C&T Palpation

• Palpation:

  • purpose:
  • assists in obtain an appreciation of the local area's response to tractile input, tissue sensitivity
  • what we're interested in:
  • response to tactile input
  • temperature
  • sweating
  • muscle spasm
  • bony anomalies
• Passive accessory examination of cervical spine:

  • surface anatomy:
  • spinous process
  • articular pillar
  • finding the level:
  • C2 most easily found by dropping off the occiput
  • spinous process of C1 is not often directly palpable, slip superiorly off the spinous process of C2
  • the most prominent spinous process is usually C7
  • articular pillar of C1 is just inferior to the mastoid process
• Passive accessory examination of thoracic spine:

  • surface anatomy:
  • spinous process
• Passive accessory examination of thoracic spine:

  • surface anatomy:
  • spinous process
  • transverse process
  • rib angle & ribs
  • finding the level:
  • T1 most easily found - under C7 (most prominent spinous process)
  • T7 spinous process is roughly in line with the inferior angle of the scapula
  • Transverse process changes depending on the part of the thoracic spine you're assessing
  • general rule:
  • T1 - T4 transverse process is 1 spinous process up, then left/right
  • T5 - T9 transverse process is 2 spinous process up, then left/right
  • T10 - T12 transverse process is 1 spinous process up, then left/right
• Passive accessory examination of C&T spine:

  • purpose/main aim:
  • pain provocation to help identify location of possible source of symptoms
  • also look to see how tissue responds to force applies - how much resistance is felt from the joint, soft tissue and comparison to levels above, below, left, right
  • techniques:
  • cervical spine:
  • central PA
  • unilateral PA
  • thoracic spine:
  • central PA
  • rib angle PA
  • transverse pressure on spinous process
  • central pressure on 1st rib
• Passive accessory examination of cervical spine:

  • Central PA
  • pts in prone, can place a folded towel under their forehead and pillow under their chest
  • therapist position: standing at the top of the bed
  • hand position: use thumb with fingers resting around the neck. Apply force through thumbs directly onto spinous process
  • lean forward to make sure youre over the level and that youre in the line of movement
  • make sure to have the bed low enough, allow you to use your body weight to apply the force
• Passive accessory examination of cervical spine:

  • Unilateral PA
  • pts in prone, can place folded towel under their forehead and pillow under their chest
  • therapist position: standing at the top of the bed
  • hand position: use thumbs with fingers resting around the neck. To find the articular pillar come directly laterally of the spinous process of your target level
• Passive accessory examination of cervical spine:

  • Unilateral PA
  • pts in prone, can place folded towel under their forehead and pillow under their chest
  • therapist position: standing at the top of the bed
  • hand position: use thumbs with fingers resting around the neck. To find the articular pillar come directly laterally of the spinous process of your target level
  • apply force through thumbs through the articular pillar
  • lean forward to make sure youre over the level and that youre in the line of movement
  • make sure to have the bed low enough to use youre body weight to apply the force
• Passive accessory examination of thoracic spine:

  • Central PA
  • pts in prone, can place towel under forehead and pillow under chest
  • therapist position: standing at the top of the bed for upper thoracic levels and side for mid to lower
  • hand position: use pisiform grip, for upper thoracic levels, observe the cervical spine as the upper cervical spine can move into extension
  • make sure to have the bed low enough, allows you to use your body weight to apply the force
• Passive accessory examination of thoracic spine:

  • transverse pressure on spinous process
  • pts in prone, bed high at xyphoid level
  • therapist position: stand to side of the pt in a step stance position, once youve found the target spinous process, move laterally onto the side of the spinous
  • hand position: use of thumbs pads reinforcing the bottom thumb with the top one. Alternative technique can use thumbs together with nail beds in contact with each other
  • make sure bed is high
• Passive accessory examination of thoracic spine:

  • unilateral PA at rib angle
  • pts in prone
  • therapist position: stand to side of the pts in step stance position. once youve found the transverse process, just come slightly laterally
  • hand position: use of thumb pads reinforcing the bottom thumb with the top one or can use thumbs together with nail beds in contract with each other or medial border of the hand
  • ensure bed is low enough to have your sternum over your hand
• Passive accessory examination of thoracic spine:

  • caudal pressure onto the first rib
  • pts in prone or supine
  • be gentle as theres a lot of sensitive structures and finding rib isnt easy
  • therapist position: stand at the top of the bed. Find superior border of upper trapezius, come anterior and push back the muscle tissue away. Direct pressure in a caudal/inferior direction
  • hand position: use of the thumb pads reinforcing the bottom thumb with the top one
  • ensure bed is at belly button height