rhythmic manner. Rate should be 20 -30x/min
11
Q
Sacral Rock
A
Position:
- Patient prone, physician at patient’s side
Hand placement:
- Place heal of cephalad hand on the sacral base with fingers pointing towards the coccyx
- Caudal hand on top, pointing in a 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 or until no further RB
12
Q
Pedal Pump
A
Position:
- Patient supine, physician at foot of table
Hand placement:
- Contact plantar portion of feet
Technique:
- Dorsiflex pt’s feet
- Apply an on-and-off rhythmic cephalad force.
- Rate should be 120x/min (2x/sec)
- Continue for 1 -2 minutes
13
Q
Effleurage and Petrissage
A
Position:
- Patient supine, physician on side to treat
Technique:
- Raise patient’s arm or leg to treat
- Effleurage: induce stroking force distally to proximally
- Petrissage: induce a kneading/twisting force distally to proximally
14
Q
IT Band Effleruage
A
Position:
- Patient lateral recumbent with the affected side up. Physician on side to treat
Hand placement:
- Place cephalad hand on patient’s greater trochanter for stabilization
- With the caudal hand, make a “C” shape and contact patient’s iliotibial band
Technique:
- Start halfway between the greater trochanter and knee, stroking distal to proximal with gentle pressure
- After some congestion frees, start just superior to the knee and continue stroking in a distal to proximal fashion
- Continue to 1-2 minutes
15
Q
Pre and Post Auricular Drainage
A
Position:
- Patient supine, physician at patient’s side
Hand placement:
- Using caudad hand, place 3rd and 4th fingers in front of and behind ear, respectively
- Use cephalad hand to stabilize patient’s head
Technique:
- Apply a clockwise & a counterclockwise motion
- Continue for 2 minutes
16
Q
Mandibular Drainage
A
Position:
- Patient supine, rotate head towards doctor.
- Physician 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 the mandible. DO NOT SLIDE OVER SKIN.
- Continue for 2 minutes, repeat on other side
17
Q
Submandibular Drainage
A
Position:
- Patient supine, physician at head
Hand placement:
- Place fingertips below the inferior rim of the mandible
Technique:
- Direct fingers superiorly and evaluate for ease/restriction of motion
- Apply principles of myofascial release, may use direct or indirect treatment
18
Q
Cervical Chain Drainage
A
Position:
- Patient supine, physician at head of table
Hand placement:
- Using caudal hand, place palmar aspect of fingers over the sternocleidomastoid (SCM) near the angle to the mandible
- Use cephalad hand to stabilize
Technique:
- Gently roll along the muscle in a milking fashion, working caudally.
- Treat one side at a time to prevent pressing on carotid sinuses bilaterally
19
Q
Cervical Stroking
A
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
