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Diagnosis of the Thoracic

by Sheldon C. Yao, DO

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    00:01 Thoracic somatic dysfunction diagnosis.

    00:03 So we start off by assessing the thoracic region by following the mantra of look-feel-move so we're gonna look and observe usually in the back what we're observing for is to look for any sort of scoliotic curves, any lateral curves, you could also look from the sides to see if there is any kyphotic, increase in the kyphosis in the thoracic spine After observation for any sort of gross assymetries, we're going to palpate and feel so we're feeling the different muscles in thoracic spine, feeling for any hypertonicity, we wanna get a sense of our landmarks, We could find T1, while we ask the patient to bend forward and the point that sticks out the most is gonna be C7 - Vertebra Prominens So the one below it is gonna be T1.

    00:46 At your spine at the scapula, if you're gonna come medially, that's gonna be T3.

    00:50 Inferior border of the scapula, that's gonna be T7 and your 12th rib is gonna lead you to T12.

    00:57 So you want to kinda get a sense of where you are, find the spinous processes and then the transverse processes are gonna be a little bit lateral from there When you want to kinda screen for somatic dysfunctions, sometimes we could perform two different tests, one is the Skin Drag Test where my fingers are gonna slowly run down the back, if there's an area of increased drag, that's usually a sign of a potential somatic dysfunction, you see that increased moisture as we're running our fingers down.

    01:24 The other test you could do is the Red Reflex Test, you're gonna push down a little more firmly and just kinda push down so we blanch the tissue in the back here.

    01:33 What's gonna happen is gonna turn red and you're gonna see if that redness clears If the redness clears equally or if there's an area that kinda stays a little bit more red, that might be a sign of increased congestion, tissue congestion decrease clearance so that's another way to screen for somatic dysfunctions.

    01:53 So after observation and palpation of the region, we could do some motion testing, we could do gross motion testings on thoracic spine, and then we could also do more specific motion testing to find segmental somatic dysfunctions.

    02:07 So when we're screening for segmental somatic dysfunctions, what we want to get a sense of is that thoracic spine, here we could see a state a little bit red around the level of T3, so what I'm gonna do is I'm gonna check the T3 level here.

    02:22 Remember your rules of three, the spinous process of T3 is gonna be in line with the transverse process of T3.

    02:28 So here I'm putting my thumbs on T3 pushing anteriorly.

    02:35 As I push anteriorly, that is causing a forward rotation and what I feel is the right side here does not like to spring and resist anterior springing so this segment T3 is rotated posterior.

    02:50 So as I try to push, it resist and so I know that this segment is rotated right.

    02:56 Now I'm gonna check if there's a change with flexion and extension.

    02:59 So I'm gonna have the patient bend forward a little bit to T3 and that flexion's T3, I'm gonna check the springing again and see if that's changed.

    03:08 And now I'm going to have the patient extend to T3 and now when I spring, that assymetry's gone So I know that this is a non-neutral dysfunction because there was a change in extension.

    03:22 So the freedom of motion is extension, the segment is rotated right.

    03:27 And because I know that this is a non-neutral dysfunction, it's a type II dysfunction, the rotation and sidebending is coupled So this is extended side bent rotated right dysfunction at the level of T3 As i screened down further, i see a little bit of a patch of red but remain more in the midback.

    03:46 So here I'm gonna check again and so it's important to understand how you find where you are based on your spinal landmarks.

    03:55 So I feel like as I pushed here, there's a segment that's more posterior on the left side.

    04:02 And so in order to find my levels, I could find the inferior borders of the scapula and draw a line to the middle and that gets me to T7.

    04:11 And then if I come up one more, that's the spinous process of T6.

    04:15 So at the spinous proces of T6, I'm gonna find the transverse process of T7.

    04:22 So here this is T7, as a push it's posterior on the left side, go ahead and bend forward, okay.

    04:29 And as I push, it doesn't really change, I come back up and towards extension, and I still like, feel like it's still present, so it didn't really change so I'm suspecting that this might be a Type I group curve because it didn't really change in flexion or extension so it points more towards the spine.

    04:45 In that case, I need to check above and below it to see if there is a group curve because group curves have to be at least a group of three.

    04:53 So here's it's T7 and as I push down, I feel like T8 is also posterior in the left, so go ahead and bend forward, good.

    05:02 And that didn't really change, and come back up - and that stayed the same too.

    05:06 So I'm gonna check T9 now, so go ahead and bend forward, and it's still posterior on the left, and come back up and it's posterior on the left too, so.

    05:16 I have a group curve here.

    05:18 T10 feels like it's posterior on the left, and so does T12 and L1 feels like it's pretty neutral.

    05:25 So here I found a T7 to T12 neutral curve, It's rotated posteriorly on the left.

    05:35 So if it's rotated left, we know that it's side bent right cause this is a Type I curve.

    05:40 So again, T7 to T12 - neutral, it's gonna be side bent right and rotated left.

    05:48 so that's how we diagnose segmental dysfunctions in the thoracic spine.


    About the Lecture

    The lecture Diagnosis of the Thoracic by Sheldon C. Yao, DO is from the course Osteopathic Diagnosis of the Thoracic Spine Region.


    Included Quiz Questions

    1. C7
    2. C6
    3. C5
    4. T1
    5. T2
    1. T3
    2. T2
    3. T1
    4. T4
    5. C7
    1. T7
    2. T6
    3. T5
    4. T8
    5. T4

    Author of lecture Diagnosis of the Thoracic

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO


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