Venous Sinus Release

OMM Hour 11

Wed August 27 1-2 pm

Dr. Russell Gamber

Kate Gadberry

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Venous Sinus Release

Dr. Gamber began by talking about the COMLEX. He notes we will be seeing what we are learning now on our boards in June. He also talked about the new physical exam portion of part 2- it will have an OMM component.

He notes we have now begun the treatment phase. The venous sinus release technique is in the blue book that was in our boxes at the beginning of the semester – make sure to look it over! These are venous sinuses- very different than the other sinuses (ie. maxillary, etc).
Goal: To enhance the flow of venous blood through venous sinuses to exit through skull at jugular foramen.
Use: This technique you can use on a patient with a severe headache that is especially concentrated at the vertex of the head to give relief as venous drainage improves. This is also good for a patient with SBS compression or throbbing congested headaches. If patient has premenstrual headaches, this is good for that too.
Treated Areas: Dr. Gamber reviewed the third and fourth slides of the powerpoints that show the venous sinus anatomy. We will be treating (and therefore should know the location of for the exam) the superior sagittal sinus, inferior sagittal sinus, straight sinus, occipital sinus, transverse sinus, and the confluence of sinuses.
Treatment:

To begin: Remember that before treat cranium must treat thoracic outlet and cervicals

so venous drainage can drain properly back to body. Begin with the patient supine. Palpate the cervicals and upper thoracic. Use any techniques we learned last year (ie. direct, indirect, HVLA, soft tissue) because if improve venous return without clearing problems with thoracic duct, there may still be blockages there. You have to promote drainage by loosening these areas.

Step 1: Treats the Confluence of Sinuses

Place your middle finger from each hand overlapping each other on the inion or external occipital protuberance. The other fingers are supporting the skull but are not used for treatment! Raise the middle fingers so the weight of the skull rests on them. Wait for the softening of the bone. Since it is living bone, it will soften. Have patience- it wont feel like soft tissue but will have a little bit of give. Softening should take 30sec- 2min.

Step 2: Treats the Occipital Sinus

Spread your middle fingers apart, parallel to each other (no longer overlapping) and move 1 finger width down the midline of the occiput towards the neck. This way you can monitor each side for tightness or hardness difference.
Step 3- Occipital Decompression

Move your middle fingers down to the area of the occipital condyles. Slowly approximate the elbows, which will spread the fingers apart. Hold this until the condyles soften.

Step 4- Treats the Transverse Sinus

Bring finger tips up to superior nuchal line. All 8 fingers should be along the nuchal line with the thumbs resting one on top of the other on the sagittal sinus. Rest the head on your fingertips. Hold until you feel the softening. Once again, discriminate left and right and each finger- feel for the differences.

Step 5- Treats Superior Sagittal Sinus

Beginning at the external occipital protuberance, cross thumbs over to contact on each side of the sagittal suture. Apply slight pressure to the thumbs to separate the sagittal suture. Hold each point, moving along the suture to the bregma, until you feel a softening. This is similar to the disengagement mechanism taught last week, but will go from lambda all the way up to the nasion. This will take a couple of minutes as you continue along each spot anteriorly.
Step 5 Part 2- Treats Superior Sagittal Sinus

Place the fingertips of each hand along the metopic suture (suture of the frontal bones) from the bregma to the nasion. Apply light pressure to the frontal bone and separate the suture. Hold until you feel a softening. Again, ask yourself, is there a difference underneath any of the fingers?

We ended this by returning to the classic vault hold and palpated for rate, rhythm, amplitude and symmetry.

Dr. Gamber notes for the exam we need make sure to know which sinus each step treats and which handhold is for each sinus.