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Chapter 10 – Part 1

Chapter 10 – Part 1 . The Thoracic and Lumbar Spine Assessment. Spine Curvature. Cervical – Lordotic Thoracic – Kyphotic Lumbar - Lordotic. Anatomy Review. Vertebrae – 24 + sacrum Greatest ROM – Cervical True rotation occurs at C1. Intervertebral Discs. 23 disks

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Chapter 10 – Part 1

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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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