Palpation of Spinal Column

Presented by
Dr muhammad usman
 Palpation
• 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
patients.
 Objectives of Palpation:
Location and Assessment

• 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.
 How to Palpate
• 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
 When do We Palpate
• During the assessment phase of session
• During the treatment phase of session
 Patients Position and Feedback
• Comfortable Position
• Expose Appropriately
• Environmental Factors
Occipital Bone
A. Occipital bone: The occipital bone is
located at the back of the skull;
it is subcutaneous and easily palpable
B. The external occipital protuberance
(EOP) is a midline bump on the superior
nuchal line of the occiput at the back of
the head. The EOP is usually fairly large
and prominent and therefore readily
palpable.
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.
 Cervical Spine
• The Atlas C1
– 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 mastoid process
• The Axis C2
– Large beaked spinous process
• The C3 Spinous Process
– Shy little bony point
– Usually missed when palpating from cranial to caudal
– Most easily felt by directing the thumb tip pressure anteriorly and
slightly cranially.
• C 4 to C 7 Spinous Processes
– 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
– 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
 Thoracic Spine
• The Thoracic Spinous Processes
– Transverse processes are 1 inch or 2.5 cm lateral to the spinous process
– 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
• Some practical comparative landmarks
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
 The Ribs
• The First Rib
– The first rib articulates with the first thoracic vertebra;
the spinous and transverse processes of T1,
– Palpation of the First Rib
• First rib from the Cepahic to caudal direction
– Costovertebral Joints
– Costotransverse Joints
– Rib Angle
– Floating Ribs
• T 11, 12
 Lumbar Spine
• Landmarks2
– Iliac Crest lies at the level of L4-L5 interspace
 Pelvis
• Landmarks
– PSIS- the Pelvic dimples lies at the level of 2nd
Sacral Vertebra