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Comprehensive Assessment of the Thoracic and Lumbar Spine: Anatomy, Curvature, and Evaluation

This chapter provides an in-depth analysis of the thoracic and lumbar spine, focusing on spinal curvature types—lordotic in the cervical and lumbar regions and kyphotic in the thoracic region. It reviews vertebral anatomy, intervertebral discs, and sacroiliac joint changes. A detailed clinical evaluation approach is outlined, including patient history, inspection of posture, and palpation techniques to assess bones and muscles. Range of motion assessments for flexion, extension, lateral bending, and rotation are discussed, alongside the implications of spine dysfunction and referred pain patterns.

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Comprehensive Assessment of the Thoracic and Lumbar Spine: Anatomy, Curvature, and Evaluation

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  1. Chapter 10 – Part 1 The Thoracic and Lumbar Spine Assessment

  2. Spine Curvature • Cervical – Lordotic • Thoracic – Kyphotic • Lumbar - Lordotic

  3. Anatomy Review • Vertebrae – 24 + sacrum • Greatest ROM – Cervical • True rotation occurs at C1

  4. Intervertebral Discs • 23 disks • None found between C0 – C1; C1 – C2 • Anatomy • Annulus • Nucleus • Derangements • Anterior, posterior, lateral, compressed

  5. Sacroiliac Joint (SI) • Mobile in youth but fuse as we age • Changes with pregnancy • Increased dysfunction • Often associated with referred pain

  6. Dermatomes • Lumbar Plexus: T12, L1 – L5 • Anterior, medial thigh • Medial leg & foot • Femoral nerve • Sacral Plexus: L4, L5, S1 – S5 • Buttocks • Posterior thigh/leg • Sciatic nerve, tibial nerve, common peroneal nerve

  7. Clinical Evaluation • History • Location of pain • Onset of pain • Injury mechanism • Type of pain • Constant or intermittent • Paresthesia • Bladder problems

  8. Inspection • Posture evaluation • Erect & forward flexed • Plumb line • Spinal curves • Skin markings • Café-au-lait-spots • Faun’s beard (spina bifida) • Gait • Muscle tone/development

  9. Palpation – Thoracic Spine • Bony Landmarks; Table 10-6, pg 334 • Spinous processes: Rule of 3’s • T1-T3, T4-T6, T7-T9, T10, T11, T12 • Supraspinous ligaments • Costovertebral junction • Trapezius • Paravertebral muscles • Scapular muscles

  10. Palpation – Lumbar Spine • Spinous processes: L1 – L5 • Check for Step-Off Deformity • Spondylolisthesis: L4/L5 or L5/S1 • Paravertebral Muscles • Tightness = lordosis

  11. Palpation – Sacrum/Pelvis • Sacral crest • Iliac crests • PSIS • Glutes • Ischial tuberosity • Greater trochanter

  12. ROM Assessment • Active • Flexion and extension - standing • Lateral bending - standing • Rotation – sitting (thoracic movement)

  13. ROM Assessment • Passive • Flexion: hook-lying position • Extension: prone, pelvis in contact with table • Rotation: hook-lying position, scapula in contact with table • Side Gliding: standing, stabilize shoulder girdle during glide • Root compression or radiating pain

  14. ROM Assessment • Resisted ROM: Box 10-4, pg 342 • Flexion: hook-lying • Extension: prone • Rotation: hook-lying

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