Thoracic and Lumbar Spine SD Diagnoses

Question 1

• The spine of the scapula corresponds to the spinous process of _

Answer 1

• T3

Question 2

• The inferior angle of the scapula corresponds with the spinous process of _ and transverse process of _

Answer 2

• T7
• T8

Question 3

• What is the rule of 3’s?***

Answer 3

• T1-T3 Spinous process is in same plane as transverse processes and vertebral body
• T4-T6 in plane halfway between its own TP and the TP of the vertebrae below
• T7-T9: SP is in the plane of the TP of the vertebrae one level below
• T10: One level below
• T11: Halfway
• T12: Same plane

Question 4

• What is the acronym for diagnosing Type I spinal dysfunctions?

Answer 4

• TONGO
• Type One Neutral Grouped Opposite (sidebending and rotation are on the opposite side)

Question 5

• What are characteristics of Type II spinal somatic dysfunctions according to Fryette’s principles?

Answer 5

• Type II are:
  
  • Not grouped
  • Flexed or extended
  • Sidebending and rotation occur in same direction

Question 6

• How do the spinous processes move with extension?

Answer 6

• Approximation
• So resistance to approximation is indicative of a flexed somatic dysfunction

Question 7

• How do the spinous processes move with flexion?

Answer 7

• Separate
• So resistance to separation is indicative of an extended somatic dysfunction

Question 8

• How do you perform segmental evaluation in neutral?

Answer 8

• Patient lies prone
  
  • Apply loading and springing force on transverse processes of vertebrae
  • Hard end feel on side of rotation dysfunction
• Sidebend by pushing transverse processes medially
  
  • Evaluate for hard end feel/ease of sidebending
  • EX: Easier to move Right TP to the left, Pt is sidebent right

Question 9

• Which position do you place the patient in to evaluate flexion in Type II SDs?

Answer 9

• “Cat back” or seated forward

Question 10

• Which position do you place the patient in when assessing static vertebral motion of extension?

Answer 10

• TV wacthing or sphinx position

Question 11

• How do you perform dymanic segmental motion testing in the thoracic sphinx position (T1-T6)?

Answer 11

• Patient in sphinx position
• Doc places inferior finger pads on spinous proccess of somatic dysfunction segment and superior hand supports patient’s head thru forehead contact
• Doc uses patient’s head as a lever to induce flexion and extension of the upper thoracics

Question 12

• How do you perform dynamic motion testing of the lower thoracic and lumbar region in the lateral recumbent position? (T7-L5)

Answer 12

• Patient is lateral recumbent with knees off the table
• Doc places superior finger pads on suspected spinous processes involved in the dysfunction and inferior hand supports knees and induces flexion/extension

Question 13

• What do you use as a lever to diagnose the thoracic spine in the seated position?

Answer 13

• Head and neck
• Perform passive sidebending by bringing the patient’s ear towards their shoulder
• Perform passive rotation by turning the patient’s head

Question 14

• What do you use as a lever to diagnose lower thoracic and lumbar spine in a seated position? (T7-L5)

Answer 14

• Trunk as a lever
• Passive sidebending by pushing down on ipsilateral shoulder with hand/fporearm while monitoring ipsilateral segmental sidebending with their other hand
• Passive rotation by contacting the front of the patient’s ipsilateral shoulder and inducing rotation
• Always evaluate in flexion and extension to note changes in rotation motion