Heme CIS: treating peripheral edema

Question 1

Biomechanical perspective- swollen arm

Answer 1

Check out ALL those beautiful anatomical connections from the upper extremity to:
Cervical spine
Thoracic spine
Ribs
Lumbar spine
Sacrum

Question 2

Generally long restrictor muscles which will cause what type of dysfunctions?

Answer 2

Type I
Rib elevation or depression
Sacral restriction that do not make sense with the model you have learned

Question 3

Neurological perspective- swollen arm after breast cancer radiation treatment

Answer 3

Somato-somatic reflexes
Upper extremity:
SNS T1-4
PNS: NONE

Breast:
SNS T3-5 (2-6)
PNS: NONE

Autonomics usually feed into the short restrictor muscles
SO: look for Type II dysfunction in these areas

Question 4

Lymphatic perspective- swollen arm patient after breast cancer radiation treatment

Answer 4

Breast
Axillary nodes (3/4)
Apical nodes
Internal thoracic nodes
Removal of part of the structure
Passive movement  through interstitial space
Regeneration of vessels
Collateral circulation
May go to contralateral breast
May go to rectus abdominus and the subperitoneal and subhepatic plexi

Question 5

Lymphatics

Answer 5

Continuous structure from the interstitial space, through terminal lymphatics, vessels, nodes and into central circulation
Baffles

Question 6

Contraindications in treating a patient with cancer

Answer 6

Risk of hematogenous spread is high
– Vertebral cancers (as a result of Batson’s plexus): NO OMT in the vertebral spine

Direct techniques directly over area of tumor
Direct techniques in the presence of loss of boney integrity

Risk of lymphatogenous spread is high
- Lymphatic techniques relatively contraindicated
- However, consider that patients who do a moderate amount of exercise daily during treatment tend to do better overall than those who don’t. Lymphatic pumps do not move as much lymph as moderate exercise will…
- If you have concerns, use other techniques to passively affect lymphatic flow rather than actively
Example: Myofascial release to the thoracic inlet rather than thoracic lymphatic pump

Question 7

Indications for OMT in the patient with cancer

Answer 7

Somatic dysfunction
- Pain associated with somatic dysfunction (not pain associated with tumor)

When to think about osteopathic evaluation and treatment

• Post-surgical
• Bed-ridden
• Lymphedema
• Constipation
• Atelectasis
• Pneumonia

In general

• indirect techniques (BLT, SCS, etc)
• or gentle direct or indirect soft tissue/myofascial