VM4 - The Thorax - Treatments Flashcards
(27 cards)
Hyoid
Mobility Test in all Directions - lateral, side bend, rotate, superior/inferior, anterior/posterior
Middle Cervical Fascia - Hyoid Anchor
Superior Hand - hyoid - anchors
Inferior Hand - along clavicle, cartilage of 1st rib, manubrium
- may go over clavicle to stretch sub clavicle tissue
Middle Cervical Fascia - Occipital Technique
One hand on occiput
Second hand omohyoid insertion medial to scapula notch
Clavipectoral Fascia Long Lever Treatment (and Middle Cervical Fascia stretch)
The CPF connect thorax to arm. Shortens when you catch yourself falling down or tension on thorax, lungs or ribs
Put arm on the side involved into external rotation and abduction (to fix brachial aponeurosis)
Rest patient head on your abdomen
Cross arms with hands in coracoid processes and push them posteriolaterally and slightly inferiorly
Use abdomen or chest to sidebend neck away from abducted arm. The side bending of the neck stretches middle cervical fascia
Clavipectoral Fascia Direct Treatment
To release fascia under pec major
Put arm on side treated into external rotation and abduction
Put thumbs under pec major to join fascia of pec minor (on top of pec minor, surf ribs)
Traction fascia by separating thumbs. Listen, don’t compress, do induction
Add arm movement as long lever. Ask patient to actively and slowly move arm into internal and external rotation to increase stretch of the fascia
Work into axillary fascia (continuous with the pectoral and clavipectoral fascia anteriorly, with the brachial fascia laterally, and with the fascia of the latissimus dorsi and serratus anterior muscles posteriorly and medially.)
Palpation of Anterior Visceral Sheath - Pretracheal Fascia
Pg 28 of study guide
Pretracheal Fascia / Visceral Sheath
Local listen then gentle mobility test to thyroid cartilage, cricoid cartilage, trachea
Treat as indicated with gentle mobilization or induction
Palpation - Deep Cervical Fascia / Prevertebral Fascia
In anatomy I have a good slide for the anatomy here
Feel the anterior scalene muscle it is wrapped by deep cervical fascia. Go behind sternocleidomastoid and behind the clavicle to find scalene tubercle of first rib
Side bend head to same side and/or lift shoulder cephaldad to gain access.
Feel the distensible subclavian vein in front of anterior scalene muscle. Subclavian vein is soft, and easily compressed.
Feel the subclavian artery behind anterior scalene muscle. Look for pulse. It is lateral and posterior to scalene tubercle.
Feel the brachial plexus; it is more posterior and lateral than subclavian artery. The nerves feel like taught strings, like the longitudinal fibers of a tendon but smaller. Brachial plexus is about to dive under the clavicle.
Feel for the pleural dome. The pleural dome is a small space medial to scalene tubercle; appreciate its elasticity. With inhalation you may feel it pull caudad.
Deep Cervical Fascia Treatment
Find anterior scalene (transverse process of C2-C6 to tubercle on 1st rib)
Engage anterior scalene at origin and insertion
Treat with induction or a direct stretch
First Rib
Supine:
First rib is witness to tension on ipsilateral side. If it won’t compress =mechanical issue of rib. Resistance with some movement = compensation for an organ on that side, or reflects tension of the deep cervical fascia. If it compresses and doesn’t come back, something is pulling it down.
Compare both sides
Contact hand is spanning all along first rib
Avoid compressing shoulder
Sidebend neck to the side you’re testing
SEATED
Avoid compressing shoulder
Sidebend ipsolateral
Compression/decompression test. Decompression is mostly passive
Compare both sides
Treat with direct, listen and follow, or recoil
Thyroid Palpation
Palpate lobes of thyroid. Should feel like tapioca pudding
Find isthmus
Palpate Motility
Any motility or mobility restrictions?
Any hard nodules?
The midline landmark for the thyroid gland is to palpate from the cricoid cartilage to the first tracheal ring. Here lies the isthmus of the thyroid, at the first tracheal ring. It is very thin.
Take the head into flexion glide fingers along trachea, slide between muscles and trachea, without compression. Feel the thyroids’ lateral lobes extending cephaldad and caudad. Compress too much you will only feel the trachea, if too light will feel only skin.
In men the thyroid is thinner than in woman. And with pregnancy the thyroid is larger.
Thyroid motility (2 buds embryologically)
Inspir; superior and spreading laterally
Expir: inferior and narrowing
Thyroid Motility
Inspir - external rotation, a spreading laterally and a superior glide
Expir - internal rotation, a narrowing and an inferior glide
Trachea Motility - Superior Aspect
Inspir - rotates to the left and a small movement inferior
Expir - rotates to the right and slightly superior
Superficial Cervical Aponeurosis Test
Mid-Cervical Aponeurosis with a Long Lever
Palpate Superficial Fascia
The superficial fascia is too thin to produce genuine restriction
The superficial fascia and platysma are closely related
Palpate Platysma muscle. (Muscle of facial expression.)
Palpate Trapezius muscle (back off to fascial layer)
Palpate Sternocleidomastoid muscle (back off to fascial layer)
Palpate Middle Cervical Fascia
Find Hyoid.
Stabilize the hyoid with 2 fingers; use other hand to test distensibility all along thoracic inlet. (May actually see tightness with naked eye)
Test at clavicle, scapular notch, manubrium and first rib at scalene tubercle. Always compare both sides.
Fascia feels flat. Muscle feels round and thicker.
Release with direct stretch in specific directions indicated by testing and if needed recoil can be utilized. This fascia has contractile fibers.
Release with induction. Stabilize hyoid and do a local listening, use inhibition to find associated structures.
For future reference if in class at this time you don’t get a good release from the middle cervical fascia. Be aware there may be other associated structures that need to be addressed before the middle cervical fascia. If the subclavius muscle and conoid and trapezoid ligaments are restricted they will hinder your release efforts.
Palpate Clavipectoral Fascia
Find coracoid process.
The clavipectoral fascia is bound by the clavicle, coracoid process and axilla.
It inserts superioirly on subclavius aponeurosis, lower down it surrounds pectoralis minor muscles and merges with skin of axillary fossa, and the brachial aponeurosis at the level of the coracobrachialis and short head of biceps brachii.
Anytime the middle aponeurosis is involved search clavipectoral for adhesions or fibrosis.
Technique: Put arm on affected side into external rotation and abduction to fix brachial aponeurosis. Place your contact on both coracoid processes. Stretch posterolateral and slightly inferior direction. Sidebend head to the opposite side (away from the targeted clavipectoral fascia). This side bend of head brings in middle cervical fascia, which inserts with the clavipectoral fascia onto the aponeurosis of the subclavius muscle.
Palpate Pretracheal Fascia / visceral sheath
Gently mobility test the thyroid cartilage then local listen.
Gently mobility test the cricoid cartilage, then local listen.
Treat as indicated with gentle mobilization or do an induction
This pretracheal fascia begins at the bottom of the thyroid cartilage and continues to posterior pericardium (via thyropericardiac lamina). It wraps around the thyroid gland, covering in front of the trachea and esophagus. It forms the visceral sheath of the neck along with the buccopharyngeal fascia, which travels behind the esophagus.
The pretracheal fascia / visceral sheath has attachments to the midcervical fascia, the deep cervical fascia (prevertebral) and the vascular sheath.
Palpate Anterior Neck
Hyoid bone C3-4
Thyrohyoid membrane (a very slight slope)
Thyroid cartilage Adam’s apple C-5
Cricothyroid ligament (another slope)
Cricoid cartilage C-6 round ring, where esophagus begins
Tracheal rings flat rings
Thyroid gland
Palpate Vascular Sheath
Carotid artery-pulse
Internal Jugular vein it is very distensible
Vagus nerve
Be careful not to compress arteries.
Sternoclavicular Joint Techniques
Mobility test Posterior SC ligament:
To test take shoulder anteromedially which brings the medial clavicle posterior.
With the fingers of your testing hand accompany the posterior movement of the medial clavicle. With a restriction there is resistance to that movement.
Mobility test Anterior SC ligament:
To test take shoulder posterolaterally until medial clavicle moves forward. If there is resistance to movement there is a restriction.
Mobility test Interclavicular ligament:
Push alternately on both shoulders inferior and slightly posterior, so that medial clavicle moves upward. Monitor movement.
Treatment for SC ligaments: use a direct stretch and or recoil
The following corrections are all performed supine with hands on abdomen and legs extended.
Posterior SC ligament:
One hand over medial clavicle take it posterior and superolateral. other hand moves shoulder anteromedial.
Anterior SC ligament: WB pg.22
Practitioners’ hands are crossed. Contact the sternum close to sc joint on the side opposite you want to correct and other hand takes the lateral clavicle posterolateral; which brings medial clavicle anterior
Useful technique when subclavian or brachcephalic vessels are compromised.
Interclavicular ligament:
Use after sc ligament is corrected. Place both hands against medial sides of sc joint. Direction for correction is inferolateral and slightly anterior.
The following corrections are performed seated. Remember engaging tissue in its anatomic orientation can be advantageous.
Posterior SC ligament:
On the side you choose to treat take the patients arm on that side to rest on your same side, thigh (your foot is on the table) Surround that shoulder with your hand and take it anteromedially, and allow your other hand to take medial clavicle posterior and slightly lateral.
Anterior SC ligament: WB. Pg.23
Take patients opposite arm of affected side over your knee. Place the palm of your hand in supraclavicular fossa with thumb against posterior angle of rib1and 1st costovertebral joint.
Put your other hand on the parietal bone of opposite affected side with elbow resting on patients shoulder. Push clavicle anteroinferior and medial. Force comes through clavicular contact. Skull hand lines up the tension, involves the entire thorax.
Costoclavicular Ligament
Supine, Mobility test and treatment keep same contacts.
Contact 1st rib under clavicle close to sternum, second contact is clavicle above rib contact.
Stretch clavicle superior and lateral OR stretch 1st rib inferior and medial.
Subclavius Muscle
Treatment is to wake up the tissue with compression and then release, compress again. Release a little less then follow the listening.
Remember this has a connection with middle cervical fascia.
