Thoracic somatic dysfunction diagnosis.
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
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.
At your spine at the scapula, if you're
gonna come medially, that's gonna be T3.
Inferior border of the scapula, that's gonna be
T7 and your 12th rib is gonna lead you to T12.
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.
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.
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
tissue congestion decrease clearance so that's
another way to screen for somatic dysfunctions.
So after observation and palpation of the
region, we could do some motion testing,
we could do gross motion testings on
and then we could also do more specific motion
testing to find segmental somatic dysfunctions.
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.
Remember your rules of three, the spinous process of T3
is gonna be in line with the transverse process of T3.
So here I'm putting my thumbs on T3
As I push anteriorly, that is causing a
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.
So as I try to push, it resist and so I
know that this segment is rotated right.
Now I'm gonna check if there's a
change with flexion and extension.
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.
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.
So the freedom of motion is extension,
the segment is rotated right.
And because I know that this is a
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.
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.
So I feel like as I pushed here, there's a
segment that's more posterior on the left side.
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.
And then if I come up one more,
that's the spinous process of T6.
So at the spinous proces of T6, I'm gonna
find the transverse process of T7.
So here this is T7, as a push
it's posterior on the left side,
go ahead and bend forward, okay.
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.
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.
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.
And that didn't really change, and come
back up - and that stayed the same too.
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.
I have a group curve here.
T10 feels like it's posterior on the left,
and so does T12
and L1 feels like it's pretty neutral.
So here I found a T7 to T12 neutral curve,
It's rotated posteriorly on the left.
So if it's rotated left, we know that it's
side bent right cause this is a Type I curve.
So again, T7 to T12 - neutral, it's gonna
be side bent right and rotated left.
so that's how we diagnose segmental
dysfunctions in the thoracic spine.