Palpation Techniques_ Surface Anatomy for Physical Therapists ( PDFDrive )

Palpation Techniques 261 Step 3: The LS spinous process is found approximately one finger-width (patient's index finger) superior to 5 1 . Its loweredge is reached by sliding the finger pads superiorly over the slanting sacrum until the tips ofthe fingers come across an explicitly hard object ( Fig. 1 0.45). The inferior edge of LS is mostly felt to be a step superior to the LS­ S 1 interspinous space. Tip: This palpatory step is im perative and must be confirmed through further information and using pal patory aids. Comments on Pathology Fig. 1 0.46 Posteroanterior pressure on 5 1 . In cases of severe spondylolisthesis in LS-5 1 , a local in­ crease in the lordosis with the formation of a step can be palpated between LS and 5 1 on slim patients (ski jump phenomena; Wittenberg et aI., 1 998). This palpatory re­ sult can be reached in the prone or standing 5P. Caution: these conclusions may not be reversed ! Not every pal­ pated step has to indicate the presence ofa spondylolisth­ esis. Confirming the Palpation Using the Shape and Fig. 1 0.47 Assessment of end feel at L5-phase 1 . Size of Structures Based on the anatomy described, it is normally expected that the LS spinous process has a smaller and rounded shape that juts out posteriorly. The Ll -L4 spinous pro- cesses are very long (superior-inferior dimensions). Oe- spite this anatomical knowledge, it may be confusing and difficult to locate LS, especially when the 51 spinous process has a distinct form. In this case, its shape and size are similar to LS. Confirmation Using the Assessment ofEnd Feel Fig. 1 0.48 Assessment of end feel at L5-phase 2 . Using anteriorly directed pressure to differentiate be­ Tip: Naturally, this differentiation technique should n o t be tween LS and 51 is diagnostically conclusive. The medial side ofthe hand is placed on the point where the therapist performed if the therapist suspects it will provoke pain. assumes Sl to be.The other hand is placed on top of it ( Fig. 1 0.46). The therapist then pushes their hand in an ante­ Confirmation Using Movement rior direction using slow oscillations. If pain is not pro­ voked by this, the therapist pushes down firmly one Another option is to feel the way LS moves when postero­ more time to clearly assess the posteroanterior end feel. anterior pressure is applied. The therapist starts by searching for the assumed position of the LS/51 interspi­ The same maneuver is performed over the point where nous space with their finger tip. Both of the neighboring the therapist assumes LS to be. The thumb is first placed spinous processes should be felt. The thumb or the hy­ over the point to emphasize the pointed spinous process pothenar eminence is then used to apply pressure to the ( Fig. 1 0.47). The thumb is then reinforced using the med­ ial side of the other hand or the thenar eminence ( Fig. 1 0.48). Rhythmical posteroanterior pressure is then reap­ plied and finishes with the end feel being assessed by firm pressure. The results of both of the posteroanterior pushes are now compared. It is expected that 51 will only minimally yield to pressure and that its end feel will be almost hard. LS usually yields significantly more to pressure and has a firm-elastic end feel.