{"id":1478,"date":"2022-01-15T20:48:00","date_gmt":"2022-01-15T20:48:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1478"},"modified":"2025-10-31T14:05:21","modified_gmt":"2025-10-31T22:05:21","slug":"omm-question-of-the-day-chapman-points","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-chapman-points","title":{"rendered":"OMM Question of the Day: Chapman Points"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-chapman-points\/#The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\" >The correct answer to today&#8217;s OMM Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-chapman-points\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-chapman-points\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-chapman-points\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>43-year-old man with a severe, throbbing holocranial headache.<\/strong> Can you figure out the answer?<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>43-year-old man<\/strong> presents to the emergency department with <strong>two weeks of a severe, throbbing holocranial headache<\/strong>. He took <strong>800 mg of<a href=\"https:\/\/www.osmosis.org\/learn\/Non-steroidal_anti-inflammatory_drugs\" target=\"_blank\" rel=\"noreferrer noopener\">\u00a0ibuprofen<\/a><\/strong>\u00a0today with no relief. He has <strong>blurry vision<\/strong>, but no neck pain or stiffness, palpitations, chest pain, or shortness of breath. He also mentions <strong>early satiety<\/strong> for the past few months. His past medical history includes<strong>\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Hypothyroidism\" target=\"_blank\" rel=\"noreferrer noopener\">hypothyroidism<\/a><\/strong>\u00a0from a <strong>total thyroidectomy<\/strong> in his 20\u2019s for\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Thyroid_cancer\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>thyroid cancer<\/strong><\/a>. He takes\u00a0<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Hypothyroidism_medications\" target=\"_blank\" rel=\"noreferrer noopener\">levothyroxine<\/a>\u00a0100 mcg daily<\/strong>. His temperature is <strong>37.1 \u00baC (98.8 \u00baF)<\/strong>, pulse is <strong>114\/min<\/strong>, respirations are <strong>12\/min<\/strong>, and blood pressure is <strong>197\/121 mmHg<\/strong>. On physical examination, he has <strong>no papilledema<\/strong> by fundoscopy. His neck is supple with full range of motion. His cardiopulmonary exam is normal other than <strong>tachycardia<\/strong>. His abdomen is <strong>distended with mild epigastric tenderness<\/strong> to palpation. <strong>Computed tomography of the abdomen with contrast<\/strong> is performed and shown below.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"310\" height=\"382\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-09T145056.237.png\" alt=\"Tomography of the abdomen.\" class=\"wp-image-1480\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-09T145056.237.png 310w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-09T145056.237.png?resize=243,300 243w\" sizes=\"auto, (max-width: 310px) 100vw, 310px\" \/><figcaption class=\"wp-element-caption\">Source:\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1930043317302893?via%3Dihub\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.1016\/j.radcr.2017.09.006<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Where would you <em>most likely<\/em> palpate a Chapman point in this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Between the spinous process of T2 and transverse process of T3<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. One inch lateral from the umbilicus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. One inch lateral and two inches superior from the umbilicus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Between the spinous process of T10 and the transverse process of T11<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. In the 4th intercostal space on the left, near the sternum<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Chile learns by Osmosis.org!\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/LKi9T707GCY?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s OMM Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. One inch lateral and two inches superior from the umbilicus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the <strong>Main Explanation<\/strong>, let&#8217;s look at the <strong>incorrect answer explanations<\/strong>. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Between the spinous process of T2 and transverse process of T3<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This corresponds to\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Chapman_points\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Chapman points<\/strong><\/a>\u00a0for the <strong>esophagus, mainstem bronchi, and thyroid<\/strong>. The patient\u2019s thyroid cancer was in the distant past and he is unlikely to have a Chapman point there.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. One inch lateral from the umbilicus<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This does not correspond to any specific Chapman point. The <strong>anterior Chapman point for the kidneys<\/strong> is <strong>one inch lateral and one inch superior from the umbilicus<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Between the spinous process of T10 and the transverse process of T11<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This corresponds to Chapman points for the\u00a0<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Small_intestine_histology\" target=\"_blank\" rel=\"noreferrer noopener\">small intestines<\/a>\u00a0and ovaries (in female bodies)<\/strong>. The <strong>posterior adrenal point<\/strong> is between the <strong>spinous process of T11 and transverse process of T12<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. In the 4th intercostal space on the left, near the sternum<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This corresponds to the <strong>anterior Chapman point for the lower lung<\/strong>. He is not having any pulmonary symptoms at this time and is unlikely to have a Chapman point there.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The above patient most likely has a\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Pheochromocytoma\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>pheochromocytoma<\/strong><\/a>. This rare <strong>neoplasm<\/strong> most often presents in the <strong>4th and 5th decade of life<\/strong> and affects men and women equally. The <strong>classic triad<\/strong> involves <strong>paroxysms of headaches, sweating, and tachycardia<\/strong>. Most pheochromocytomas are located within the <strong>adrenal gland<\/strong>. They can occur on their own or be associated with <strong>multiple endocrine neoplasia type 2<\/strong>, which this patient may have if his thyroid cancer was the <strong>medullary type<\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"585\" height=\"665\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-09T145203.221.png\" alt=\"Title: CHAPMAN POINTS ANTERIOR\n\nMIDDLE EAR\nPHARYNX\nSINUSES\nEYES\nLARYNX\nTONSILS\nTONGUE\nHEART, BRONCHI, ESOPHAGUS\nMIDLINE \u2013 PYLORUS\nUPPER LUNG\nLOWER LUNG\nL \u2013 STOMACH\nR \u2013 LIVER &amp; GALLBLADDER\nL \u2013 SPLEEN\nR \u2013 PANCREAS\nSMALL INTESTINE\nR \u2013 APPENDIX\nADRENAL GLANDS\nKIDNEYS\nMIDLINE \u2013 BLADDER\nL \u2013 SIGMOID\nR \u2013 CECUM\nURETHRA, GONADS\nUTERUS\nRECTUM\nPROSTATE\nL \u2013 DESCENDING COLON\nR \u2013 ASCENDING COLON\nTRANSVERSE COLON\n\n*All points are bilateral, unless otherwise noted with L (left), R (right), or MIDLINE.\n\" class=\"wp-image-1482\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-09T145203.221.png 585w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/2024-09-09T145203.221.png?resize=264,300 264w\" sizes=\"auto, (max-width: 585px) 100vw, 585px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/learn\/Chapman_points\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Chapman points<\/strong><\/a>\u00a0are <strong>palpable rubbery nodules<\/strong> in the skin which represent <strong>lymphatic stasis within the fascia<\/strong> due to increased <strong>sympathetic tone from viscera<\/strong>. They represent a <strong>viscerosomatic response<\/strong>. Treatment involves applying a <strong>gentle, rotary motion<\/strong> over the point for <strong>15\u201330 seconds<\/strong> until the tissue tension releases. The <strong>anterior adrenal Chapman point<\/strong> is located <strong>one inch lateral and two inches superior from the umbilicus<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Pheochromocytomas<\/strong> most frequently present in the <strong>4th and 5th decades of life<\/strong> with <strong>paroxysms of headaches, sweating, and tachycardia<\/strong>. Approximately <strong>90% are found in the adrenal gland<\/strong>. The <strong>anterior adrenal<\/strong>\u00a0<a href=\"https:\/\/www.osmosis.org\/learn\/Chapman_points\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Chapman point<\/strong><\/a>\u00a0is located <strong>one inch lateral and two inches superior from the umbilicus<\/strong>.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>free trial<\/strong><\/a>\u00a0to find out why millions of current and future <strong>clinicians <\/strong>and<strong> caregivers<\/strong> love learning with us.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Explore a clinical case presenting with headaches and tachycardia. Discover how to locate the anterior adrenal Chapman point for diagnosis and treatment.<\/p>\n","protected":false},"author":202,"featured_media":1479,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,34,16],"tags":[2144,2153,2146,2150,2145,733,2148,739,645,2152,2149,2143,315,2151,2147],"class_list":["post-1478","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-omm","category-do","tag-adrenal-chapman-point","tag-adrenal-neoplasm","tag-adrenal-tumor","tag-autonomic-symptoms","tag-chapman-points","tag-clinical-case","tag-headache","tag-hypertension","tag-omm","tag-omm-treatment","tag-osteopathic-manipulative-medicine","tag-pheochromocytoma","tag-tachycardia","tag-thyroid-cancer","tag-visceral-somatic-reflex"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>OMM Question of the Day: Chapman Points - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-chapman-points\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OMM Question of the Day: Chapman Points - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Explore a clinical case presenting with headaches and tachycardia. 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