Thoracic & Lumbar Palpation Notes

Sternum & Anterior Thorax

• Identify clavicles → slide medially to \text{manubrium}
• Continue inferiorly over \text{body of sternum} until “squishy part” (soft tissue) just below \text{xiphoid process}
• Palpation tip: start at soft tissue & move superiorly to reassure patient
• In women, ask for self-palpation first; verbally guide each step

Ribs

• True ribs attach directly to sternum; false ribs angle upward; floating ribs (last 2) only posterior
• Injury most common mid-axillary → palpate laterally rather than anteriorly
• Technique
  • From vertebral level: slide laterally to rib body
  • Locate intercostal space → drop to next rib without returning to spine
  • Floating ribs: “karate-chop” edge of hand posteriorly to feel rib tips toward spine

Scapular Landmarks

• C7 = most prominent cervical SP (check by neck flexion)
• T1 ≈ superior angle of scapula
• T7 ≈ inferior angle of scapula
• Winging scapula = medial border lifts from thorax; often weak posterior muscles

Thoracic Vertebrae

• From identified C7, count spinous processes (SPs) down
• For each level: slide laterally to transverse process (TP) to assess vertebral rotation (deeper TP indicates rotation toward that side)
• Scapula covers ribs T1{-}T7, limiting anterior rib contact here

Lumbar Spine

• L4 SP aligns with iliac crests (find with bilateral “karate-chop” at flanks)
• L5 SP at line connecting bilateral PSIS
• From each SP, slide laterally to assess TP orientation (same purpose as thoracic)

Sacrum & Pelvis

• Base of sacrum = superior border just below L5
• Apex = inferior “tailbone” (coccyx)
• Sacral spine: palpate midline ridge inferiorly
• Sacral sulci: from PSIS → move slightly medial & inferior; compare depths for torsion
• Inferior lateral angles (ILAs): palpate lower-lateral sacral edges; depth comparison supports torsion diagnosis

Patient-Comfort Principles

• Approach from side, not head-on; avoid rapid anterior neck contact
• Explain actions before touch; gauge sensitivity at trachea, xiphoid, floating ribs
• Encourage self-palpation for sensitive regions; place clinician’s hand over patient’s for confirmation