The Thoracolumbar Spine.pptx

medicine

1. THORACIC AND LUMBAR SPINE Ballesteros, Victoria Nina Mercado, Shannen Alyssa Marie

2. ROM of SPINE

3. End Feel: FIRM Mark the spinous processes of the C7 and S2 vertebrae using a skin marking pencil, with the subject in the standing position. The chosen to use the spinous process of S2 for a landmark as it is easier identify than the spinous process of S1, and there is no motion between S1 and S2. Align the tape measure between the two spinous processes and record the distance at the starting of the ROM. Hold the tape measure in place as the subject performs flexion ROM. Record the distance at the end of the ROM. The difference between the first and the second measurements indicates the amount of thoracolumbar flexion ROM. 20XX 3 THORACOLUMBAR FLEXION (TAPE MEASURE)

4. End Feel : Firm Mark the spinous processes of the C7 and S2 vertebrae using a skin marking pencil, with the subject in the standing position. Align the tape measure between the two spinous processes and record the measurement. Keep the tape measure aligned during the motion and record the measurement at the end of the ROM. . The difference between the measurement taken at the beginning of the motion and that taken at the end indicates the amount of thoracic and lumbar extension. 20XX 4 THORACOLUMBAR EXTENSION (TAPE MEASURE)

5. NORMAL ROM: 0-35 degrees Fitzgerald and associates found that normal values ranged from a mean of 37.6 degrees (in a group of 20 to 29 year olds ) to 18.0 degrees (in a group of 70 to 79 year olds ) Normal End-Feel : FIRM Procedure: 1. Mark the spinous processes of C7 and S2 vertebrae using a skin marking pencil. 2. Center fulcrum of the goniometer over the posterior aspect of the spinous process of S2 3. Align proximal arm so that it is perpendicular to the ground. 4. Align distal arm with the posterior aspect of the spinous process of C7 20XX 5 THORACOLUMBAR LATERAL FLEXION (GONIOMETER)

6. Normal Values 0-45° ; Fulcrum is over the center of the cranial aspect of the patient's head; Proximal Arm is parallel to an imaginary line between the two prominent tubercles on the iliac crests ; Distal Arm is with an imaginary line between the two acromial processes . The positioning of the patient is sitting in neutral and the end feel is firm. 20XX 6 THORACOLUMBAR ROTATION (GONIOMETER)

7. Use a ruler to locate and place a first mark at a midline point on the sacrum that is level with the posterior superior iliac spines (this mark will be over the spinous process of S2). Make a second mark 15 cm above the midline sacral mark. Align the tape measure between the superior and inferior marks. Ask the subject to bend forward as far as possible while keeping the knees straight. Maintain the tape measure against the patient's back during the motion, but allow the tape measure to unwind to accommodate the motion. At the end of flexion ROM, note the distance between the two marks. The ROM is the difference between 15 cm and length measured at the end of the motion. 20XX 7 LUMBAR FLEXION (TAPE MEASURE): MODIFIED-MODFIED SCHOBER TEST 0 OR SIMPLIFIED SKIN DISTRACTION TEST

8. Place the first mark at the lumbosacral junction with a skin marking pencil. Place a second mark 10 cm above the first mark. Place a third mark 5 cm below the first mark at the lumbosacral junction. Align the tape measure between the most superior and the most inferior marks. Ask the subject to bend forward as far as possible while keeping the knees straight. Maintain the tape measure against the subject’s back during the movement, and note the distance between the most superior and the most inferior marks at the end of the ROM. The ROM is the difference between 15 cm and the length measured at the end of the motion. 20XX 8 LUMBAR FLEXION (TAPE MEASURE): MODIFIED SCHOBER TEST

9. Hold a ruler between two posterior superior iliac spines (PSIS) and place a first mark on a midline point of the sacrum t h a t i s o n a l e v e l w i t h t h e P S I S ; t h i s w i l l b e o v e r t h e s p i n o u s p r o c e s s o f S 2 . A s e c o n d m a r k s h o u l d b e m a d e o n t h e l u m b a r s p i n e t h a t i s 1 5 c m a b o ve t h e f i r s t m a r k . A l i g n t h e t a p e m e a s u r e b e t w ee n t h e f i r s t a n d s e c o n d m a r k s on the spine and ask the subject to bend backward as far as possible. A t t h e e n d o f t h e R O M , n ot e t h e d i s t a n c e b e t w ee n t h e superior and the inferior marks. The ROM is the difference b e t w ee n 1 5 c m a n d t h e l e n g t h m e a s u r e d a t t h e e n d o f t h e motion . 20XX 9 LUMBAR EXTENSION: SIMPLIFIED SKIN ATTRACTION TEST MODIFIED- MODIFIED SCHOBER TEST (MMST)

10. Use a skin-marking pencil to place a first mark at the lumbosacral junction. Place a second mark 10 cm above the first mark. Place a third mark 5 cm below the first mark (lumbosacral junction). Align the tape measure between the most superior and the most inferior marks. Ask the subject to put the hands on the buttocks and to bend backward as far as possible. Note the distance between the most superior and the most inferior marks at the end of the ROM, and subtract the final measurement from the initial 15 cm. The ROM is the difference between 15 cm and the length measured at the end of the motion 20XX 10 LUMBAR EXTENSION: MODIFIED SCHOBER TEST

11. References: Norkin , Cynthia C. (1995). Measurement of joint motion : a guide to goniometry. Philadelphia :F.A. Davis.