Thoracic and Lumbar

Question 1

TART

Answer 1

1. Tissue texture abnormality
   
   1. Tension
   2. Any tenderness?
   3. Ropiness
2. Asymmetry
3. ROM (look for restricted motion)
   
   1. T1-T6
      
      1. Have patient seated.
      2. Use the patient’s head as a lever: [flex, extend, SB by moving head toward and away ear] with your hand on their transverse process
   2. T7-12.
      
      1. Have patient seated
      2. Have pt fold arms
      3. Tell patient to bend forward, extend, rotate their core and sidebend
   3. *** FOR LUMBAR (5 segments), do the same thing you for T7-12

Question 2

Evaluate the thoracic spine prone

Answer 2

1. Prone intersegmental Definition

• · Pt on stomach PRONE
• · Find T1 (spine of scapula is T3) – go up 2 segments
  
  • Lumbar L4 at Iliac crest – go down 1 segment to start at L5
• LOAD TP to examine if any are posterior (PTP) and SPRING to check rotation in neutral T1-T12 or L1-L5
• o If likes to rotate right–> RR
• o If likes to rotate left–> RL

· Check side-bending in neutral (to do very side, more lateral, where fingers fall off) These are static.

o Check rotation of restricted segment(s) only in flexion – “cat back” position

o Check rotation of restricted segment(s) only in extension – “TV watching position”

§ If better in flexionà flexion

§ If better in extensionà extension

§ If unchanged à neutral segment

Question 3

Evaluate the thoracic spine seated static

Answer 3

JUST GLIDE YOUR HANDS ON THE PTPS AND SEE IF ANY ARE STICKING OUT!

1. . Pt is seated

• 2. Find T1 (one segment below C7)
• 3. Assess static position
• 4. Thumbs placed on transverse process – assess if any PTPs
• 5. . From T1-6
• i. Check same thing in Flexion (Pt look down) & Extension (Pt look up)
• à if better in flexion à flexed
• à if better in extension à extended

c. From T7-12 & L1-L5

• i. Find T7 (inferior angle of scapula)
• ii. Start at L1 (L4 is at iliac crest – go up 3 segments)
• iii. Palpate transverse process es – assess if any PTPs
• 1. Check same thing in Flexion (bend forward towards knees) and Extension (look at ceiling and arch back)
• à PTP would indicate rotation in the same direction, would need to check sidebending for proper diagnosis

Question 4

Assess seated rotation intersegmental definition

Answer 4

TEST BILATERALLY to see which side is worse than the other.

but only TEST IPSILATERAL SIDE (SAME SIDE AS PATIENTS SHOULDER CONTACT)

1. Pt seated
2. Doc seated next to patient and put forearm on top of pts shoulder
3. ipsilateral PTPs LOAD & SPRING all the way down T1-12 (or L1-L5) WHILE rotating patient with your arm
   b. Test lateral sidebending by sidebending Pt with your shoulder and translate segment using thumb
   c. ^^ Do the same thing by moving to the other side of the patient

—Whichever feels harder–> way your are rotated. If R is harder–> rotated R.

SB–> oppsite of the way you are translating—-

Name for where it likes to rotate—-

Question 5

As we go down, how to the lumbar spine changes?

Answer 5

TPT go thurther out!