Thoracic spine somatic dysfunction

FIG. 43-5 Alternative thrusting technique for thoracic spine somatic dysfunction, patient supine. 

Type I and type II dysfunctions refer only to somatic dysfunctions in the thoracic and lumbar vertebrae because Fryette s principles only apply to these areas. However, in common usage, somatic dysfunctions in the typical cervical spine are often referred to as type II, Motion characteristics of the cervical region dictate that the typical cervical vertebrae side-bend and rotate toward the same side regardless of dysfunction or normal functioning. The distinction is the involvement of a flexion or extension component in the dysfunctional unit. 

Posteriorly, Chapman s reflexes are located in the soft tissues between the spinous process of a vertebra above and the transverse process of a vertebra below. For example, the posterior Chapman s point for the heart is located between the spinous and transverse process of the second and third thoracic vertebrae. The posterior points have the feel of a classic viscerosomatic reflex the operator will palpate what feels like a rubbery nodule. If the physician attempts to articulate a vertebral somatic dysfunction and the spine "bounces" away from the force, the possibility of a viscerosomatic reflex should be considered. 

Observation of the thoracic spine shouid be performed from the back and from each side. One should observe for any abnormal curvature of the spinal column. Kyphosis, an increase in the normal anteroposterior curvature of the spine, or scoliosis, an abnormal lateral curve should be looked for. Kyphosis is sometimes manifested in the upper thoracic spine as the dowager s hump so frequently seen in osteoporosis, especially in older women. Flattening of the thoracic spine may be seen in the presence of muscle spasm or somatic dysfunction. See Chapters 48, 58, and 78 for a further discussion of these postural changes and their significance. 

This section describes the application of techniques to group curves and single-segment somatic dysfunctions in the thoracic spine. All of the techniques begin with the patient sitting... 

This chapter describes Still techniques for treating somatic dysfunctions of the thoracic spine. Type I (regional) and type 11 (segmental, single) somatic dysfunctions occur within the thoracic region and are treated by positioning into the directions of ease of the diagnostic components. 

This chapter describes high-velocity, low-amplitude thrusting techniques for treating somatic dysfunctions of the thoracic spine by region-upper, middle, and lower spine. For most of the techniques, the patient is supine a variation is iiiustrated in which the patient is seated. 

The thoracic spine is subject to many conditions that affect the cervical and lumbar spine including somatic dysfunction, herniation of an intervertebral disk, arthritis, and other bony and soft tissue injuries and degenerative processes. Osteoporosis coimnonly manifests in the thoracic spine, with vertebral compression fractures and formation of the dowager s hump, caused by micro fractures of the anterior bodies of the vertebrae leading to a forward bending of the upper thoracic spine. This chapter discusses some of the conditions most commonly affecting the thoracic spine. 

The condition of "flat back" in the thoracic spine may be caused by an exaggerated "military" type of posture or may be caused by bilateral paravertebral muscle hypertonicity or spasm. Extension somatic dysfunctions may cause the individual to keep the back in an unusually straight posture because of discomfort or pain on flexing. The cause of the problem must be determined. Most of the causes are responsive to osteopathic manipulation. 

Physical examination revealed a blood pressure of 13 8/86, with heart sounds and rhythm normal. A few crackles on exhalation were noted scattered throughout the lung fields. The thoracic spine was mildly kyphotic. There were several somatic dysfunctions found T1FS,R, T4FSiRt and TIOESlRl- The paravertebral muscles were hypertonic and tender throughout the thoracic region. 

Localized thoracic flattening is most often caused by areas of posterior muscular lension and/or somatic dysfunction. It can also be habitual in nature as in a militaiy posture, with the shoulders held back and the spine straightened. Flattening can also be compensatory because of flattening In other regions of the spine, cervical or lumbar. 

Note This technique is very similar to that performed for the posterior somatic dysfunctions of the thoracic spine performed in the... 

Somatic dysfunction of the thorax may occur anteriorly, involving ribs, sternum, or clavicle, or posteriorly, involving costovertebral articulations or the scapulae. Muscle attachments connect the thoracic cage to the cervical spine, the thoracic spine, the lumbar spine, the innominate bones, and the upper extremities. These regions must be evaluated when problems occur in the thoracic cage. 

Examination revealed normoactive bowel sounds and tenderness to palpation in all four quadrants. There were type 11 somatic dysfunctions in the lower thoracic spine, with Chapman s points on the lateral right thigh. There was no abdominal rebound and the patient was afebrile. 

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