Intervertebral Motion Assessment of Upper Thoracic Spine Flexion | PIVMs

In this video

I'm going to show you how to assess regional and segmental intervertebral motion of the upper thoracic spine in flexion.

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Hi and welcome back to Physiotutors,

passive assessment of the quantity and quality of segmental intervertebral motion, also known as motion palpation,

is part of the diagnostic clinical expertise of manual practitioners to guide decisions on a

therapeutic strategy for patients with spinal pain. Hypomobility

indicates mobilizing interventions, while hypermobility calls for a stabilizing approach.

A study done by Walker et al. in the year 2015

evaluated the reliability of passive segmental assessment of the thoracic spine on restricted and

painful segments and found only pool to low level agreement between the raters.

For this reason the clinical value of passive

thoracic spine assessment is weak.

In order to perform regional range of motion assessment for upper thoracic flexion of vertebraes T1 till T4

have your patient sit upright at the edge of the bench, while the examiner stands on the contralateral side to be examined.

The bench height should be adjusted so that your patient's shoulder is a little bit lower than your own.

Then ask your patient to put his hands behind his cervical spine and his elbows together and

establish contact with the patient's upper arm on the contralateral side by placing your arm above your patient's elbow.

Fixate your patients vertebrae T5 with your thenar eminence into a ventrocaudal direction and perform

a homonymous 3D movement with equal components of flexion, ipsilateral lateral flexion and

ipsilateral rotation. This movement causes maximal opening of the facet joints of the thoracic spine on the contralateral side.

The whole movement is judged on resistance during motion and at end range, range of motion, as well as possible pain provocation

compared to the other side.

In order to continue with

segmental assessment of say T2/T3

have your patient sit straight again.

Fixate the spinous process of T3 with your thenar eminence and

perform a maximal homonymous 3D movement with equal components of flexion,

ipsilateral lateral flexion and ipsilateral rotation again. To test each component of intervertebral motion

slightly move out of the end range and now test flexion between T2 and T3 by pushing the spinous process of

T3 ventraocaudally.

To assess rotation move on to the ipsilateral

transverse process of T3

and be aware that the transverse process in the thoracic spine is about 1-2cm centimeters higher than the spinous process of the same

level and then move it ventrally with your thenar eminence or thumb.

For lateral flexion,

place your thumb ipsilaterally between the spinous process of T2 and T3

and move your patient's thoracic spine into lateral flexion with your upper arm.

Each component is judged on resistance during motion, end-feel, as well as possible pain provocation

compared to the segment above or below.

Alright, this was our video on intervertebral motion assessment of upper thoracic flexion.

If you want to learn how to assess intervertebral motion of the mid and lower thoracic spine in flexion click on a video

right next to me. As always, thank you very much for watching!

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This was Kai for Physiotutors. I'll see you in the next video. Bye!