1. The Clavicular/Sternal Relationship A Bio-Geometric Integration Approach To Understanding Their Relationship Jeffrey Hoffman, D.C.

3. Purpose of Presentation Apply BGI framework to clavicular/sternal relationship Provide a functional explanation of clavicular/sternal region Provide structural model to visualize the clavicular/sternal region which can assist in future 3-D modeling Improve clinical skills through greater clarity of clavicular/sternal region Introduce a theoretical model to give a possible explanation of the clavicular/sternal region

4. Anterior and Posterior Geometry Lower neck/upper back geometry –Relationships of cervical triangle, facial triangle, sternal triangle, and thoracic triangle Root of the neck can be very unstable –mobility –6 actions –stabilization Clavicular triangle –transverse plane

5. Sternocleidomastoid: origin - 2 heads, from the sternum and clavicle insertion - outer surface of the mastoid process Sternohyoid: origin - inner extremity of the clavicle insertion - lower border of the Os hyoides Sub-clavicle: origin - first rib insertion - under surface of clavicle Trapezius: origin - external occipital protuberance insertion - outer 1/3 of posterior border of clavicle

8. Sagittal Geometry Typical sagittal relationship –Base to Base –Apex to Apex Sagittal relationship framework –Spokes Clavicular/Sternal sagittal relationship –Rotating clavicular triangle 90 degrees –Weave –Foundation –Size and strength of sternum –Moment of neck creating load

9. Cranial – Frontal Cervical – Facial Clavicular – Sternal Thoracic – Abdominal Lumbar – Umbilical Sacral - Pelvic

10. The sagittal planes are defined by the relationship between the anterior and posterior geometry. They can be most easily be visualized as a progressive series of triangles through the center of the body.

12. Coronal Geometry Cranial Coronal Plane moment –Fulcrum at external acoustic meatus –Potential of 360 degrees of motion –Limited by cervical spine and other neck structures Structure can be analogous to Ferris Wheel –Clavicle/Sternum provide stability and foundation –Cervical spine supports weight Mastoid Process –CCP geometry –SCM connection –Attached to sternum and clavicle –Stabilizer –Could help release most of geometry

17. Mastoid

18. Advanced Geometry Tetrahedron –Typical Clavicle Tetrahedron –Atypical Sternal Tetrahedron –Atypical Vibrational nature of tetrahedron Added complexity to clavicular/sternal relationship

19. TETRAHEDRON

23. The Future Computer Aided Technology –3-dimensional modeling –Software which allows for translation –How to hook up the geometry? Is computer modeling worth the effort?