EB

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