P&P analysis exam

palpation

to touch or feel the body for diagnostic/analysis purposes

what does static palpation allow

vertebral positional characteristics

- heat differences

- skin turgidity

- skin texture

- point tenderness

acute skin turgidity (bounce)

changed by edema and present at the damaged tissue site

usually unilateral edema that palpates as a well circumscribed spot

chronic skin turgidity

where the edema has resolved and the tissue damaged site has fibrous tissue with less resiliency

often bilateral and feels like a depression that is not as firm as the surrounding tissue

acute skin texture

noted over bony provinces such as spinous and will feel wetter or greasy

chronic skin texture

will feel dryer over the spinouses and is often referred to as skin drag

acute point tenderness

superficial pain and is more sensitive to touch

chronic point tendernes

patient is unaware of it until the examiner palpates the spinous

usually deeper and considered dull

posterior body rotation

the more prominent side of the articular prominence is posterior

cervical laminae are

up 1 interspace

T1-4 TVP are

up 1 interspace

T5-9 TVP are

up 2 interspaces

where is the instrumentation break for T5-9

up 1 interspace

T10-12 TVP are

up 1 interspace

lumbar maxillary processes are

up 1 interspace

the spinous that is usually found at the tip of the scapula with patient standing

T7

the first palpable bump below the EOP

C2

what is the vertebral prominence 60-70% of the time

C7

what is typically the most prominent thoracic vertebra

T4

the first blade like spinous is

L1

which thoracic spinous is typically closest together

T9-10

what is the VP 30-40% of the time

T1

spinous usually found at the tip of the scapula with the patient prone is

T6

spinous most often at the level of the iliac crest with patient standing

L4

last freely moveable cervical segment on extension

C6

Thoracic imbrication area is usually

T5-9

the smallest lumbar spinous

L5

most prominent lumbar spinous

L4

motion palpation

start assessing quality not just quantity of motion

aberrant motion

acute problems

end feel

chronic problems

order of exam of occiput

PA glide

lateral bend

rotation (tissue prominence over lateral mass of atlas)

atlas order of exam

AS or AI

lateral bend

rotation (have to list the P and A from the side lateral bend is restricted)

tissue prominence

APL and OPL diverge to the front

AS with inverted V sign

APL and OPL converge to the front

AI with V sign

M

lumbar

T

thoracic

L

cerivcal

what is the extra step for the special L5 listings

patient is passively laterally bent to determine the overall curve

just bend to the side and do not push on spinous, look at overall curve

side of concavity typically exhibits

smooth curve

side of convexity typically exhibits

stacking

occ-atlantal efficiency aid

occipital glide with lateral flexion

atlanto axial efficiency aid

lateral flexion

if there is no lateral restriction, there is no lateral listing

C2-T2 efficiency aid

circumduction combination of extension, lateral bend, and rotation

circumduction

the spinous will move well to the side of the open wedge when there is a wedge

if no wedge, spinous will move better to the side of spinous laterality

restricted right circumduction and left tissue prominence

PRS

T3-12 circumduction

rotation and lateral bend with limited extension from coronal facets

L1-L5 circumduction

L1-4 has sagittal facets emphasizing extension and lateral bend

L5 has coronal so add some rotation

reasons to use instrumentation

patient management

limit the number of segments adjusted

when to start and where

when to stop

break analysis

refined by Dr. Gonstead in the early 1950s

suggests probable levels of subluxations

break

rapid deflection of the needle over the distance of a single spinal segment or sensory/dermatomal field

repeatable finding

heat swing defined

slow deflection of the needle which occurs over a multi-segmental area

broad sweeping movement of the needle

C0-C2 breaks

very close together

condyle or atlas sublux may create a differential at any location between C2 and C0

C2-T3 breaks

inferior to the spinous process

T4 break

same level of the spinous

T5-9 break

appear in the interspinous space above the spinous process of the involved vertebra

T10-12 break

at the level of the spinous process

L1-5 break

at the level of the lower 1/4 of the spinous process

pattern analysis

BJ and lyle Sherman in early 1930s in conjunction to the shift in emphasis to the upper cervical region

The pattern of heat distribution will be observed on 3 separate readings, spaced as widely as possible, generally over a 24 hour period

chriotherm

single probe heat thermometer

placement angled I-S and A-P at the styloid fossa

textbook normal when both sides within 1 degree bilaterally

dermathermagraph

single probed, infrared heat sensing instrument to read absolute skin temperature from 82-102 degrees

basically an infrared thermometer

DT25

reads absolute temp on one side instead of bilateral comparisons

does not come in contact with the skin

bilateral atlas fossa reading is employed as a routine portion of the analysis

graph component is used

Tyron

due probe infrared heat sensing instrument

reputability is dependent upon the operators ability to maintain a consistent starting and termination point of the scan

environmental control

70 degree room

no direct heating or cooling

scanner should not be in direct sunlight

scanner holder should be placed away from the compute monitor and CPU

patient prep

No EMS, TENS, US, massage, hot or cold packs or acupuncture before scanning

spinography purposes

finding potential subluxations

understanding the anatomy to give the most appropriate adjustment

developing the most appropriate management plan for the patient

10 visual indicators

visual posteriority

IVF encroachment

stacking

hourglasing

increased disc angle

thin disc

spurring

eburnation

stairstepping

schmorls nodes

acute visual indicators

visual posteriority

IVF encroachment

chronic visual indicators

spurring

thing disc

eburnation

stair stepping schmorls nodes

when should you worry about heel lifts

when it is past 6mm because the body doesn't care before then

criteria for heel lifts

last lumbar body rotation to the low leg side

lumbar curve convexity on the low leg side

patient must have no hip, knee, or ankle pathology

patient not holding adjustment

what determines the right or left in atlas

TAL and APL diverging

PI ilium

taller

AS ilium

shorter

EX ilium

narrow

IN ilium

wider

spondylolisthesis

disc wedge open in front

base posterior

disc wedge open in back

posterior L5

disc wedge open in front

what view for spurring on lateral cervical

IVF of oblique

what view for spondylo

oblique

what view is needed if you see visible posteriority or stair stepping on the lateral cervical

flexion and extension