Palpation

Question 1

How to palpate Lumbar spine SPs

Answer 1

SPs of the lumbar vertebrae can be palpated in a central cleft down the midline

SPs of L5 can be felt in a deep hollow, just above the sacrum, approximately 2 cm above a line drawn between the PSIS. From here, the SP of L4 is easily recognizable above that of L5

Question 2

Lumbar spine TPs

Answer 2

On either side of the midline is a powerful column of muscle tissue running from the posterior part of the sacrum up towards the thoracic region

On deep palpation, lateral to this bulk of muscle, small pointed tubercles can be felt running down either side = tips of the TPs, each being located just above the level of the centre of its corresponding SPs

Higher up, level with the SP of L1, the tip of the 12th rib can be palpated, level with the 9th cc

Question 3

Thoracic spine SPs

Answer 3

much easier to identify, particularly if the subject is sitting with the trunk flexed

Identification is made easier, however, if one finger is placed on the SP above to mark it while that below is determined

SP T1-11 = pointed
T12 = flattened; similar to Lx

Question 4

Thoracic spine TPs

Answer 4

lying prone, a line of smaller tubercles can be felt approximately 2 cm either side of the SPs (Rule of three)

T1-3: TP 1cm (same level) to SP

T4-6: TP 2cm (half level) sup to SP

T7-9: TP 2-3cm (one level) sup to SP

T10: TP 2-3cm (one level) sup to SP

T11: TP 2cm (half level) sup to SP

T12: TP 1cm (same level) to SP

Question 5

Thoracic spine ribs

Answer 5

Just beyond the TPs, each rib can be felt passing downwards and laterally around the chest wall

Question 6

Cervical spine SPs

Answer 6

most easily examined with the subject prone and the forehead supported on the hands with the chin slightly tucked in; even so, the central area (C3–C5) may be difficult to distinguish

C2: approx 2cm inf to external occipital protuberance; there is a deep hollow between the two landmarks because C1 has no SP

C7: 10cm inf to SP of C2

C6: disappears on ext

Question 7

Cervical Spine TPs

Answer 7

Deep palpation lateral to the muscle mass either side of the SPs reveals another line of bony projections running up the side of the vertebrae = tips of the TPs

Appear blunted because the fingers are feeling both anterior and posterior tubercles at the same time

C1: below the mastoid process of the skull

C7: projecting further laterally than the rest; it may also be tender to the touch.