Thoracic Spine: Introduction – Osteopathic Manipulative Medicine | Lecturio


so we're going to talk a little bit

about the thoracic spine here's some

general characteristics of the spine

that you could appreciate the thoracic

spine is primarily a cathodic curve

which means that it is convex

posteriorly this convexity is present

from birth it's relatively immobile it's

not really mobile because it's connected

to our ribcage and the ribcage limits

the ability for motion and movement in

the region it is a transition zone

between the cervical and thoracic

regions and it helps to form the

posterior portion of the thorax we could

divide the thoracic spine into

functional divisions from T 1 2 T 3 this

is the cervical thoracic Junction it is

slightly lordotic whereas from T 49 this

is where we consider the truth'

thoracics and this is more Chi photic

and then from T 10 to T 12 there's a

little bit more backward bending this is

where the thoracic spine starts to

transition to the lumbar spine you could

usually find an apex around t5 to t6 so

the rule of threes helps us to have a

better understanding of the relationship

between a spinous process and the

transverse processes this is important

because in much of what we do with

osteopathic diagnosis we are going to be

utilizing the transverse processes to

identify for somatic dysfunction

remember for somatic dysfunction we're

looking for tissue texture changes tart

changes which stands for tissues texture

changes asymmetry restriction of motion

and tenderness and so if you find these

somatic dysfunctions you're going to be

looking for them along the transverse

process once we find a samac dysfunction

along the transverse process it's

important to understand the relationship

between the transverse process and the

spinous process so we know anatomically

where our level is and so there's

certain key landmarks to find along the

spine where the spinous process helps us

identify which level of this spine

we're located so if you think about the

t1 level it's right below c7 which is

vertebral prominence which is easy to

find if you have someone flex their head

forward if you look at the scapula and

at the spine of the scapula if you come

directly at the same level of the spine

of scapula that'll get you to t3 if

you're at the inferior board

of the scapula that gets you the t7 and

if you find the 12th rib and track

yourself immediately to the spinous

process that will be at t12 so it's easy

to identify these landmarks for the

spine midline but when we diagnose for

smart dysfunction we're pushing on the

transverse process so most of the times

we need to find a transverse process

level by first identifying the

dysfunction and then going backwards and

seeing where the spinous process is and

this takes us to the rules of three so

the rule of three helps us to find where

we're located in the spine based on the

spinous process and transverse process

relationship so the rules of three

you're looking at three thoracic

vertebra at a time and so from t 1 to t

3 you will find the spinous process

pretty much at the same level as the

transverse process from t 4 to t 6 now

the spinous process start to shingle

down a little bit more in fear early and

you'll find the spinous process is

halfway between the transverse process

of that level and the one below it from

t 7 8 and 9

here the spinous processes are at the

level of the transverse process below it

so it's moving a lot more in fear early

and so for instance if i am looking for

the spinous process of t 7 i'm going to

find that at the level of the body of t8

t10 functions like t 7 2 9 so this

spinous process is going to be found at

the level below at t 11 t 11 it's more

like t 4 - t 6 so this spinous process

we found halfway below between 11 and 12

and t 12 now is going to be at the same

level similarly to t 1 to t 3 so now

let's take a look at how you would

utilize this in clinical practice so if

you have a patient and you found

tenderness at the right tran list

process in the back and you note that

that's at the level of the thoracic

spinous process that's in line with the

inferior border of the scapula what is a

level of transverse process you palpate


so here we have to work backwards first

we have to identify the spinous process

level so like we said before the

inferior border the scapula is going to

be in line with the spinous process of

t7 so if you have the spinous process of

t7 what is the transverse process at

that same level and so going back to the

rules of three you know that because the

spinous process is going to be one full

level below you know that that's going

to be the transverse process of t8