Thoracic Spine Competency

Question 1

a. Demonstrates the use of the Rule of Threes relative to topical anatomy of the thoracic spine.

Answer 1

• Student states T1-3: SP is in the same plane as TPs & vertebral body
•  Student states T4-6: SP is in a plane halfway between its own TP and the TP of the vertebra one level below
•  Student states T7-9: SP is in the plane of the TP of the vertebra one level below
•  Student states T10: like T7-9
•  Student states T11: like T4-6
•  Student states T12: like T1-3
•  Student states these are utilized to identify superficial anatomy to localize the thoracic spinal level they are palpating.

Question 2

b. Performs the seated and prone evaluation for thoracic spine Type 1 somatic dysfunction and documents appropriately. Describes the mnemonic: TONGO.

Answer 2

- Type I: “TONGO” (Type One, Neutral, Group, side bending and rotation go Opposite)

PRONE:
- Patient placed prone with the head in neutral, or in position of comfort.

- Student will stand at side of table and palpate the transverse process (TP)
with the pads of the thumbs.

- “Load and Spring” on L and R TPs, evaluating for ease of motion and hard end
feels/PTPs.

- States this is performed to evaluate R and L rotation

- Student evaluates patient in Prone (Flexion) and Prone (Extension) positions
and repeats as above.

•  States that if there is no change in end feel between flexed and extended positions, (doesn’t prefer Flexion or Extension), you can assume Type I Mechanics/Dysfunction
•  Student states translatory glide can also be used to evaluate side bending at each segmental level and states ease of translation from L to R indicates L SB and vice versa.
•  States the group curve would be documented in the objective portion of the SOAP note as T_-_ N S_R_ (eg. T2-6 N SrRl).

SEATED:
- Segmental motion testing can also be assessed doing seated loading and springing.

•  Patient is seated while examiner is standing behind and evaluating transverse processes.
•  Student assesses from T1-T12.
•  States they would also assess during active flexion and extension of spine.  Passive Sidebending (in seated position): examiner pushes down on patient’s shoulder with their hand or forearm, while monitoring the side bending with their other hand which is on the ipsilateral transverse process.
•  Passive Rotation (in seated position): examiner contacts the front of the patient’s shoulder & induces rotation by pulling the shoulder girdle posterior and simultaneously pushing anterior on the ipsilateral transverse process (load and spring the segment).
•  Student states they are able to diagnose neutral dysfunction by noting that ease of motion relative to the side bending and rotation would be palpated as opposite from each other.
•  States the group curve would be documented in the objective portion of the SOAP note as T_-_ N S_R_ (eg. T2-6 N SrRl).

Question 3

c. Performs the seated and prone evaluation for thoracic spine Type 2 somatic
dysfunction and documents appropriately.

Answer 3

•  Type II: “Non-Neutral”, Flexion or Extension component, usually a single vertebrae, sidebending and rotation are to the same side.

PRONE (Non-Neutral):
- Patient placed prone with the head in neutral, or in position of comfort.

- Student will stand at side of table and palpate the transverse process (TP) with the pads of the thumbs.

- “Load and Spring” on L and R TPs, evaluating for ease of motion and hard end
feels/PTPs.

•  States this is performed to evaluate R and L rotation.
•  Student evaluates patient in Prone (Flexion) and Prone (Extension) positions and repeats as above.
•  States if the segment improves or rotational end feel becomes more symmetric in flexion (thus restricted to or becomes more asymmetric in extension). This is defined as a Flexion Type II Mechanics/Dysfunction.
•  States if the segment improves or rotational end feel becomes more symmetric in extension (thus restricted to or becomes more asymmetric in flexion). This is defined as an Extension Type II Mechanics/Dysfunction.
•  Student states translatory glide can also be used to evaluate side bending at each segmental level and states ease of translation from L to R indicates L SB and vice versa.
•  States the segment would be documented in the objective portion of the SOAP note as T_ F or E S_R_ (eg. T2 F SrRr)

SEATED (Non-Neutral):
- Segmental motion testing can also be assessed doing seated loading and springing.

•  Patient is seated while examiner is standing behind and evaluating transverse processes.
•  Student assesses from T1-T12.
•  States they would also assess during active flexion and extension of spine.
•  Passive Side bending (in seated position): examiner pushes down on patient’s shoulder with their hand or forearm, while monitoring the side bending with their other hand which is on the ipsilateral transverse process.
•  Passive Rotation (in seated position): examiner contacts the front of the patient’s shoulder & induces rotation by pulling the shoulder girdle posterior and simultaneously pushing anterior on the ipsilateral transverse process (load and spring the segment).
•  Student asks patient to slump forward to assess segment in flexion and performs same technique as above noting if rotational end feel becomes more symmetric in flexion: thus a Flexion Type II Mechanics/Dysfunction.
•  Student asks patient to sit up straight to assess the segment in extension and performs same technique as above noting if rotational end feel becomes more symmetric in extension: thus an Extension Type II Mechanics/Dysfunction.
•  States the segment would be documented in the objective portion of the SOAP note as T_ F or E S_R_ (eg. T2 F SrRr).