Hi guys, my name is Jason Shen, I'm a second year Allergy Immunology Fellow here at UH, and today as part of the Scholar Teacher Program, we're going to be going over the thoracic inlet outlet, and in my part, we'll be talking about the musculature and the anatomy that is involved in somatic dysfunction that we most commonly encounter. We'll talk a little bit about transition points, the muscles themselves, and some about the diaphragms that are also involved. So if you have any questions, let me know. So we'll go ahead and start. When you look at the spine, the major transition portions are the occipital cervical up high, then you have a cervical thoracic, then you have the thoracolumbar, and then the lumbosacral down at the bottom. But today for us, what we're going to be concentrating on is a cervical thoracic area. And in that area, as far as respiration goes, you have the two main diaphragms that are involved. You have the one that we're most aware of in the abdomen, but then you also have one called Sibson's diaphragm, and that's up here at the apices of the lungs. So when someone goes to breathe and create negative pressure, intrathoracic pressure to have a breath come into the lungs, the one in the abdomen will go down inferiorly, and the one on top will rise superiorly to draw in as much air as possible. Now if there's any kind of somatic dysfunction that's present, that can cause a reduction in tidal volume and just chest expansion in general. So that's one element to know about. The other thing is the different musculature. So you have the trapezius, which is a large muscle. It goes all the way down from T12, along the spinous processes. It's attached to the scapula and also to the clavicle, and up on the neck as well. So that one can become hypertonic in many different places, and so that's one that you're going to have to take into consideration when you're evaluating somebody. The second one, the second group we're going to go over is the levator scapula. Levator scapula is, depending on where you're looking at on the person, you would want to find the medial border of their scapula, go up, and just as it starts to bend and turn into the spine, that's where the origin of the levator scapula is, and it will go up and attach to the transverse processes of the cervical, upper cervical vertebrae. And so those can become hypertonic as well and cause dysfunction. And then lastly, I'm going to talk about the anterior scalenes in the front, and those are kind of the counterpart to the levator scapula, if you will, with how they are, where their origin and insertions are, along the clavicle up into the upper cervicals. So, and those are best appreciated from the front. They are, I misspoke, their origins are the first and second ribs, and then they go up into the, and insert on the transverse processes of the cervical vertebrae. So we talked about today the anatomy of that, of the thoracic inlet, and its major muscle groups, trapezius, the levator scapula, and the scalenes. Talked about transition points on the spine, and in relation to the thoracic outlet, inlet, it'd be the cervical thoracic junction. And we also spoke a little briefly about the different diaphragms that are involved. So you have the classical, the main one is the thoracic diaphragm that's in the abdomen, but you also have a smaller diaphragm. There's two of them on either side, and those are called Simpson's diaphragm. And when you breathe in, the abdominal diaphragm, of course, goes inferiorly, and the Simpson's up top moves superiorly, and that aids in ventilation. Okay, so this is the assessment process. So tell me, how do you think you did? What did you do right? I think I spoke clearly, and it was in English. Yes, it was. But, yeah, I mean, it was a little rushed. Okay. I'm kind of skipping ahead on what you're going to ask me to ask next, so sorry. All right, what else did you do right? Oh, I guess just hands-on pointing out where structures are. Okay, good. Looking at people, you know, in their eyes. And I think that's pretty much it. Okay. I think there's a lot of improvement. So we'll go to the improvement afterwards. Let's get some feedback from the students. So tell me what you saw. Good job. I thought it was very detailed, and I appreciated the eye contact. Okay, any other comments? Yeah, I agree. I think it was detailed. I liked how you, you know, were pointing at everything, especially, like, the insertion sites for all the muscles, and explaining, like, functionality along with the diagrams and everything. So, yeah, it was a good job. Thank you. Okay, any other comments? I don't really like the way that you started out with kind of explaining what you were going to talk about, and why it was important before you even started. So I think that kind of gave us an idea of what to look for. Okay. Okay, good. Those are all good comments. Okay, let's talk about ways you think you might be able to improve. There's a lot to talk about here. So I think I was rushed, and needed to have a little bit, you know, I should have maybe known the, not the material necessarily, but just, like, just not feel like I need to get through this, right? So that's part of it. And then what I remember from last year, part of active learning is involving the students, right, or whoever you're teaching. So I remember now that, you know, I would do, I would show something, and, like, maybe palpate the muscle group, and then have you guys come up and actually do the same thing. So it will kind of burn into your cortex, too. So and it wasn't until you walked out that I remember that part. So those are two big, big things, I think. Okay. So let's talk about, okay, yeah, you identified some areas that you think you could improve. What are other strategies that you could use in that process to get more active learning out of your students? I think at each, at each spot, or after each, like, muscle group or whatever, then I would have to make a conscious, you know, remember to stop, and then ask them, do you have any questions, and then invite them in. Because then they're not going to, likely, I mean, I wouldn't just walk up and start to try to fill, you know, and to try to ascertain what I was just told. So I think that would be, I think that's one thing I need to remember, this, you know, having pauses or set points during the teaching, that you stop and have them come and participate. Okay. In whatever fashion, whether that's a question, whether that's hands-on. Okay, that's good. Let me kind of share with you what I saw. I thought you were very clear in the way you talked about things. I know that you were, you felt you were a little bit rushed, but you still went through and covered the points that you wanted to cover. So although you could see a little bit of tension in your voice, you still accomplished the mission and did what you needed to do. And that's fine. You will find it when you teach in front of groups. Yeah, there is some anxiety when you first get started. And usually after 60 to 120 seconds, that goes away. So it's just fake it until you make it. That's okay. You know, I know you know this because I've watched you do it with the other groups. So it's, it's, you know, situational or, you know, you're just at a higher point in whatever you're doing. That's fine. Okay. If you really want to have a little crutch, you can put a little three by five card or something and said, okay, you know, objectives, body, summary, those things, and literally put it on the table. If you want to do that, it's okay. Okay. The goal is make, have the students learn. Okay. One little tip for you. You struggled a little bit thinking about the scalings to say, now I'm a little unsure about the anatomy. Right. And one tip for you that will help you in that when you struggle is the toss out question. So you can toss it out to your students to say, who knows the origin and insertion of the scaling? Oh, that's so that way the students can answer number one, it puts the students on the spot. Yeah. Number two, you don't have to worry about them being engaged now because they're all engaged. Oh my God, this guy's going to ask me questions. Okay. Pay attention. Okay. And then the third thing to get you off the hook, because it's much easier to recognize something that's in front of you than to remember it. The Nova. Yeah. Okay. That's perfect. And it's funny, like thinking back, I've seen, have that, I've seen that happen so many times now. I don't know. Actually, you've got some smart people who probably know all this stuff. Oh yeah. You're okay with that. Yeah. The other piece, of course, you forgot your summary, but you went and made it up afterwards. Okay. So get in the habit of everything you do. You do, you summarize. Do an introduction, objectives, body, and summary. Okay. This is what I'm going to, this is what I'm going to tell you. This is what you tell them. I mean, I, the summary is what I, I'm telling you what I told you. Yep. And it's okay to be so rote that you're using the same boring language every time. Like, you know, this is the introduction. This is the learning objective. Okay. But when you do that over and over again, you develop a pattern that you don't forget. Okay. And it just becomes, you know, when you get flustered or whatever, you're still familiar enough with that pattern to be able to reproduce it under stress. Okay. So, excellent. It was a very good presentation. Thank you. You made a couple of little stumbles, but that, you know, it was okay. You recovered yourself. Everything was good. You got good feedback from your students. So, that's not bad. So that's good.

Allergy Immunology

somatic dysfunction

thoracic inlet outlet

musculature

active learning