Lymphatic System & Pumps
Comprehensive OMT reference hub, interactive cheat sheets, and board review notes for COMLEX Level 1, 2-CE, and 3.
Key Takeaway
Lymphatic techniques enhance immune surveillance, clear metabolic waste, and reduce edema. Remember the strict sequence: ALWAYS open the Thoracic Inlet FIRST before performing lymphatic pumps! The Left Thoracic Duct drains 3/4 of the body, while the Right Lymphatic Duct drains only the right arm, right head/neck, right heart, and right lungs (plus left lower lung lobe).
Anatomy of Lymphatic Drainage
COMLEX tests lymphatic drainage patterns with exact anatomical precision. The body is divided into two unequal drainage territories.
| Drainage Pathway | Body Regions Drained | Terminal Entry Point |
|---|---|---|
| Left Thoracic Duct (3/4 of Body) | Both Lower Extremities, Abdomen/Pelvis, Cisterna Chyli, Left Arm, Left Head & Neck, Left Chest, Left Upper Lung Lobe. | Junction of Left Internal Jugular and Subclavian Veins. |
| Right Lymphatic Duct (1/4 of Body) | Right Upper Extremity, Right Head & Neck, Right Heart, Right Lungs (entire right lung + Left Lower Lung Lobe). | Junction of Right Internal Jugular and Subclavian Veins. |
HIGH-YIELD BOARD TRAP: The Left Lower Lung Lobe drains into the RIGHT Lymphatic Duct! The Right Heart also drains into the Right Lymphatic Duct, while the Left Heart drains into the Left Thoracic Duct.
Strict Sequence of Lymphatic Treatment
Treating lymphatics out of order is a classic COMLEX failure point. You MUST open central drain bottlenecks before driving peripheral fluid into the system.
- Step 1: Open the Thoracic Inlet FIRST (Clavicle, Rib 1, T1 MFR / MET). This removes the terminal restriction at the subclavian vein junction.
- Step 2: Release Regional Transverse Diaphragms (Thoracoabdominal respiratory diaphragm, Pelvic diaphragm, Popliteal fossa).
- Step 3: Perform Central Lymphatic Pumps (Thoracic pump, Abdominal pump, Pedal pump) to propel lymph centrally.
- Step 4: Perform Local Drainage Techniques (Galbreath technique for otitis media, effleurage, milking techniques).
Lymphatic Treatment Techniques
| Technique Name | Mechanism & Setup | Primary Clinical Indication |
|---|---|---|
| Thoracic Inlet Release | Direct or Indirect MFR applied to Rib 1, Clavicle, and Sibson's fascia. | MANDATORY FIRST STEP for all lymphatic treatment protocols. |
| Miller Thoracic Pump | Rhythmic chest wall compression during expiration; sudden release at end of max inspiration. | Pneumonia, URI, atelectasis, post-op pulmonary clearance. |
| Galbreath Technique | Patient supine; downward and anterior traction on mandible on affected side. | Otitis media, Eustachian tube dysfunction, allergic rhinitis. |
| Dalrymple Pedal Pump | Rhythmic plantarflexion/dorsiflexion of feet creating systemic fluid wave. | Lower extremity edema, bedridden patients, generalized stasis. |
| Rib Raising | Rhythmic anterolateral traction on rib angles; reduces sympathetic tone. | Normalizes hyper-sympathetic constriction of lymphatic vessels. |
| Splenic / Hepatic Pump | Rhythmic manual compression over left (spleen) or right (liver) lower ribcage. | Infectious illness, boosting immune cell mobilization. |
Contraindications for Lymphatic Techniques
Absolute Contraindications: Anuria (renal failure without dialysis), uncontained bacterial infection with high fever (>102°F), active deep vein thrombosis (DVT), metastatic cancer (unless palliative care), severe acute asthma / COPD exacerbation with bullae (for thoracic pump).
Relative Contraindications: Bone fracture near pump site, acute surgical incision, pregnancy (for deep abdominal pump), congestive heart failure (CHF exacerbation - risk of volume overload).
High-Yield Board Traps & Practice Drills
Q: A 4-year-old child presents with right otitis media. What is the correct sequence of OMT?
A: 1. Treat Thoracic Inlet first. 2. Treat Cervical spine / MFR. 3. Apply Galbreath technique to right mandible.
Q: Which lymphatic duct drains the right arm, right side of head, and the LEFT LOWER lung lobe?
A: The Right Lymphatic Duct.
Q: Why is Miller Thoracic Pump contraindicated in a patient with severe emphysema and lung bullae?
A: The sudden negative intrathoracic pressure change and mechanical compression can rupture a pulmonary bulla, causing a pneumothorax.
Source
Based on the publicly available table of contents and topic organization of OMM Review: A Comprehensive Review of Osteopathic Medicine. All notes are original; no copyrighted text, figures, or full source material is included.