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Thoracic

spine diagnosis T1 T12 vertebrae


Possiblediagnoses
TypeIdysfunction(3
ormorevertebrae,
groupcurve)
NRRSL

Rotationfindings

Sidebendingfindings

Findingswithflexion
andextension

RightTPsaremore
posterior

Sidebentleft

NRLSR

LeftTPsaremore
posterior

Sidebentright

Rotationand
sidebendingfindings
areunchangedwith
flexionandextension
Rotationand
sidebendingfindings
areunchangedwith
flexionandextension
Findingswithflexion
andextension
Rotationand
sidebendingfindings
aremoreequalwith
flexion(childspose
orrollingfingersover
topofTPs)
Rotationand
sidebendingfindings
aremoreequalwith
flexion(childspose
orrollingfingersover
topofTPs)
Rotationand
sidebendingfindings
aremoreequalwith
extension(patientup
onforearmsorrolling
fingersunderTPs)

TypeIIdysfunction(1 Rotationfindings
or2vertebrae)
FRSR
RightTPismore
posterior

Sidebendingfindings

FRSL

LeftTPismore
posterior

Sidebentleft

ERSR

RightTPismore
posterior

Sidebentright

Sidebentright

Copyright2013NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine
DepartmentofOsteopathicMedicine

ERSL

LeftTPiismore
posterio
or

Sidebeentleft

Rotattionand
sidebendingfindings
moreequalw
with
arem
exten
nsion(patien
ntup
onforearmsorro
olling
fingerrsunderTPss)

Figure1Te
estingofthoracicspineinflexio
on

Figuree2Testingoftthoracicspinein
nextension

Figure3Ch
hild'sposetoinduceflexion

Figure4PPatientuponforrearmstoinducceextension

Copyrightt2013NewYorkInstitute
eofTechnolo
ogyCollegeoffOsteopathiccMedicine
Departme
entofOsteop
pathicMedicin
ne


Figure5Fllexionbyrollinggthumbsupove
erTPsandpressingup

wnoverTPsandpressingdown
Figure6Exxtensionbyrolliingthumbsdow

RelatedA
Anatomy:

Copyrightt2013NewYorkInstitute
eofTechnolo
ogyCollegeoffOsteopathiccMedicine
Departme
entofOsteop
pathicMedicin
ne

Briefdesscription:Whhendiagnosinngthethoracicspine,grosssandsegmenntalmotionttestingis
importantt.Grossmotio
ontestingcan
nhelpnarrow
wdownthea reaofdysfun
nctionwhilessegmentalmo
otion
testingwiilllocalizethe
especificverttebraeinthedysfunction. Whenusingssegmentalmotiontesting
flexion,exxtension,rotaationandside
ebendingaretested.ThetthoracicspineemayeitherhaveaTypeII
dysfunctio
on(groupcurrve,threeorm
morevertebrraeinvolved) oraTypeIId
dysfunction(ttwoorfewer
vertebrae
einvolved).

Look(ob
bservation):Observethetthoracicspineefromall4s idesofthepaatient(patienntsfront,bacck,
leftandriight)byhavin
ngthepatienttturn.Lookfo
ordifferencessinshoulderheight(canindicate
sidebendiing),rotationoftheshould
ders(canindiicaterotationnofthethoraacicspine)and
danyforward
dor
backward
dbendingofthetorso(can
nindicateflexxionandexte nsion,respecctively,oftheespine).Also,look
foranysccars,marksorrtraumatoth
hearea.

Feel(palpation):
Physician
nposition:SStandorsittooeithersideoofthepatientt
Patientp
position:Proneorseated
Handpositioning:Ussethepadsoffyourthumbbstopalpatetthespinouspprocesses(SPss)andtransverse
processess(TPs).

Techniqu
ue:
1. Withthepati
W
enteitherp
proneorseatted,runyouurindexfingeerovertheSSPsfromT1
T12.Feelforanycurvein
nthespineth
hatmayind icatesidebeending.
2. Nowuseyou
N
rindexandmiddlefinge
ersandrunyyourhanddowntheTPssfromT1TT12.
Fe
eelforanyp
posteriorTPssthatmayin
ndicaterotation.

Copyrightt2013NewYorkInstitute
eofTechnolo
ogyCollegeoffOsteopathiccMedicine
Departme
entofOsteop
pathicMedicin
ne

3. TotestforindividualvertebrastartbyfindingT1.InordertofindT1,palpatetheSPof
C7andhavethepatientflextheirhead.IfyourfingersareovertheC7andT1SPs,the
C7SPwillmovewhiletheT1SPstaysrelativelyfixed.
4. AfterconfirmingyouareontheT1SP,moveyourfingers12cmlaterallyfromtheSP.
YouwillbeontheTPsforT1.
5. Todeterminethedysfunction,feelforwhichTPisposterior(thisisthedirectionof
rotation).Ifitisagroupcurvetherotationwillbeoppositetothedirectionof
sidebending,ifitisaTypeIIdysfunctionthenthedirectionofrotationandsidebending
willbethesame.
6. Testingforflexionandextensionmaybedonemultipleways.Ifthepatientisseated
placethehandthatisnotontheTPsalongthebackoftheneck.Gentlyflexthepatient
withthishandandthenextendwhilecheckingforwhichdirectionmakestheTPsmore
even.Ifthepatientisprone,youcancheckflexionbyhavingthepatientgointochilds
poseandcheckextensionbyhavingthepatientcomeupontotheirforearms(asif
watchingtv).Finally,themoreadvancedmethodcanbeusedineithertheproneor
seatedposition.SimplyrollyourthumbsoverthetopoftheTPsandpressupwardto
induceflexion;youreyourthumbsundertheTPsandpressdowntoinduceextension.
7. TonameTypeIdysfunctions,theTPsfor3ormorevertebraewillberotatedinthe
samedirectionanduponflexion/extensiontherewillbenoimprovement.(Ex.T5T9TPs
areallposteriorontherightanddonotimprovewithflexion/extension.Sidebendingis
oppositeofrotationwithTypeIdysfunctionssothediagnosisisT5T9NeutralRRSL.)
8. TonameTypeIIdysfunctions,theTPwillbeposteriorononeside(directionofrotation).
Rotationwillbeinthesamedirectionassidebending.TheTPswillfeelmoreevenin
eitherflexionorextension.(Ex.T4TPfeelsmoreposteriorontheleftandtheTPsfeel
moreeveninflexion.ThediagnosiswillbeT4FRSL.)

Move(motiontesting):
Activemotiontesting:
1. Askthepatienttoextendbackwardsasfaraspossible.Observehowfarthepatientcan
moveaswellasfluidityofmotion.
2. Askthepatienttobendforward(flexion)asfaraspossible.Observehowfarthepatient
canmoveaswellasfluidityofmotion.
3. Askthepatienttobendtowardstherightandleft(sidebending)asfaraspossible.
Observehowfarthepatientcanmoveaswellasfluidityofmotion.
4. Askthepatienttoturntowardstherightandleft(rotation)asfaraspossible.Usethe
shouldersasareference.Observehowfarthepatientcanmoveaswellasfluidityof
motion.

Passivemotiontesting:
1. Withthepatientseated,testtheregionsofthethoracicspinebyplacingyourhandson
theacromionbilaterally(totestT1T12),midwayontheclaviclebilaterally(totestT1
T8)andatthenapeoftheneckbilaterally(totestT1T4).
Copyright2013NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine
DepartmentofOsteopathicMedicine

2. Sidebendthepatientwithyourhandsandtesteachregion.ForT1T1220degreesis
normal,T1T810degreesisnormalandforT1T45degreesisnormal.
3. Totestforrotation,havethepatientstraddlethetable.Nowrotatethepatientusing
theirshoulders,40degreesisnormalmotionofthethoracicspine.

Othernotes:Itisimportanttorememberthatwhenmotiontesting,mostofthemotiontestingwillnot
onlyengagethethoracicspine,butalsothelumbarspine.Therefore,itisthoracolumbarmotiontesting.
Also,inaTypeIdysfunction,rotationandsidebendingareinoppositedirectionswhileinaTypeII
dysfunction,rotationandsidebendingarecoupledtothesameside.RemembertousetheRuleof3s
tofindtheTPsinrelationtotheSPs.(T1T3,SPisatsamelevelofTPs;T4T6,SPishalfalevellowerthan
TPs;T7T9,SPisonefulllevelbelowTPs;T10islikeT1T3,T11islikeT4T6,T12islikeT7T9)

Copyright2013NewYorkInstituteofTechnologyCollegeofOsteopathicMedicine
DepartmentofOsteopathicMedicine