Искусство пальпации - Чейтоу Л.
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the anterior axillary fold.
Fig. 4.12 Chapman's neurolymphatic reflexes.
Fig. 4.13 Chapman's neurolymphatic reflexes.
Fig. 4.14 Chapman's neurolymphatic reflexes.
Fig. 4.16 Chapman's neurolymphatic reflexes.
Fig. 4.17 Chapman's neurolymphatic reflexes.
Fig. 4.18 Assessment of 'blind'/restriction barrier with the first sign of resistance in the adductors (medial hamstrings) of the right leg. (A) The operator's perception of the transition point, where easy movement alters to demand some degree of effort, is regarded as the barrier. (B) The barrier is identified when the palpating hand notes a sense of bind in tissues which were relaxed (at ease) up to that point.
Fig. 4.19A Assessment of gastrocnemius and soleus. The sole of the foot should achieve a vertical position without effort once slack is taken out via traction on the heel.
Fig. 4.19B With the knee flexed, the same assessment is evaluating the status of soleus alone.
Fig. 4.20 In the test position, if the thigh is elevated (i.e. not parallel with the table) probable psoas shortness is indicated. The inability of the lower leg to hang more or less vertically towards the floor indicates probable rectus femoris shortness (TFL shortness can produce a similar effect).
Fig. 4.21 Assessment for shortness of TFL - modified Ober's test. When the hand supporting the flexed knees is removed the thigh should fall to the table if TFL is not short.
Яд. 4.22 Palpation assessment forquadratuslumborum overactM/, The musc/e /spa/pateC/, as is (he gfufeus medi'us, during abduction of the leg. The correct firing sequence should be jluteus, followed at around 25° elevation by quadratus. If there is an immediate 'grabbing' action )y quadratus it indicates overactivity, and therefore stress, so shortness can be assumed.
F G H
Fig. 4.24 Assessment of shortness in pectoralis major and latissimus dorsi. Visual assessment is used: if the arm on the tested side is unable to rest along its full length, shortness of pectoralis major is probable; if there is obvious deviation of the elbow laterally, probable latissimus shortening is indicated.
Fig. 4.25 Assessment of relative shortness of right side upper trapezius. The right shoulder is stabilised while the neck is side-bent to its first sign of resistance ('bind') without force. One side is compared to the other. Normal range is thought to be approximately 45°.
Fig. 4.26 Assessment of levator scapula shortness involves taking the neck into full flexion and side-bending rotation, away from the tested side, while maintaining firm shoulder pressure on the tested side to prevent this from elevating. Discomfort reported at the upper medial border of the scapula or the upper cervical spine suggests shortness in this muscle, as does nature of the resistance noted during performance of the assessment.
Fig. 5.1A Schematic representation of cranial motion. During flexion, the occiput is thought to move antero superior, which causes the sphenoid to rise at its synchondrosis. Simultaneous movement occurs in the frontal, facial and nasal bones as indicated. The extension phase of this motion involves a return to a neutral position.
Fig. 5.1 В The flexion phase of cranial motion (inhalation phase) causes the skull, as a whole, to widen and flatten.
Оспріїгчі лліз of г [fl/і! ifih Sacral a*i$ al fotafoon
- Occipuf Spi паї dural tut№ Застилі
Fig. 5.2 Schematic representation of the synchrony of motion between the sacrum and the occiput.
Fig. 5.4 Palpating craniosacral rhythmic motion via the feet.
Fig. 5.5 Smith's palpation exercise to assess the interface between the physical and the 'energetic' structures of the arm.
Fig. 5.6 Low back palpation. Hands under sacrum and low back apply no pressure - contact only. Forearm resting on edge of table acts as Becker's fulcrum. Increased pressure downwards at the fulcrum enhances palpator's awareness of tissue status.
Fig. 5.7 Palpation of sacrum and pelvis. Becker's fulcrum points are the right elbow on table and contacts on anterior iliac spines with left hand/arm.
Fig. 5.8 Palpation of rib cage. Becker's fulcrums are on the operator's crossed knees and patient's anterior superior iliac spine (left).
Fig. 5.9 Palpation of cervical spine. Becker's fulcrums are forearm contacts on the table.
Special Topic Fig. 6A Traction on the sacrum (or legs) will ensure a direct pull, via the dura, on the occiput, while traction from the occiput will ensure direct pull on the sacrum via the dura.
Special Topic Fig. 6B Upledger's skill training exercise for assessment of dural restrictions.
This utilises polyethylene cling film (to represent the dura) and a 'restricting' object (to represent adhesion or restriction in the dural sheath). By standing at the feet (or by using the sacrum) or the head, restrictions can be assessed via gentle and highly focused traction.