In this video, we're going to review common landmarks of the thoracic and lumbar spine that are helpful for physical examination. As I work through this demonstration, I'm going to be putting my hands in a few different places: at the bottom of your neck, along your spine, on your shoulders, along your rib cage, and also along your pelvis. If you feel uncomfortable at any time, or if you feel any areas of tenderness, or if you need me to stop or change my position, let me know and I will do so. Is it okay if I begin? Yes, all right. So, in order to orient ourselves to our landmarks, we're going to be using appendicular landmarks to then find the spinous processes. Our first landmark is going to be C7, which is the vertebra prominence. We can find it most prominently with our patient flexing their head forward. So, go ahead and bend your head forward, and we can see and feel it prominently at the base of their neck, and then we can use that to find T1.

directly below it, and bring your hand back up. We can either use those spinous processes and move one by one to feel the rest of the spinous processes, or we can use other landmarks to find other corresponding spinous processes. We can find the medial scapular border by taking one hand, bracing the shoulder, and then using our other hand to cup on the medial aspect of that scapula. Then we can move to the superior angle of the scapula, then move directly medial to find what is most likely to be T2 spinous process. We could also use the spine of the scapula, move directly medial from that medial scapular border to find most likely T3 spinous process. Then we can also find the inferior angle of the scapula, move medial to find the T7 spinous process. We can move down to the bottom of the rib cage, follow the bottom rib medial until we find what is most likely to be T12 spinous process. Then we can also use the iliac crest to

find L4. So, iliac crest, we can find at the top of the pelvis. In that soft space between the top of the pelvis and the bottom of the rib cage, we can take our hands and allow them to roll into that space. And then with our hands, which are creating a little bit of a table here with our straight thumbs, and with our thumbs, we can touch the midline here. And that is most likely to be L4 spinous process. Now that we know where the spinous processes are, we can use the rule of Threes to predict where the transverse processes most likely are going to be for each of the spinous processes. For T1 to 3, the transverse processes are most likely to be directly in line with the spinous processes. For T4 through six, the transverse processes are most likely to be half a level above the spinous processes. For T7 through 9, these transverse processes are most likely to be a full level above the spinous processes. For T10, we would

expect the transfer process to be a full level above the spinous process for T11. We would expect the transverse process to be a half a level above the spinous process, and for T12, we would expect the transverse process to be directly in line with the spinous processes. As an example, we'll use the rule of Threes to find the transverse processes for T4. We're going to use the appendicular landmarks that are closest to the segment. So, we can use the spine of the scapula to move medial and find T3, then move one level down to T4. And we know, according to the rule of Threes, that the transverse processes of T4 are expected to be one half level between T3 and T4. So, we would expect the transverse process to be about here. As another example, we can use the rule of Threes to find the transverse processes of T10. So, we're going to use the inferior angle of the scapula to find T7 spinous process. Then we're going

to count down T8, T9, T10. And according to the rule of Threes, we would expect that the transverse processes would be a full level above the spinous process of T10. So we would move up to T9 and then directly lateral to find the transverse processes of T10. For L1 to L5, the transverse processes are most likely to be directly in line with the spinous processes. So we can use either T12 or L4. So T12, using the ribs, then finding T12, and then moving down to find our spinous processes of each of the corresponding lumbar levels, and then moving directly lateral to find the transverse processes. Or using the iliac crest to find L4, and then moving up to find L3, 2, or 1, or move down to find L5, and then lateral to find the transverse processes.

Thoracic & Lumbar Spine Palpatory Landmarks for Physical Examination & Osteopathic Structural Exam

Osteopathic Clinical Skills is a channel dedicated to discussing and exploring Osteopathic Clinical Skills concepts for medical students, residents, and clinicians and presenting them in an easy to understand manner.

Throughout the videos in this channel, we explore principles of physical diagnosis and Osteopathic Manipulative Treatment (OMT).

These videos are not intended as a complete source of physical diagnosis or OMT instruction.

Instead, it should be treated as a supplement to independent learning using primary physical diagnosis and Osteopathic Manipulation instructional resources. Clinical skills are best learned and developed with support from faculty in the context of a complete Osteopathic Medical School Curriculum.