any dexterous procedure. See also entries under method, operation, procedure, surgery, and technique. Adson maneuver, a test for thoracic outlet syndrome: with the patient in a sitting position, hands resting on thighs, the examiner palpates both radial pulses as the patient rapidly fills the lungs by deep inspiration and, with breath held, hyperextends the neck and turns the head toward the affected side. If the radial pulse on that side is decidedly or completely obliterated, the result is considered positive. Called also Adson test. Allen maneuver, with the elbow flexed at a right angle, the arm is extended horizontally and rotated externally at the shoulder, the head being rotated to the contralateral shoulder; obliteration of the radial pulse suggests scalenus anterior syndrome. Barlow maneuver, a dislocation maneuver used together with the Ortolani maneuver in diagnosing developmental dysplasia of the hip. Bracht maneuver, (for breech presentation), the breech is allowed to spontaneously deliver up to the umbilicus. The body and extended legs are held together with both hands maintaining the upward and anterior rotation of the fetal body. When the anterior rotation is nearly complete, the fetal body is held against the mother's symphysis. Maintenance of this position can lead to spontaneous completion of delivery. Brandt-Andrews maneuver, a method of expressing the placenta from the uterus in the third stage of labor: the left hand grasps the umbilical cord while the right is placed on the maternal abdomen with the fingers over the anterior uterine surface. The right hand is gently pressed backward and slightly upward as the left applies gentle traction on the cord. Catell maneuver, mobilization and reflection superiorly to the left of the right colon, root of the small bowel mesentery, duodenum, and head of the pancreas to expose the retroperitoneal vascular structures. Credé maneuver, see under method. forward-bending maneuver, a method of detecting retraction signs in neoplastic changes in the mammae; the patient bends forward from the waist with chin held up and arms extended toward the examiner. If retraction is present, an asymmetry in the breast is seen. Gowers maneuver, Gowers sign (def. 2). Hallpike maneuver, a test for benign positional vertigo: the examiner turns the head of the seated patient to one side and pulls the patient backwards into a supine position with the head hanging over the edge of the examining table; the patient then looks straight ahead and the examiner observes for positional nystagmus, which is indicative of benign positional vertigo. Heimlich maneuver, a method of dislodging food or other material from the throat of a choking victim: after wrapping the arms around the victim at the belt line and allowing his upper torso to hang forward, make a fist with one hand and grasp it with the other; with both hands placed against the victim's abdomen slightly above the navel and below the rib cage, forcefully press into the abdomen with a quick upward thrust. If the victim is sitting, stand behind him and perform the same procedure; if he is prone, turn him on his back, kneel astride the torso, place both hands at the location on the victim's abdomen as described above and press forcefully with a sharp upward thrust. The maneuver may be repeated several times if necessary. Hoguet maneuver, in hernioplasty, conversion of the direct hernial sac to an indirect one by withdrawing the sac from beneath the deep epigastric vessels. Hueter maneuver, downward and forward pressure on the patient's tongue by the left forefinger of the physician during introduction of a stomach tube. Jendrassik maneuver, a procedure for emphasizing the patellar reflex: the patient hooks hands together by the flexed fingers and pulls apart as hard as possible. Kocher maneuver, operative mobilization of the duodenum for exposure of the retroduodenal, intrapancreatic, and intraduodenal portions of the common bile duct. Leopold maneuvers, four maneuvers in palpating the abdomen for ascertaining the position and presentation of the fetus. McDonald maneuver, measurement of the contour of the abdomen to calculate the duration of pregnancy; see also under rule. Mattox maneuver, mobilization and medial reflection of the abdominal viscera to expose the suprarenal aorta for repair of traumatic injury. Mauriceau maneuver, Mauriceau-Smellie-Veit maneuver, a method of delivering the aftercoming head in cases of breech presentation: the infant's body rests on the physician's palm and forearm with the index and middle fingers over the maxilla to flex the head while the other hand is placed on the infant's shoulders to apply traction. Called also Smellie method. Müller maneuver, an effort to inhale with a closed glottis after exhalation, used during fluoroscopic examination to cause a negative intrathoracic pressure with engorgement of intrathoracic vascular structures, which is helpful in recognizing esophageal varices and distinguishing vascular from nonvascular structures. Ortolani maneuver, a reduction maneuver used together with the Barlow maneuver in diagnosing developmental dysplasia of the hip. Osler maneuver, a technique for identifying pseudohypertension: the sphygmomanometer cuff is inflated above systolic blood pressure; if the pulseless radial or brachial artery remains palpable, pseudohypertension may be present. Pajot maneuver, a maneuver for forceps delivery with traction along the axis of the superior pelvic aperture; one hand over the lock of the forceps pulls downward towards the floor, while the other hand applies horizontal traction. Phalen maneuver, (for detection of carpal tunnel syndrome), the size of the carpal tunnel is reduced by holding the affected hand with the wrist fully flexed or extended for 30 to 60 seconds, or by placing a sphygmomanometer cuff on the involved arm and inflating to a point between diastolic and systolic pressure for 30 to 60 seconds. Pinard maneuver, a method of bringing down the foot in breech extraction. Prague maneuver, a method in breech presentation of delivering the head when the fetal back is posterior, by bringing down the breech and making traction on the head with the finger, which is hooked over the nape of the neck. Ritgen maneuver, delivery of the fetal head by extending it upward and forward through the vulva, between contractions, by pressing with the tips of the fingers upon the perineum behind the anus. Scanzoni maneuver, a method of forceps rotation of the fetal head when it is in the posterior position of the occiput. Schreiber maneuver, rubbing of the inner side of the upper part of the thigh while testing for patellar reflex. Sellick maneuver, the application of pressure to the cricoid cartilage in order to compress the esophagus and prevent passive regurgitation during endotracheal intubation. Toynbee maneuver, pinching the nostrils and swallowing; if the auditory tube is patent, the tympanic membrane will retract medially. See also Toynbee test, under test. Called also Toynbee experiment. Valsalva maneuver, forcible exhalation effort against a closed glottis; the resultant increase in intrathoracic pressure interferes with venous return to the heart. Called also Valsalva experiment.forcible exhalation effort against occluded nostrils and a closed mouth causes increased pressure in the eustachian tube and middle ear, so that the tympanic membrane moves outward; formerly used as a test of eustachian tube patency. Called also Valsalva method or test. Wigand maneuver, see under version. Leopold maneuvers. (A), First maneuver. One or both hands are placed over fundus and the fetal part identified. (B), Second maneuver. The palmar surface of one hand is used to locate the back of the fetus and the other hand to feel the irregularities, such as hands and feet. (C), Third maneuver. Thumb and third finger are used to grasp presenting part over the pubic symphysis. (D), Fourth maneuver. Both hands are used to outline the fetal head.   Heimlich maneuver.