|
|
|
|
Excerpts from the book “A Mini Manual for Manual Therapy Procedures”
By Sandro Strix S. Toledo, M.D., OMTC, DMS
Manual Medicine Integrated Solutions
Thoracic Somatic Dysfunctions: Diagnoses and Treatments
Upper thoracic soft tissue treatment
1. Position: patient prone, with head rotated contralateral to treatment side.
2. Operator position: opposite treament side.
3. Pressure / treatment hand on top of application / contact hand, with arms in extension lock.
4. A lateralizing paraspinal stretch is delivered at 90 degrees to paraspinal fiber orientation.
5. An intial endpoint of tissue crawl or give is expected.
6. An increase in local tissue warmth and bogginess may also be felt that corresponds with vasodilation and return of good ciculation to local tissue.
7. Reposition hold after every significant myofascial crawl reaches its compliant endrange.
8. An increased paraspinal compliance with decreased tone is the best endpoint.
Excerpts from the book “A Mini Manual for Manual Therapy Procedures”
By Sandro Strix S. Toledo, M.D., OMTC, DMS
Manual Medicine Integrated Solutions
Thoracic Somatic Dysfunctions: Diagnoses and Treatments
Reproduction without permission is in violation of intellectual property laws.
For notes and billing, the ICD-9 code for Thoracic Somatic Dysfunction is 739.2
Anatomic Landmarks for the Thoracic spine
1) Slowly flex the neck to engage the cervico-thoracic junction. T1 does not lock into flexion with the cervical spine. It lags behind C7 and remains protruding posteriorly when the cervical spine is engaged in flexion.
2) T3 is at about the level of the scapular spine.
3) T5 is at about mid-scapular level.
4) T1-3 spinous processes project posteriorly and lie directly at level with their corresponding transverse processes.
5) T4-6 spinous processes project postero-inferiorly to halfway between its level's transverse processes and the transverse processes of the the vertebra inferior to it.
6) T7-9 spinous processes project even more inferiorly than T4-6. They lie at the level of the inferior vertebrae's transverse processes.
The transverse processes lie lateral to the longissimus muscle bundles at about an inch from midline.
The “Rule of Threes” for the Thoracic Transverse Processes Leveling states:
1) T1-3 (and T12) transverse processes are at the level of the corresponding thoracic spine.
2) T4-6 (and T11) transverse processes lie superiorly between its level's spine and the spine of the thoracic segment above it.
3) T7-9 (and T10) transverse processes lie superiorly at the level of the superior segment's spine.
4) T10 transverse processes are at the level of the T9 spine.
5) T11 transverse processes are midway between the T10 and T11 spine.
6) T12 transverse processes are at level with its spine.
Excerpts from the book “A Mini Manual for Manual Therapy Procedures”
By Sandro Strix S. Toledo, M.D., OMTC, DMS
Manual Medicine Integrated Solutions
Thoracic Somatic Dysfunctions: Diagnoses and Treatments
Reproduction without permission is in violation of intellectual property laws.
For notes and billing, the ICD-9 code for Thoracic Somatic Dysfunction is 739.2
Thoracic Somatic Dysfunction Segmental Examination and Diagnosis
Upper thoracic: T1-4
1. Our patient is seated, with operator behind her.
2. General posterior thoracic local warmth is assessed
a. with the back of palms and fingers hovered at about an inch from the skin.
b. Local blood flow differences, as related to tissue inflammation or ischemia may be postulated from the above relative heat survey.
3. Paraspinal tissues are assessed by segment, noting moisture, warmth, texture, and reaction to palpation.
a. A 'red reflex' is assessed by running fingers simultaneously on each side of the spinous process cephalocaudad with blanching pressure.
i. Areas of delayed appearance and clearance of the red reflex are carefully assessed for somatic dysfunctions.
ii. A red reflex streak that persists at or beyond three minutes is deemed an to be an abnormal autonomic / vasodilator response secondary to facilitation (spinal sensitization phenomenon)
bravenet.com