Learn about the somatic dysfunctions that may be causing lung findings in a 34-year-old man with cystic fibrosis. Learn about his symptoms, medical history, and examination findings to determine the appropriate treatment approach.
A 34-year-old man presents to the office with three days of shortness of breath and a cough productive of green sputum. He has had several episodes like this in the past. He has no chest pain or fever. His past medical history is significant for cystic fibrosis. His medications include inhaled dornase alfa, nebulized hypertonic saline, and lumacaftor. His temperature is 37.7 ºC (99.9 ºF), pulse is 90/min, respirations are 20/min, blood pressure is 122/76 mmHg. On physical examination, he has increased respiratory effort. There is diffuse wheezing in his lungs and decreased air movement. C6 is E SR RR, T6-T8 is N SL RR. There are tender rubbery nodules between the spinous and transverse process of T2, between the spinous process of T4 and transverse process of T5, and in the right 5th intercostal space. Treatment of which of the following somatic dysfunctions will help improve his lung findings?
A. C6, E SR RR
B. T7-T9, N SL RR
C. Chapman point, between the spinous and transverse process of T2
D. Chapman point, between the spinous process of T4 and transverse process of T5
E. Chapman point, in the right 5th intercostal space
Scroll down for the correct answer!
The correct answer to today’s OMM® Question is…
D. Chapman point, between the spinous process of T4 and transverse process of T5
Before we get to the Main Explanation, let’s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!
Incorrect answer explanations
A. C6, E SR RR
Incorrect: While treatment of dysfunctions from C3-C5 could potentially help via acting on the phrenic nerve, treating his C6 dysfunction is unlikely to help his respiratory complaints.
B. T7-T9, N SL RR
Incorrect: While treating thoracic somatic dysfunctions can normalize sympathetic tone to the viscera via a somatovisceral reflex, the lungs receive their sympathetic innervation from T1-T6.
C. Chapman point, between the spinous and transverse process of T2
Incorrect: This Chapman point correlates to the mainstem bronchi and would not improve his lung findings as much as treating a Chapman point around T3 or T4 (which would be the lungs).
E. Chapman point, in the right 5th intercostal space
Incorrect: This Chapman point correlates to the liver. Points in the 3rd and 4th intercostal space correlate to the upper and lower lung, respectively.
Main Explanation
Cystic fibrosis is the most common life-limiting autosomal recessive disease among white people in the United States. It is very commonly tested on boards and is important to know for clinical practice. Mutations in the CFTR gene cause abnormal chloride transport across epithelial tissues, leading to issues with the lungs, digestive system, sweat glands, and reproductive tract. Chronic treatment involves aggressive chest physiotherapy, inhaled medications to help break up mucus (e.g., dornase alfa, hypertonic saline), modulating agents (e.g., lumacaftor) and sometimes chronic antibiotics. Exacerbations of the obstructive lung disease of cystic fibrosis are treated with bronchodilators and antibiotics targeting Pseudomonas (e.g., ceftazidime, levofloxacin).
Chapman points are palpable rubbery nodules in the skin which represent lymphatic stasis within the fascia due to increased sympathetic tone from viscera. They represent a viscerosomatic response. Treatment involves applying a gentle, rotary motion over the point for 15-30 seconds until the tissue tension releases. The posterior Chapman points for the lung are found between the spinous process of T3 and transverse process of T4 (upper lung), and between the spinous process of T4 and transverse process of T5 (lower lung).
Major Takeaway
Cystic fibrosis is very commonly tested on boards and is important to know for clinical practice. The posterior Chapman points for the lung are found between the spinous process of T3 and transverse process of T4 (upper lung), and between the spinous process of T4 and transverse process of T5 (lower lung).
________________________
Want more OMM Questions as well as practice questions for USMLE® Step 1 and Step 2 CK? Try Osmosis today! Access your free trial and find out why millions of current and future clinicians and caregivers love learning with us.
Leave a Reply