OMM III
24 Sept. 2003 3pm
Chapman
Nathan Seaman
Pg. 1 of 3
Epidydymitis
I. Case presentation: A 23 year old white male presents with the complaint of fever and
unilateral scrotal pain with tenderness and swelling. Palpation of the scrotum is
described as feeling like a "bag of worms." Patient relates history of unprotected sex two
weeks ago. Diagnosis - EPIDYDYITIS! Via urethral swab with Culture & Sensitivity.
a. Heterosexual men under 35 yrs - 70% chlamydia trachomatis, remaining
Neisseria gonorrhoeae (Always treat for both!)
b. Heterosexual men older than 35 yrs - Coliforms and pseudomonas aeruginosa
post urologic instrumentation or surgery
c. Homosexual men - coliforms
d. Anterior Chapman's points for Urethra located in myofascial tissues along the
superior margin of the pubis ramus about 2cm lateral to the symphysis (Also the L5
strain/counterstrain points). Pelvic diaphragm positive for somatic dysfunction.
e. Osteopathy is an adjunct, it does not cure epidydymitis, use the drugs...
Ceftriaxone 250mg IM and Doxycycline 100mg PO BID for 10 days or Ofloxacin
(harrison's DOC) 300mg PO BID for 10 days for treatment, hand in hand.
f. beware of testical torsion - requires surgery. beware of testicle tumors (age
mid 20's - 30's)
II. Case presentation: A 59 year old male who presents iwth fatique, malaise, urinary
urgency, pain and difficulty with urination, and complans of perineal and low back pain
for 10 days. Patient relates a history of urinating 5-6 times during the night for past
couple of months. (Classic findings! Always ask old men how often they're getting up in
the night to urinate). Diagnosis - PROSTITIS! via palpation with the digit.
a. Prostate feels warm, boggy, noddules and tender to palpation
b. Pyuria and bacteriuria in UA (urinalysis) with Culture & Sensitivity of
expressed prostatic secretions or voided urine (first void in the morning, mid-stream
catch).
c. Anterior Chapman's points for Prostate located in myofascial tissues along the
posterior margin of the superior iliotibital band (on lateral thigh).
d. Asymmetry in tension of right and left sides of pelvic (urogenital) diaphragm
is positive for dysfunction.
e. BPH - non bacterial (treated with alpha blockers which are a direct
contraindication to PDE5 inhibitors i.e. Viagra)
f. TMP/SMX DS po BID x 14 days (acute) or Cipro 500mg po BID x 4 weeks
(chronic) and don't forget the stool softeners! (makes it easier for a BM)
III. Erectile Dysfunction
a. Simply put, impotence is the failure to acheive erection, ejaculation, or both.
Pg 2. of 3
b. Causes can be from specific urogenital or endocrine disorders, secondary to
systemic disease, or psychological disorders.
c. Harrison's lists 35 different organic causes of erectile dysfunction.
d. Percentage for having ED is same as your age. If you're diabetic, add 15 years
to age...if you're 50 yrs old and have diabetes then the percentage/risk of having ED is
65%. 50 + 15 = 65 : )
e. Treat with Viagra or Caverject (direct injection into the corpus cavernosum)
other drugs and implants and pumps.
IV. OMM Treatments
a. Pubic decompression
1. Always do this treatment before you treat the pelvis - insure pelvic
treatment to remain.
2. For muscle energy refer to previous lecture (Fotopolus)
3. HVLA - Patient supine, doctor spreads patients knees, have patient
resist spread (muscle energy) then thrust knees open further (short quick thrust)
4. Time Savy treatment - Set up as in number three above and instead of
thrusting, have patient lift their buttocks of the table and set back down.
b. Treatments of Pelvic Diaphragm Dysfunction
1. Prone (493.41A) Kimberly Manual
2. Supine (4931.41B) Kiberly Manual
3. Seater (per lecture)
c. Correction of sacral and thoracolumbar dysfunction.
V. Anatomy
a. ischiorectal fossa - contains pelvic diaphragm comprised of the Levator Ani,
and the Deep transverse Perineal muscle of the urogenital diaphragm
b. bordered primarily by the Sacrotuberous ligament and a line passing
between the Ischial Tuberosities
c. see Netter plates 337-340, 356, 361
VI. Innervations
a. Prostate, Cowpers's gland, and the Corpus Cavernosa
- sympathetic T12-L2 - Hypogastric plexus (Ejaculation L1-L2)
- parasympathetic S2-S4 - Pudendal (that of which to be ashamed) nerve
(Erection)
b. Point - parasympathetic (erection)
c. Shoot - sympathetic (ejaculation)
d. Sacral 2-3 and 4 keeps the penis off the floor.
VII. Lymphatics - pelvic organs dependant on the synchornous motion of the active
thoracic diaphragm during respiration. The prostate is continuosly masaged by the
passive motion imparted by respiratory activity when the pelivc floor is free to move.
When you breath in, the pelvic diaphragm descends and vice versa.
Pg. 3.of 3
VIII. Pubic decompression - explained earlier by Dr. Fotopous
IX. Treatment of the Pelvic Diaphragm Dysfuntion - prone
a. superior portion of pelvic diaphragm - directly engage
b. Operator places thumbs inferiorly and lateral to the patients ILAs, press
laterally and spuperiorly.
c. Ask patient to cough, or breath deeply while resisting diaphragm excursion,
follow diaphragm cephalad with relaxation.
d. May use respiratory cooperation as well.
X. Prone - Ischial tuberosity spread - Inferior portion of pelvic diaphragm
a. Operator places thumbs medial to patient's Ischial Tubersities and pull
laterally. (warn patient your coming)
b. Ask patient to cough 3 times, or whatever is necessary, while resisting
diaphragm excursion, follow diaphragm cephalad with relaxation.
c. May use respiratory cooperation
d. Most beneficial technique for the pelvic diaphragm. Excellent shotgun
technic.
XI. Supine - direct release
a. Patient supine, operator contacts the medial surface of patients Ischial
Tuberosity (work down hamstrings to find it), continue insertion until tension is
experienced.
b. Have patient breath in and then out. During exhalation, follow the pelvic
diaphragm cephalad as it relaxes, allowing your fingers to extend further into the
ischiorectal fossa.
XII. Seated technic
a. Patient seated, operator contacts the medial surface of patients Ischial
Tuberosities (have them sit on your hands), continue insertion until tension is
experienced.
b. Allow weight of patient to rest on fingertips
c. Have patient breath in and then out. during exhalation, follow the pelvic
diaphragm cephalad as it relaxes, allowing your fingers to extend further into the
ischiorectal fossa.
d. To treat lumbars, raise hands on one side (push on Ischial Tuberosity) then
alternate to other, feel restriction in lumbard, take it indirect and feel the release, you can
feel this up into the thorasics.
XII. Summary - Mind, body, spirit
a. treat respriatory diaphragm
b. treat pelvic diaphragm
c. correct sacral dysfunction
d. correct thoraco-lumbar somatic dysfunction
e. treat throracic inlet
f. treat Occipito-atlantal Joint