1. LOGO Palpation of Spinal Column Dr Hafiz Sheraz Arshad

2. Palpation 1 derives from the Latin palpatio, meaning "to touch" Palpation is not just touching, but also the act of sensing or perceiving what is being touched. Palpation not only involves fingers and hands but also involves Brain As a rule, it is always best to first visually inspect the region that is to be palpated before placing your hands on the client.

3. Objectives of Palpation: Location and Assessment 1 Locating the Target Structure Assessing the Target Structure  Assessment requires interpretation of the sensations that the palpating fingers pick up from the target structure.  It involves becoming aware of the qualities of the target structure; its size, shape, and other characteristics. Is it soft? Is it swollen? Is it tense or hard? All of these factors must be considered when assessing the health of the target structure.

4. How to Palpate 1 Move Slowly Palpation is a cooperative effort between the hands and the mind Use Appropriate Pressure An exercise to see how ineffective too much pressure can be is to press the pad of your thumb forcefully against a hard surface for 5 to 10 seconds. Directly afterward, try to palpate something on a client's body and note how much sensitivity is lost. Quality of Palpation Finger pad more sensitive than finger tips

5. When do We Palpate 1 During the assessment phase of session During the treatment phase of session

6. Patients Position and Feedback Comfortable Position Expose Appropriately Environmental Factors

7. Occipital Bone 1 A. Occipital bone: T h e occipital bone is located at the back of the skull; it is subcutaneous and easily palpable (A). B. T h e external occipital protuberance (EOP) is a midline bump on the superior nuchal line of the occiput at the back of the head. T h e EOP is usually fairly large and prominent and therefore readily palpable (B). C. To palpate the superior nuchal line of the occiput, begin by locating the EOP at the center of the superior nuchal line; then palpate laterally for the superior nuchal line. It should feel like a raised ridge of bone running horizontally (C).

8. Cervical Spine The Atlas C1 2 Posterior tubercle of the Atlas may be felt in the midline The lateral Lip of the Transverse process of the atlas is palpable, between the angle of the jaw and mastois process The Axis 2 Large beaked spinous process The C 3 Spinous Process 2 Shy little bony point Concealed by the overhanging beak of C2 Usually missed when palpating from cranial to caudal Most easily felt by directing the thumb tip pressure anteriorly and slightly cranially

9. C 4 to C 7 Spinous Processes 2 Patient should be in side lying or prone lying Spinous process lies in the midline Place your finger tip to palpate Differentiation of C6 and C7 Spinous Process 2 Doubt about whether one is palpating C6 or C7 spinous process can be resolved by placing the fingertip so that it lies between two spinous processes. On extending the subject’s neck, C7 spinous process remaining palpable while the C6 glides away (anteriorly) from the palpating finger C7 Spinous Process Prominent one Have to differentiate among C6, C7 and T1

10. Thoracic Spine The Thoracic Spinous Processes 1,2 Transverse processes are 1 inch or 2.5 cm lateral to the spinous process 1 Mitchell et al speaks the Rule of 3 T1,2,3 have spinous processes projecting directly posterior, the tip of the spinous process is in the same horizontal plane as the transverse process of the same vertbrae T4,5,6 have spinous processes that project slightly downwards and the tip of the spinous process is in the plane that is halfway between its own & transverse process of the vertebrae below it T7,8,9 spinous process that projects moderately downward therefore the tip of the spinous process is in the plane with the transverse process of the vertebra below it T10,11,12 T10 spinous process is near the plane of the transverse processes of the vertebra below it T11 spinous process Is halfway between its own transverse processes and those of the vertebra below it T12 spinous process is in the plane of its own transverse process For practical counting it is better to place your fingertip in the interspinous space

11. Some practical comparative landmarks 2 These landmarks can provide you the rough idea, for cross opinion or confirmation you should calculate from T1 to downward or L5 to upward Acromioclavicular joint lies level with the C7-T1 interspace The Spine of the Scapula lies approximately level with T3 spinous process Inferior angle of the scapula lies approxmiately with T 7 spinous process

12. The Ribs The First Rib 2 The first rib articulates with the first thoracic vertebra; the spinous and transverse processes of T1, and the angle of the first rib are on the same horizontal level Palpation of the First Rib First rib from the Cepahic to caudal direction Costovertebral Joints Costotransverse Joints Rib Angle Floating Ribs T 11, 12

13. Lumbar Spine Landmarks 2 Iliac Crest lies at the level of L4-L5 interspace

14. Pelvis Landmarks 2 PSIS- the Pelvic dimples lies at the level of 2 nd Sacral Vertebra

15. References 1. Joseph E. Muscolino. The Muscle and Bone Palpation Manual: with Trigger Points, Referral Patterns and Stretching. Mosby: China: Elsvier; 2009 2. Georgy P Grieve, Hugh Philips. Mobilization of the Spine: A Primary Handbook of Clinical Methods. 5 th Ed. LONDON: Churchill Livingstone; 1991