3. OMM | Basics of Diagnosing the Thoracic Spine

What are the characteristics of T1–T3 in the thoracic spine?

Cervicothoracic junction, backward bending, slightly lordotic (belly pushed outward - the way I think of it)

What are the characteristics of T4–T9 in the thoracic spine?

True thoracics, forward bending, kyphotic (belly pushed inwards the way I think about it)

What are the characteristics of T10–T12 in the thoracic spine?

Thoracolumbar junction, backward bending, lordotic

Where is the apex of the thoracic curve located?

T5–T6

What is the superior facet orientation mnemonic for the cervical spine?

BUM = Backward, Upward, Medial

What is the superior facet orientation mnemonic for the thoracic spine?

BUL = Backward, Upward, Lateral

What is the superior facet orientation mnemonic for the lumbar spine?

BM = Backward, Medial

According to the Rule of 3s, what is the spinous process location for T1–T3?

Same level as transverse processes

According to the Rule of 3s, what is the spinous process location for T4–T6?

Halfway between its own transverse process and the one below

According to the Rule of 3s, what is the spinous process location for T7–T9?

Same level as the transverse process of the vertebra below

What is the spinous process location for T10 according to the Rule of 3s?

Same level as the transverse process of the vertebra below

What is the spinous process location for T11 according to the Rule of 3s?

Halfway between its own transverse process and the one below

What is the spinous process location for T12 according to the Rule of 3s?

Same level as its own transverse processes

What plane is associated with flexion and extension?

Sagittal plane

What plane is associated with rotation?

Horizontal plane

What plane is associated with sidebending?

Coronal plane

What are the articulations of intervertebral discs?

Nucleus pulposis (elastic) and annulus fibrosis (fibrocartilage)

What is the function of zygapophyseal (facet) joints?

Permit gliding motion

What structures are weight bearing in the vertebrae?

Anterior portion: vertebral bodies and discs

What structures are motion guiding in the vertebrae?

Posterior portion: facets

Where do costal articulations occur?

On the vertebral body and transverse process

What is Fryette’s First Principle?

In neutral spine, sidebending and rotation occur in opposite directions; applies to group curves (Type I)

Where does Fryette’s First Principle apply?

Group curve (3+ vertebrae), neutral spine

What muscles maintain Type I dysfunction?

Long restrictors – erector spinae

What is Fryette’s Second Principle?

In a non-neutral spine, sidebending and rotation occur in the same direction; applies to single vertebra (Type II)

Where does Fryette’s Second Principle apply?

Apex or end of Type I curves, non-neutral spine

What muscles maintain Type II dysfunction?

Short restrictors – intertransversarii

What is Fryette’s Third Principle?

Motion in one plane modifies motion in other planes during OMM

What is arthrodial restriction?

Facet locking—joint restriction, often acute

What is muscular restriction?

Involves long restrictors (Type I) or short restrictors (Type II)

What is fascial and ligamentous restriction?

Due to fibrosis or shortening from inflammation

What is edema-causing restriction?

Swelling that limits motion, e.g., post-trauma or infection

How is Type I thoracic somatic dysfunction defined?

Dysfunction in neutral spine (no flexion/extension), involving 3 or more vertebrae

What is the coupling in Type I dysfunction?

Sidebending and rotation occur to opposite sides

What is the shorthand for documenting Type I dysfunction?

Example: T3–T6 N SL RR

What is the mnemonic for Type I dysfunction?

Neutral Opposites

How is Type II thoracic somatic dysfunction defined?

Dysfunction in flexion or extension, involving a single vertebra

What is the coupling in Type II dysfunction?

Sidebending and rotation occur to the same side

What is the shorthand for documenting Type II dysfunction?

Example: T3 F RR SR

What is the mnemonic for Type II dysfunction?

Flex Same Side

What facet is stuck in ERS Left?

Left facet is stuck closed (cannot open in flexion)

What happens to the spinous processes in ERS?

They should come closer together during extension

What facet is stuck in FRS Left?

Right facet is stuck open (cannot close in extension)

What happens to the spinous processes in FRS?

They should come farther apart during flexion

What is the mnemonic for ERS dysfunctions?

ERS = Same side stuck closed

What is the mnemonic for FRS dysfunctions?

FRS = Opposite side stuck open

What does a posterior transverse process indicate?

Side of vertebral rotation

What is the order of evaluation in diagnosing thoracic dysfunction?

Check in neutral, flexion, and extension for changes in symmetry

How do you document Type I thoracic dysfunction?

Format: N Sx Ry (e.g., T3–T6 N SL RR)

How do you document Type II thoracic dysfunction?

Format: F/E Rx Sx (e.g., T4 F RR SR)

What is a clinical correlate of Type I dysfunction?

Often compensatory, associated with chronic postural changes

What is a clinical correlate of Type II dysfunction?

Associated with acute trauma or strain; should be treated before Type I

What is the facet issue in extended Type II dysfunction?

Facet on same side as posterior TP won't open

What is the facet issue in flexed Type II dysfunction?

Facet on opposite side of posterior TP won't close

Given dz: ERS (Type II), in extreme flexion, on which side does a posterior facet remain closed/restricted? To what side do rotation and sidebending thus occur?

Facet on the same side remains closed/restricted; therefore, vertebra rotates and sidebends to one side

What motion should typically occur with extension regarding facets and spinous processes respectively for Type II?

Close; should come closer together

Given dz: FRS (Type II), in extreme extension, on which side does a posterior facet remain open? To what side do rotation and sidebending thus occur?

Facet on the opposite side remains closed/restricted; therefore, vertebra rotates and sidebends to opposite sides

What motion should typically occur with flexion regarding facets for Type II?

Facets typically should open superiorly and anteriorly

What motion should typically occur with flexion regarding spinous processes for Type II?

Spinous processes typically should come farther apart