spine palpations

Question 1

how is the patient placed to examine the cervical spine?

Answer 1

pt is in prone, with head in the hole of the treatment tables.

Question 2

how should the cervical spine be positionned during palpation?

Answer 2

Cx is in neutral or slight flexion (using the table – to adjust the angle) – no cervical extension/hyperextension

Question 3

what first gets palpated on the cervical spine?

Answer 3

the external occipital protuberance

Question 4

how do you palpate the posterior arch of C1

Answer 4

from the external occipital protuberance, fall into a space before reaching the first bump as you make your way inferiorly`

Question 5

what is particular about the posterior arch of C1

Answer 5

it has no SP

Question 6

what is the first bump you feel that is located inferior to the dip (C1)

Answer 6

Spinous process of C2

Question 7

how can you identify the SP of C3-C7?

Answer 7

from C2, simply have to count down the SP

Question 8

what must PT be aware and careful to when palpating C4-C4?

Answer 8

these may be more anterior due to the lordosis of the Cx spine and as such may be located closer to one another. important not to miss any during palpation

Question 9

how to identify the TP of C7?

Answer 9

1. Place your 1st MCPs joints at the base of the neck on top of the trapezius muscle
2. Keep the palm of your hand and fingers on each side of the neck
3. push inferiorly with 1st MCP joint and you should feel a bump underneath, this should be TP of C7

Question 10

how to confirm that you have found the TP of C7?

Answer 10

grasp the TP anteriorly and posteriorly and then move laterally along the thoracic spine to ensure that there is no rib associated to the TP, presence of a rib indicated that you have gone too far.

Question 11

identify the Z-joints (facet) of the thoracic spine?

Answer 11

lateral to the T1 SP on either side are the Z-joints which can be counted from T1/T2 all the way to T11/T12

Question 12

How to locate the facet joints in the thoracic spine?

Answer 12

in the thoracic spine you must locate the facet joints by locating the facet joint of T1/T2 and count down, because the facet joints are not inline with the spinous processes.

Question 13

how to identify the costotransverse joints of the thoracic spine?

Answer 13

Move laterally from T1 SP about 1 inch to a bump
This is the rib that attaches to that vertebra
ranges from T1-T12

Question 14

what is located medially to the costotransverse joint?

Answer 14

TP

Question 15

how to identify rib 12?

Answer 15

Palpate your pt’s waist laterally, and slide inferiorly until you feel you are on the last ribs with your index fingers, notice that if you continue to make your way down you will reach soft tissue.

Question 16

when identifying the 12th rib, how should thumb and index be positioned relative to one another

Answer 16

Position your thumbs so that you follow the

ribs to the CT joint medially for rib 12, thumb should be higher than index due to the rib angles

Question 17

what portion of the spine is PSIS located?

Answer 17

Lx spine

Question 18

how is the patient positionned to palpate PSIS

Answer 18

In prone

Question 19

how to identify and palpate PSIS

Answer 19

Go medially to PSIS to fall onto the sacrum thus reaching your sacral sulcus

Question 20

how to identify SP of L5?

Answer 20

Place hand on sacrum and allow fingers to take the shape of the sacrum; palpate for the dip of the sacrum of the first bump you feel which identifies L5

Question 21

how to identify SP of L1-L4

Answer 21

from L5, count the bumps as you make your way up superiorly, going from L4 to L1

Question 22

identifying lumbar facet joints

Answer 22

from lumbar SP, fall off laterally to reach the facet joints.
in the lx spine the facet joints are alligned with the SP

Question 23

if you are at SP of L4, which facet joint is found at that level

Answer 23

L4/L5 facet