Lymphatics

Question 1

Thyroid exam

Answer 1

Palpate cricoid cartilage, down and slightly out
Should feel like butterfly
Shouldn’t be inflamed
One side at a time
Rotate head slightly to relax SCM

Question 2

Exam of lymph node- characteristics

Answer 2

Size- no bigger than pea
Consistency- soft, characteristically rubber- metastatic cancer- hard but not painful
Tenderness- infection may cause swelling/tenderness
Fixation- fixation= malignancy

Question 3

Lymph exam sequence

Answer 3

Inspect for enlarged nodes
Palpate one side at a time using flat fingers
Compare to contralateral side
Site, size, consistency, tenderness

Question 4

Cervical nodes

Answer 4

Start under chin
Along to masseter area for parotid
Up to maxillary
Move towards front of ear- pre-auricular
Behind ears- retro-auricular
Follow round occiput and down neck for poster cervical chain
Back to mastoid process, palpate down SCM for superficial and deep anterior chain
Palpate supra/infraclavicular areas (stomach/breast cancer)

Question 5

Axillary and epitrochlear

Answer 5

1st sign of malignancy in breasts
Ant and central- flat hand
Lats/teres grab underneath and push
Hands on hips, push elbow slightly forward
Epitrochlear- look for signs of skin cancer on forearm, slightly up from normal PROM
Assess axillary, cervical and epitrochlear if problem is suggested

Question 6

Inguinal

Answer 6

ASIS- follow inguinal ligament –> fem pulse, bring contact down slightly
Follow horizontal group then vertical group

Question 7

Popliteal

Answer 7

Behind knee
Some may have lumps- Bakers cyst
Synovial cyst in capsule, arthritis causes inc of synovial fluid–> inflammation
Should be able to reduce it but likely to come back
Extreme arthritis stays, lymph node would be moveable and stays

Question 8

Thoracic inlet

Answer 8

• Removing barrier
• Fingers fix off 1st rib
• SB head towards hand, rhythmically compress when head is closest to hand
• Rot head away from hand- warn Pt it may be slightly uncomfortable as inc stretch
• Support head with stomach, aim for full range of rotation whilst fixing 1st rib

Question 9

Thoracic inlet via clavicle

Answer 9

• Ask Pt to place hands on chest
• Fix ribs 2-3 (relatively medial/close to sternum)
• Ask Pt to hold your side, grip arm between your arm and your side
• Rhythmically pull arm out laterally

Question 10

Diaphragm

Answer 10

• Assess movement from each side- move side to side
• Find xiphoid cartilage, move a couple of cm inferiorly, place thumbs here
• Ask Pt to breathe in deeply, and out, apply pressure down/lean in into diaphragm
• If restriction is found, hold
• Bend knees to relax rectus abdominals
• Variation
  o If Pt is too big/cant apply pressure through thumbs
  o Stand above head
  o Grip fingers underneath ribs
  o Be mindful of palms in relation to chest
  o Pull/grip underneath as Pt breathes out

Question 11

Ischial tuberosa/diaphragm

Answer 11

• Supine, bend knee, locate ischial tuberosity (medial)- explain where you are going, “ischial tuberosity is sitting bone, lmk if you feel uncomfortable”
• Rest leg against your shoulder
• Place hand over diaphragm (fingers point towards couch)
• Inhibition- should feel like they move together

Question 12

Pectoral traction

Answer 12

• Practitioner sitting
• Grip underneath pec major
• Lean back and pull
• Useful for people with shoulder protraction/problems
• Keep pulling until release is felt

Question 13

Thoracic pump

Answer 13

• Cross hands- more important to do so on a female, can have arms uncrossed
• Pump 2x1s- caution= osteoporosis
• Push down (CPR like movement)
• Promotes blood and lymph movement (redness on skin is blood flow)

Question 14

Abdominal pump

Answer 14

• Bend knees
• Applying pressure to thoracic duct
• Push in under ribs