High Yield OMM for COMLEX II

Martinez

• 1- Neck: T1-T4 2- Heart: T1-T5 3- Lungs: T2-T7 4- Esophagus: T2-T8 5- Foregut (Stomach, liver, gallbladder, spleen, portions of the pancreas and 1st and 2nd parts of the duodenum): T5-T9 6- Midgut (Portions of the pancreas and 3rd and 4th portions of duodenum, jejunum, ascending colon, proximal 2/3 of transverse colon, ilium): T10-T11 7- Hingut (Distal 1/3 of transverse colon, descending colon, sigmoid colon, rectum): T12-L2 8- Appendix: T12 9 Upper ureters: T10-T11 10- Lower ureters: T12-L1 11- Adrenal medulla: T10 12- Kidneys: T10-T11 13- Bladder: T11-L2 14- Uterus and cervix: T10-L2 15- Prostate: T12-L2 16- Upper extremities: T2-T6 17- Lower extremities: T11-L2

• The Chapman’s points for the appendix are located anteriorly at the tip of the 12th rib and posteriorly on the right of the transverse process of T11. 1inch lateral and 2inches superior to the umbilicus are the points for the adrenals bilaterally. The preiumblical region contains the Chapman’s points for the bladder. Renal points are located bilaterally between the spinous and transverse processes of T12 and L1.

• Atelectasis, or alveolar collapse, can be improved with deep breathing or incentive spirometry after surgery.

• The phrenic nerve arises from C3-5 (“3, 4, 5 keeps the diaphragm alive”) and treatment to that area would improve diaphragmatic excursion

Tissue Texture Changes

• Acute findings include heat, moisture, fullness, edema, tension, and/or erythema.

• Chronic findings include coolness, thickness, dryness, ropiness, pimples, and/or prolonged blanching.

• Condylar compression of the newborn can result in CN XII impairment, which manifests as poor suckling in the newborn.

• Osteopathic research has also suggested that cranial nerves IX and X are involved with this process.

• Subcondylar decompression is the preferred treatment in newborns presenting with poor suckling and should be attempted in the case above

• The physiology is important: lymphatics drain upwards from the extremities and periphery before dumping into the left and right thoracic ducts. These ducts cross in close proximity of the clavicle. Restriction at the thoracic duct backs up the whole system, so peripheral treatments are ineffective if restrictions in this area are not addressed first.

• Ankle sprains are graded I to III, based on ligamentous damage and commonly occur following inversion injuries.

• Grade I sprains are characterized by stretching of the anterior talofibular and calcaneofibular ligaments.

• Grade II sprain, the anterior talofibular ligament tears partially, and the calcaneofibular ligament stretches.

• The grade III sprain is characterized by rupture of the anterior talofibular and calcaneofibular ligaments, with partial tearing of the posterior talofibular and tibiofibular ligaments.

Bottom line: Know the sequence of ligamentous injury that occurs during inversion ankle injuries.

1) Anterior talofibular 2) Calcaneofibular 3) Posterior talofibular

• Abnormal straining patterns at the SBS and cervical or upper thoracic spine dysfunction are common somatic findings associated with migraines

• For diseases associated with the prostate, one would expect to find a Chapman’s point located anteriorly along the superior margin of the iliotibial band.

• In muscle energy, the treatment setup is ALWAYS opposite the patient's diagnosis, and therefore, into the barrier

• By Fryette's mechanics (type I), we know that rotation and sidebending occur in opposite directions in a group curve in Neutral

• Chapman’s points are always tested on COMLEX. Anterior Chapman’s points are typically used for diagnosis and their corresponding posterior Chapman’s points are used for treatment.

• The anterior Chapman’s point for the myocardium is in the 2nd intercostal space, near the sternum.

• The Chapman’s points for the upper and lower lungs are located at the 3rd and 4th intercostal spaces, near the sternum.

• The Chapman’s points for the stomach, liver and gallbladder are located at the 5th/6th intercostal space in the midclavicular line.

• During pronation the radial head moves posteriorly. During supination the radial head moves anteriorly. Therefore, if the patient can pronate well, the radial head's position of ease is in the posterior position. Restricted passive range of motion implies that there is something impeding supination of the forearm, not simply pain preventing supination

• The Thomas test is a useful tool in the evaluation of psoas syndrome.

TMJ

• Isometric Jaw exercises are useful in improving symptoms in patients with TMJ pain.

• Other conservative therapies include: stress reduction, soft diets, and avoidance of extreme jaw movements.

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• Treat mild scoliosis with conservative measures including osteopathic manipulative therapy, Konstancin exercises, and physical therapy.

• Respiratory compromise is an indication for surgery in patient suffering from scoliosis and has been associated with thoracic curvatures greater than 50 degrees.

• In addition to diagnosing sacral dysfunctions, there are classic scenarios that are associated with particular sacral dysfunctions.

• Bilateral sacral flexion is commonly associated with childbirth. As the baby traverses the birth canal, pressure is exerted against the apex (bottom) of the sacrum, causing both ILAs to move posteriorly and the sacral base to move anteriorly.

• Rib 1: Anterior and middle scalenesRib 2: Posterior scaleneRibs 3-5: Pectoralis minorRibs 6-9: Serratus anteriorRibs 10-11: Latissimus dorsi Rib 12: Quatratus lumborum

COMLEX Insight: Rib dysfunctions and treatments are typical questions on COMLEX. Knowing muscle attachments and techniques will be high yield.

• Posterolateral disc herniation at the L3-L4 level can cause L4 nerve root entrapment

• Injuries to the L3-L4 disc are uncommon but would likely result in L4 nerve root impairment, giving rise to loss of ankle dorsiflexion and inversion. A severe dysfunction to this nerve root could result in "foot drop". This occurs from motor dysfunction of the tibialis anterior, which is innervated by the deep peroneal nerve.

• L1: Sensation to the anterior thigh approximately just below the inguinal ligament (C) L2: Sensation to the middle and anterior parts of the thigh L3: Sensation to the anterior part of the thigh just above the patella (D) L4: Sensation over the medial malleolus (E, correct) L5: Sensation over the dorsal aspect of the foot, as well as the great toe (A) S1: Sensation over the lateral malleolus (B)

• There are many viscerosomatic questions on COMLEX. It is in your best interest to memorize the autonomic associations of the visceral organs to get these easy points.

Cranial pearls• A) Compression occurs when the sphenoid and occipital bones are forced towards one

another at the sphenobasilar synchondrosis (SBS) articulation. This commonly occurs when there is an impact to the back of the head, such as during a high speed motor vehicle accident. The associated clinical finding is a severely decreased (sometimes absent) CRI.

• B) A flexion/extension straining pattern occurs when the cranium is restricted in either flexion or extension (named for the direction of ease). This is diagnosed by observing asymmetry while palpating the CRI.

• C) Lateral strain occurs when the sphenoid deviates laterally in relation to the occiput. The cranium will feel like a parallelogram during palpation.

• D) Torsion occurs when the sphenoid rotates about an anterior-posterior axis relative to the occiput at the SBS. The torsion named by the side of the moiré superior greater wing of the sphenoid. Torsion can be a physiological variant if it does not interfere with the CRI.

• E) Vertical strain occurs when the sphenoid deviates superior or inferior relative to the occiput. There will not be asymmetry between the greater wings of the sphenoid.

• Bottom line: Assess leg length discrepancy by measuring the distance from the anterior superior iliac spine (ASIS) to the medial malleolus on each side.

• OA compression (or condylar compression) of cranial nerve XII can result in poor suckling of the newborn.

• Ulnar nerve entrapment at the wrist (Guyon’s canal) results in hypothenar atrophy and difficulty with finger adduction/abduction. If the entrapment occurs a the level of the elbow (cubital tunnel), there will also be impaired flexion of the 4th and 5th digits.