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8/18/2019 OMT Review
1/12
Chapman Reflex Points
Diagnosis and Treatment
STRUCTURE ANTERIOR POINT POSTERIOR POINT
CNS
retina, conjunctiva lateral superior humerus
cerebellum tip of the coracoid process
ENTsinuses medial inferior clavicle
middle ear medial superior clavicle
pharynx superior lateral edge of manubrium
tonsils middle lateral edge of manubrium
tongue 2nd costosternal joint
neck medial superior humerus
GI
esophagus superior aspect of 3rd intercostal space T2-T3 between SP and TP
stomach (parietal) left 5th intercostal space T5 between SP and TP
stomach (peristalsis) left 6th intercostal space T6 between SP and TP
small intestine 8th, 9th, and 10th intercostal spaces
appendix tip of the 12th
rib T11 between SP and TPcolon iliotibial band
flip the colon over; cecum near the greatertrochanter and hepatic flexure near knee)
rectum lesser trochanter of femurHINT: attachment site of psoas major
SNS GANGLIA
celiac ganglion below xiphoid process
superior mesenteric ganglion between umbilicus and xiphoid process
inferior mesenteric ganglion above umbilicus
ORGANS
heart, thyroid, bronchi left 2nd intercostal space T2-T3 between SP and TP
upper lung 3rd intercostal space T3 between SP and TP
lower lung 4th intercostal sapce T4 between SP and TPliver right 5th and 6th intercostal spaces right T5-T6 between SP and TP
gallbladder right 6th intercostal space right T6 between SP and TP
pancreas right 7th intercostal space right T7 between SP and TP
spleen left 7th intercostal space left T7 between SP and TP
adrenal 1in lateral, 2in superior to umbilicus T11-T12 between SP and TP
ovary lateral to pubic symphysis (superior edge)
prostate posterior ilotiband
URINARY
kidneys 1in lateral, 1in superior to umbilicus T-12-L1 between SP and TP
bladder periumbilical upper edge L2 TP
urethra superior pubic ramus, 2cm lateral
to symphysis
L2 TP
COMLEX OMM Chapman’s Reflex Points
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8/18/2019 OMT Review
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Anterior Chapman’s Points: Posterior Chapman’s Points:
COMLEX OMM Chapman’s Reflex Points
sinuses
cerebellum
retina,
conjunctiva
neck
larynx
pylorus
small intestines
appendix (R)
Umbilicus
intestinal
peristalsis
prostate or
broad ligament
colon
rectum
uterus
ovaries, urethra
middle ear
nasal sinuses
pharynx
tonsils
tongue
esophagus,
bronchus
thyroid,
myocardium
upper long
lower lung
stomach (acidity) (L)
left adrenal
left kidney
Bladder area
retina, conjunctiva
middle ear
pharynx, tongue,
larynx, sinuses, arms
neck, esophagus, bronchus
thyroid
upper lung, myocardium
upper lung
lower lung
stomach (acidity) (L)
liver (R)
stomach (peristalsis) (L)
liver, gallbladder (R)
adrenals
kidneys
abdomen, bladder
urethra
uterus
vagina, prostate, uterus,
broad ligament
rectum, groin glands
Fallopian tubes,
seminal vesicles
clitoris, vagina
cerebellum
nasal sinuses
cerebrum
arms
(and pectoralis m
neuroansthesia
(and pectoralis m
pyorus (R)
ovariesintestines (peristalsis
appendix (R)
large intestines
sciatic nerve (poster
hemorrhodial plexus
sciatic nerve (ante
Most likely to be asked
about on COMLEX(all are possible)
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Segmental Sympathetic Innervation
STRUCTURE SEGMENT
sinuses , eustachian tube,
lacrimal glandsT1-4
thyroid T1-4
trachea, bronchiT1-6lower 2/3 esophagus T5-6
aortic arch T1-5
heart T1-6
lungs T2-4
stomach T5-9 left
dudodenum T5-9
liver T5 right
gallbladder, biliary tree T6 right
spleen T7 left
pancreas T7 right
small intestine T10-T11
proximal colon T10-T12distal colon T12-L2
appendix T12
adrenal glands, kidney, upper
ureter, ovary and testesT10-11
lower ureter, T12-L1
bladder, trigone/sphincter,
uterus, prostateT12-L2
genital cavernous tissue, penis,
seminal vesicleL2
mammary glands T1-6
arms T2-8
legs L11-L2
Parasympathet ic Innervation Vagal nuclei
STRUCTURE SEGMENT
pupils (constriction aka miosis) CN III (midbrain)! ciliary ganglion
lacrimal and nasal glands CN VII (pons)! sphenopalatine ganglion
submandibular and sublingual glands CN VII (pons)! submandibular ganglion
parotid gland CIX (medulla)! otic ganglion
heart, bronchial tree, esophagus
(lower 2/3), stomach, small intestine,
liver, gallbladder, pancreas, kidney
and upper ureter, ovaries and testes,
ascending and transverse colon,
ascending/transverse colon
CN X (medulla)! dorsal motor nucleus
lower ureter and bladder, uterus,
prostate, genitalia, descending colon,
sigmoid, and rectum
pelvic splanchnic (S2-4)
COMLEX OMM ANS Innvervation
Nucleus Solitarius ! 5+(8.-#1 !.&(*-2
+&9*-%#,+*& D.303 ,#(,.C 4 %*,*- 9+
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Treatment order
COMLEX OMM ANS Innvervation
J3 "#$%& &($ )*+,-./&01. +$23$.& -.($*&(+
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Upper extremity nerves
NERVE INNERVATES NOTES
Axillary (C5, C6) deltoid and teres minor (arm abduction,
external rotation)
sensory shoulder
injured by dislocated shoulder
Radial (C5-T1) arm and forearm (wrist) extensors supinator
sensory posterior arm and forarm
sensory part of thenar eminence on
palmar hand, PIPs and proximal dorsu
of hand from thumb to half of ring
finger
common injury with fracture of midshaft humorous
RES – radial, extensors, supinator
Median (C5-8, T1) wrist flexors, pronator teres
lumbricals 1 and 2, thenar muscles,
cutaneous sensation
sensory palmar hand! thumb, first and
second digit, half of third digitsensory dorsal hand! PIP and distal
thumb, index, middle, and half of ring
finger
Meat-LOAF
Median nerve, 2 Lateral Lumbricals, Oponens
pollicus, Abductor pollicis brevis, Flexor pollicis
brevis
MFP – median, flexors, pronator
Ulnar (C8, T1) flexor carpi ulnaris
intrinsic hand muscles
lumbricals 3 and 4, hypothenar
muscles, interossei, adductor pollicis,
flexor pollicis brevis
sensory fifth and! fourth digit on both
dorsal and palmar side
A OF A OF A
first AOF thenar muscles
Adductor pollicis, Opponens digit minimi, Flexor
digiti minimi, Abductor digiti minimi
Musculocutaneous
(C5-7)
anterior (flexor) compartment of the arm
sensory lateral arm
biceps brachii, brachialis, coroacobrachialis
flexion and supination
Rotator cuff muscles
Other shoulder muscles
COMLEX OMM Upper Extremity
Pectoralis major – one of two primary adductors, lateral and medial pectoral nerves (C5-T1)
Deltoid (anterior) – primary flexor, axillary nerve (C5-C6)
Deltoid (middle) – primary abductor, axillary nerve (C5-C6)
Deltoid (posterior) – one of three primary extensors, axillary nerve (C5-C6)
Teres major – one of three primary extensors, axillary nerve (C5-C6)
Latissimus dorsi – primary extensor and adductor, thoracodorsal nerve (C6-C8)
Supraspinatus – initiation of abduction, suprascapular nerve (C5)
Infraspinatus – external rotation, suprascapular nerve (C5-C6
Teres minor – external rotation, axillary nerve (C5)
Subscapularis – internal rotation, upper and lower subscapular nerve (C5-C6)
“SITS” muscles
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Upper extremity nerve injuries
NERVE/MUSCLE TYPICAL INJURY MOTOR DEFICIT SENSORY DEFICIT SIGN/NOTES
Axillary (C5, C6) Fractured surgical neck of
humerus, dislocation of
humeral head
Deltoid – arm
abduction at
shoulder
Over deltoid muscle Atrophied deltoid
Radial (C5-T1) Fracture at midshaft of
humerus; “Saturday night
palsy” (extended
compression of axilla by
back of chair or by
crutches)
“BEST extensors” –
Brachioradialis,
Extensors of wrist
and fingers (C6-7)
Supintor, Triceps
Posterior arm and
dorsal hand and
thumb
Wrist drop
Median (C5-8, T1) Fracture of suprachondylar
humerus (proximal lesion
Opposition of thum
Lateral finger flexio
Wrist flexion (C7-8)
Dorsal and palmar
aspects of lateral
3/12 fingers,thenar eminence
“Ape hand”; “Pop
blessing” (hand
Travels through ttwo heads of
pronator teres
Ulnar (C8, T1) Fracture of medial
epicondyle of humerus,
“funny bone”
Hook of hamate injury
(bicycle riders)
Medial finger flexio
Wrist flexion (C7-8)
Medial 1! fingers,
hypothenar
eminence
Radial deviation o
wrist upon wris
flexion
Musculocutaneous
(C5-7)
Upper trunk compression Biceps, brachialis,
coracobrachialisFlexion of arm at
elbow
Lateral forearm
Tear of rotator cuff muscles
Radial head somatic dysfunction A nterior radial head! radial head does not glide posteriorly;Restricted Pronation, +/- pain with pronation
most likely to occur with backswords fall on extended arm
Posterior fibular head ! radial head does not glide anteriorly;
Restricted Supination; wrist and elbow pain
FOOSH injury (fall on out-stretched hand)
“Restricted PPS”
acute, sharp pain in shoulder followed
by ongoing dull achh and tenderness at
acromion process
(+) drop arm test, weak abduction
treat less severe cases with RICE, NSAIDS,
and OMT
more commonly an injury of the tendons rather
than the actual muscles
supraspinatus tendon most frequently affected
because it passes below the acromion
the site of injury usually occurs at the point of
insertion at the greater tubercle of the
COMLEX OMM Upper Extremity
8/18/2019 OMT Review
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Shoulder dysfunctions
DYSFUNCTION DEFINITION ETIOLOGY NOTES
Erb-Duchenne palsy injury to upper brachial
plexus, usually lateral
stretching
infant! lateral traction on
neck during delivery
adult! trauma
waitor’s tip posturing,
C5-6 upper trunk
arm extended and pronated Klumpke’s Palsy injury to lower branchial
plexus,
most often trauma during
childbirth
paralysis of intrinsic hand muscles
C8-T1 sensory loss+/- Horner’s syndrome
winged scapula long thoracic n injury!
paralysis of serratus
anterior muscle
trauma to the long thoracic n
shoulder blow, repetitive
movements, mastectomy)
while patient pushes anteriorly (e.g.
against a wall) scapula protrudes
posteriorly
thoracic outlet
syndrome
compression of brachial
plexus, subclavian vein,
and subclavian artery
can occur between:
ant and mid scalenes
clavicle and 1st rib
pectoralis minor and
upper ribs
ache and/or paresthesia of neck or ar
COMLEX OMM Upper extremity
8/18/2019 OMT Review
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COMLEX OMM Upper Extremity
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Upper Extremity Special Tests
STRUCTURE EVALUATES TECHNIQUE
Apley’s scratch test range of motion patient reaches behind head to scratch back –
evaluates abduction and external rotation;
patient reaches across chest to scratch other
should and/or reaches around the back at
waist and scratches back – evaluates internalrotation and adduction
Adson’s test thoracic outlet syndrome patient extends elbow and arm, turns head
towards ipsilateral side.
positive if radial pulse markedly weakened or
absent
Roos’s test thoracic outlet syndrome patient abducts both arms to 90˚, externally
rotates, then flexes the elbows to 90˚; patient
repetitively opens and closes firsts for 3min
positive if exacerbations of symptoms
drop arm test rotator cuff tear patient abducts arm to 90 degrees and slowly
drops arm to side
positive if arm rapidly falls
Speed’s test biceps tendon patient extends elbow; supinates forearm whileflexing the arm at the shoulder against
resistance
positive if there is tenderness in the bicipital
groove
Yergason’s test stability of biceps tendon
in bicipital groove
patient flexes elbow to 90 degrees while
clinician holds the patient’s wrist with one
hand and elbow with the other
clinician resists the patient’s flexion/pronationforce while passively externally rotating
positive if there is pain in biceps tendon as it
pops out of the bicipital groove
Wrist Special Tests
STRUCTURE EVALUATES TECHNIQUE
Tinel’s test carpal tunnel syndrome clinician taps over volar aspect of patient’s
traverse carpal ligament (Tinel Tap)
!test = paresthsia of thumb, index, ring fingers
Phalen’s (and reverse Phalen’s)
tests
carpel tunnel syndrome patient's wrist passively but maximally flexed
(extended in reverse) by the clinical, held for
one minute
!test = paresthsia of thumb, index, ring fingers
Allen’s test radial and ulnar artery
patency/blood flow
patient opens and closes hand several times an
makes a tight first
clinician occludes oneartery and has patient open hand
test failed if hand remains pale
Finkelstein test tenosynovitis of pollicis
longus and extensor
pollicis brevis
(DeQuervain’s
tenosynovitis)
patient makes a tight first with thumb tucked
into first clinician induces adduction of
the wrist
!test = pain over tendons of wrist
COMLEX OMM Upper Extremity
8/18/2019 OMT Review
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Lower extremity nerves
NERVE TYPICAL INJURY MOTOR DEFICIT SENSORY DEFICIT SIGN
Obturator (L2-L4) Anterior hip dislocation Thigh adduction Medial thigh
Femoral (L2-4)Pelvic fracture
Thigh flexion and
leg extension
Anterior thigh and
medial leg
Common peroneal
(L4-S2)
Trauma or compression of
lateral aspect of leg or
fibula neck fracture
Foot eversion and
dorsiflexion; toe
extension
Anterolateral leg and
dorsal aspect of foo
Foot drop, foot sl
steppage gait
Tibial (L4-S3) Knee trauma Foot inversion and
plantarflexion; toflexion
Sole of foot
Superior gluteal
(L4-S1)
Posterior hip dislocation or
polio
Thigh abduction !Trendelenberg s
contralateral hi
drops when stan
on leg ipsilatera
to lesion
Inferior gluteal
(L5-S2)
Posterior hip dislocation Can’t jump, climb
stairs, or rise from
seating position;can’t push
downwards
Lateral forearm
PED = Peroneal E verts and Dorsiflexes; if injured, foot droPED
TIP = Tibial Inverts and Plantarflexes; if injured, can’t stand on TIPtoes
Sciatic nerve (L4-S3) – posterior thigh, splits into common peroneal and tibial nerve
Lower extremity muscles
MUSCLE ACTION INNVERVATION
Ilopsoas hip flexion L1, L2, L3
gluteus maximus hip extension inferior gluteal n (L5, S1, S2)
gluteus medius, minimus thigh abduction superior gluteal n (L5, S1)
hamstrings
semitendinosus
semimembranosus
biceps femoris (long head)
biceps femoris (shorthead)
knee flexion
(hip extension)
L5, S1, (S2)tibial ntibial n
tibial ncommon peroneal n
adductors
adductor brevis, longus, magnus, and
minimus
gracilis
hip adduction obturator n (L2, L3)
pirformis abduction of flexed thigh S1, S2
quadriceps
rectus femoris
vastus lateralis, medialis, and
intermedius (deep)
knee extension femoral n (L2, L3, L4)
COMLEX OMM Lower Extremity
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Lower extremity muscles continued)
MUSCLE ACTION INNVERVATION
anterior tibialis dorsiflexion and inversion
of foot
deep peroneal n (L4)
extensor halluces longus foor dorsiflexion and
great toe extension
deep peroneal n (L5)
gastrocnemius foot plantarflexion tibial n (S1, S2)
peroneus longus and brevis foot eversion superficial peroneal n (S1)
Fibular head somatic dysfunction A nterior fibular head! foot stuck in internal rotation and plantarflexion; treat with
muscle energy by placing the foot in Inversion (loose pack fibula), External rotation of
tibia, and Dorsiflexion
Tx = AED plus inversion
Posterior fibular head ! 9**, (,68; +& .H,.- -*,#,+*& #&/ /*-(+91.H+*&S ,-.#, 7+," %6(81.
energy by placing the foot in Inversion (loose pack fibula), Internal rotation of thetibia, and Plantarflexion
Tx = PIP plus inversion
COMLEX OMM Lower Extremity
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Pir i f ormis syn drome
Ankle sprains
Important angles
Osgood-Schlatter Disease
Neuromuscular disorder in which the sciatic nerve is compressed by the piriformis
muscle. Characterized by tingling and numbness in buttocks descending into the
lower thigh and leg
Treatment includes muscle energy and counterstrain:
ME: patient abducts against resistance
CS: patient prone, knee and thigh flexed, thigh abducted and externally rotated(“peeing dog” position) “peeing dog with a problem” is for LPL5 point
alternate treatment is extension on prone patient
COMLEX OMM Lower Extremity
Ankle strain! muscular injury
Ankle sprain! ligament injury
Grade 1 (first degree) microtears
Grade 2 (second degree) partial tear
Grade 3 (third degree) complete tear
Lateral ankle sprain much more common than medial ankle sprain (deltoid
ligament supporting medial ankle very strain)
Classifications
Type I = sprained ATFL ATFL “Always Tears First Ligament”
Type II = sprained ATFL and CFL
Type III = sprained ATFL, CFL, and PTFL
Femoral head angulation! the angulation between
the neck of the femur and the shaft of the femur>135 degrees = coxa valgum
12 degrees = genu valgum
135˚Coxa varum
=