Lecture 3 Flashcards
Palpating TP of T1-T3
The is one interspinous space above and approximately 2.5cm lateral to the spinous of the segment palpated
Palpating TP of T4
The TP is 2.5cm lateral to the upper 1/3 of the T3 SP
Palpating TP of T5-T9
The TP is two interspinous spaces and above approximately 2.5cm lateral to the spinous of the segment palpated
Palpating TP of T10
TP is approximately 2cm lateral to the spinous of T9
Palpating TP of T11-T12
The TP is one interspinous space above and approximately 1.25cm lateral to spinous palpated
Landmarks T11/T12
- Spinous process of thoracic vertebrae are long and slender, but T12, as a transitional vertebra, may have more of a blade-like SP
- TP of T11 and T12 are one interspinous space above and approximately 1.3cm lateral to the spinous of the segment palpated.
Landmarks T10
- The vertical dimension of the T10 spinous is the smallest among the thoracic vertebrae.
- T10 may present a challenge when first doing this
Landmarks T6/7:
T6:
- SP is at the level of the inferior angle of the scapula with the client prone
T7:
- SP is at the level of the inferior angle of the scapula with client seated
Landmarks T4
- Typically demonstrates the largest (greatest vertical dimension) SP of the thoracic
Landmarks T3
- SP is at the level of the root of the scapular spine, the flattened region of the scapular spine at the medial border of the scapula
Landmarks T1/T2
- Vertebral prominence is usually C7 but can also be T1
- To locate T1 use motion properties of the C6 SP, count down to fine T1-T2
Palpation of T1
Move downward 1 more SP from C7
Palpation of T3
Find the spine of the scapula. Move towards the midline. Keep on the same plane. Mark T-3.
Palpation of T4
Has the largest SP. It is longer and wider. Remember this is the last spinous with the greater sticking out angle.
Palpation of T5
First SP the really goes inferiorly
- Move down T4
- Move up T6
Palpation of T6
- Find the inferior angle of the scapula by sliding your hand up the client’s side with your thumb pointing upward.
- Next, slide your thumb toward the midline, keeping in a horizontal plane.
-You will feel an interspace.
-This is between T6 and T7 or T8. - T7 or T8 sitting or standing with arms at rest at sides
- T6 prone
Rhomboid Palpation
- Have the patient lie face down.
- Relax the trapezius muscle by placing your hand in the small of the patient’s back.
- Palpate the rhomboids along the vertebral border with your fingers.
- Ask the patient to lift their hand off their back while resisting.
- The rhomboids will push your fingers out.
Levator Scapulae Palpation
- Place fingers at the superior angle of the scapula.
- Ask the patient to shrug to feel contraction.
- Follow the muscle superiorly along the neck toward C1-C4.
- Confirm by asking the patient to rotate and laterally flex the head to the same side.
Upper Trapezius Palpation
- Place fingers on the top of the shoulder near the lateral clavicle.
- Ask the patient to shrug their shoulders to feel contraction.
- Follow the muscle superiorly along the neck toward the base of the skull.
- Confirm by applying gentle resistance to shoulder elevation
Supraspinatus Palpation
- Locate the spine of the scapula and move superiorly into the supraspinous fossa.
- Press gently into the fossa to feel the flat, firm supraspinatus muscle belly.
- Follow the muscle laterally toward the greater tubercle of the humerus.
- Confirm by asking the patient to initiate shoulder abduction (first 15°) against resistance—the muscle should contract under your fingers.
Deltoid Palpation
- Place your fingers over the lateral shoulder, covering the anterior, middle, and posterior deltoid fibers.
- Ask the patient to abduct their arm while you feel for contraction.
- Follow the muscle fibers downward to the deltoid tuberosity on the humerus.
- To differentiate fibers:
- Anterior fibers: Palpate near the clavicle, resist shoulder flexion.
- Middle fibers: Palpate over the acromion, resist shoulder abduction.
- Posterior fibers: Palpate near the scapular spine, resist shoulder extension.
Pectoralis Minor Palpation
- Locate the coracoid process (below the clavicle, lateral to midline).
- Move inferomedially to palpate the pectoralis minor beneath the pectoralis major.
- Ask the patient to protract their scapula (push shoulder forward) to feel contraction.
- Apply gentle pressure to differentiate from the pectoralis major, which is more superficial.
Latissimus Dorsi Palpation
- Place your fingers on the lateral side of the trunk, just below the inferior angle of the scapula.
- Ask the patient to extend, adduct, or internally rotate the shoulder against resistance.
- Feel for the broad, firm muscle contraction along the lateral torso.
- Follow the muscle inferiorly toward the thoracolumbar region and superiorly toward the humerus.
