Lumbar Spine and Pelvis Surface Anatomy Lab Outline 2024 PDF

PT 8361 Clinical Conference I The Lumbar Spine & Pelvis Bony Anatomy of the Lumbar Spine PRONE  PSIS/S2: o Start laterally and a bit cranially….palpate inferiorly to ID the iliac crest. o Palpate bil...

PT 8361 Clinical Conference I The Lumbar Spine & Pelvis Bony Anatomy of the Lumbar Spine PRONE  PSIS/S2: o Start laterally and a bit cranially….palpate inferiorly to ID the iliac crest. o Palpate bilaterally along the superior aspect of the iliac crest coming from lateral to posterior medial. Feel bone widening switch from finger tips to thumb o As palpation continues posteriorly the iliac crest curves downward to end at a bony step called the PSIS (Posterior Superior Iliac Spine).  Use your thumb perpendicular to the underside of the PSIS o From the inferior part of the PSISs…. draw a dashed helper’s line connecting these two points. This line represents the level of S2.  The S2 SP is variable in size  L5 SP o Measure two thumb widths’ cranially from the spinous process of S2 and you should be in the area of the L5 spinous process. o Confirm this by (version 1):  standing to the side of the patient’s pelvis and with your cranial hand palpate and block the side (same side as the examiner) of the L5 spinous process.  Your caudal hand reach across and grab the opposite anterior and lateral aspect of the ilium. So stabilize L5 and move the ilium towards the center. If you don’t feel the L5 move, then you’re probably on S1 and not S2  Apply a mobilizing rotational force (lifting the pelvis up toward you) while stabilizing L5.  If you feel the pelvis move in opposition to the stabilizing hand then you have confirmed that you are on the spinous process of the lumbar spine.  If you move your cranial hand caudally to the next spinous process and repeat the above mentioned procedure.  If the stabilizing hand and the pelvis move together, in the same direction you have confirmed that you are on S1 and that the previous cranial spinous process was L5. o Confirmation of this (version 2)  When press on L5 it is a give to it, vs. S2 is very firm  SP of L1-L4 o Palpate cranially the remaining lumbar spinous processes.  Palpate on the sides of the SPs and interspinous spaces Version_8.16.23 PT 8361 o Note that the spinous process of L5 is much smaller and rounded as compared to the longer spinous process of L1-L4. o Also note a larger interspinous space in the lumbar spine as compared to the thoracic spine. o The location of the L1 spinous process can be confirmed by noting the transition in the size of the spinous process of L1 (larger) to T12 (smaller) and/or following the 12th rib up to its attachment at the level of T12 to confirm the location of T12 in relation to L1. S2 Line A Sacral Hiatus  Ischial tuberosity o Use palm of hand walking up from proximal hamstring into glutes to find ischial tuberosity  In the region of the medial aspect of the gluteal fold palpate the ischial tuberosity. Muscles of the Lumbar Spine and Abdomen  Erector spinae group (Spinalis, Longissimus, Iliocostalis). o Have the patient lie prone. o Standing to the lateral side of the patient o place the pads of the fingers to the lateral side of lumbar vertebrae and feel a large group of muscles known as the erector spinae group (Spinalis, Longissimus, Iliocostalis). o Collectively branches of this muscle group run from the sacrum to the occiput along the posterior vertebral column. o Difficult to palpate individually. o Ask the patient to slowly alternate extension of the lower limbs, tension can be felt under the palpating fingers. This palpation can be continued from the sacrum cranially toward the thoracic spine. In the region of the thoracic spine you can ask the patient to elevate the head and chest off the table to palpate tension within this muscle group. SUPINE  ASIS Version_8.16.23 PT 8361 o Supine, palate from posterior lateral to anterior medial along the iliac crest until you fall off a prominent bony edge, the ASIS (Anterior Superior Iliac Spine).  Pubic crest o supine o Walk the heel of your hand; with your fingers pointed cranially; from the umbilicus toward the pubis. o The heel of your hand will come in contact with the firm ridge of the pubic crest.  Pubic tubercles o prominent forward-projecting tubercle on the upper border of the medial portion of superior ramus of the pubis. o The inguinal ligament attaches to it. https://slide-finder.com/match/CHAPTER-16-REPRODUCTIVE-SYSTEM.219753.68.html  Rectus abdominus o supine o ask your patient to raise their head and chest off the table to activate the rectus abdominis which runs longitudinally between xiphoid and pubic crest.  External obliques o raise their head and chest off the mat and bring the shoulder toward the opposite ASIS. If you palpate laterally you will fall off of the longitudinal fibers of the rectus abdominis onto the oblique fibers of the external obliques. Attach from Ribs into rectus abdominus Can’t really palpate internal obliques  Transverse abdominis o locate the ASIS bilaterally o palpate1 inch caudal and medial from the ASIS. o Ask the patient to take a deep breathe in and then at the end of exhalation ask them to draw their umbilicus in toward their spine and tension will be felt under the palpating fingers. Version_8.16.23 PT 8361  Piriformis o Locate PSIS (lower part) o Find lateral edge of Sacrum, then move laterally towards coccyx o Piriformis attaches to anterior aspect and inserts at greater trochanter (Superior Border) so it creates a T shape o Rotate leg in and out of external rotation to find greater trochanter  This outlines where you should palpate for the piriformis  Have patient perform bent leg hip external rotation References: All images taken from Reichert B. Palpation Techniques: Surface Anatomy for Physical Therapists. New York: Thieme Publishing; (2011). Version_8.16.23