Motion Palpation

Joint Assessment – P.A.R.T.S.

By Frank M. Painter|November 12, 2023|Joint Dysfunction, Motion Palpation, Subluxation|

Joint Assessment – P.A.R.T.S.

SOURCE: Topics in Clinical Chiropractic 2000; 7 (3): 1–10
Thomas F. Bergmann, DC, Bradley A. Finer, DC, DACAN

Professor, Clinical Science Division
Northwestern Health Sciences University
College of Chiropractic
Bloomington, Minnesota

Purpose: An approach to systematically perform clinical work-up for chiropractic subluxation is proposed. Literature on assessment approaches is reviewed and a discussion is presented.

Method: A qualitative review of clinical and scientific literature related to assessment methodologies for subluxation was performed.

Summary: Variation in assessment techniques exists for identification of spinal and other articular joint dysfunction. Useful scientific data also are limited to only a few approaches, and there is a need for a more systematic assessment approach profession wide.

Key words: Articular range of motion, chiropractic, Medicare, palpation, physical examination, subluxation

From the FULL TEXT Article

Background

Doctors of chiropractic are portals of entry to the health care system for many patients seeking health care services. As such, they must maintain broad and thorough assessment/diagnostic skills. Before employing any therapy, a clinician must first determine if there is a need for treatment. Therefore, the clinical information that any primary contact provider would want, including a case history, physical examination, clinical laboratory findings, radiographic findings, and any other tests necessary to check for suspected health problems, is needed. Having gathered and interpreted this information, it must be processed in order to arrive at a sound clinical conclusion.

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LOCATING SUBLUXATIONS Section

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Interexaminer Reliability of Seated Motion Palpation

By Frank M. Painter|January 13, 2019|Motion Palpation|

Interexaminer Reliability of Seated Motion Palpation for the Stiffest Spinal Site

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2018 (Sep); 41 (7): 571–579

Kelly Holt, PhD, David Russell, DC, Robert Cooperstein, MA, DC, Morgan Young, DC, Matthew Sherson, DC, Heidi Haavik, DC, PhD

Center for Chiropractic Research,
New Zealand College of Chiropractic,
Aukland, New Zealand.

OBJECTIVES: The purpose of this study was to assess the interexaminer reliability of palpation for stiffness in the cervical, thoracic, and lumbar spinal regions.

METHODS: In this secondary data analysis, data from 70 patients from a chiropractic college outpatient clinic were analyzed. Two doctors of chiropractic palpated for the stiffest site within each spinal region. Each were asked to select the stiffest segment and to rate their confidence in their palpation findings. Reliability between examiners was calculated as Median Absolute Examiner Differences (MedianAED) and data dispersion as Median Absolute Deviation (MAD). Interquartile analysis of the paired examiner differences was performed.

RESULTS: In total, 210 paired observations were analyzed. Nonparametric data precluded reliability determination using intraclass correlation. Findings included lumbar MedianAED = 0.5 vertebral equivalents (VE), thoracic = 1.7 VE, and cervical = 1.4 VE. For the combined dataset, the findings were MedianAED = 1.1 VE; MAD was lowest in the lumbar spine (0.3 VE) and highest in thoracic spine (1.4 VE), and for the combined dataset, MAD = 1.1 VE. Examiners agreed on the segment or the motion segment containing the stiffest site in 54% of the observations.

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The Accuracy of Manual Diagnosis

By Frank M. Painter|January 14, 2014|Manual Diagnosis, Motion Palpation, Palpation, Spinal Joint Pain|

The Accuracy of Manual Diagnosis for Cervical Zygapophysial Joint Pain Syndromes

The Chiro.Org Blog

SOURCE: Med J Aust. 1988 (Mar 7); 148 (5): 233–236

Jull G, Bogduk N, Marsland A.

University of Queensland, St Lucia.

The ability of a manipulative therapist to diagnose symptomatic cervical zygapophysial joint syndromes accurately was evaluated in a series of 20 patients. In 11 patients the presence, or absence, of a symptomatic joint was established by means of radiologically-controlled diagnostic nerve blocks. These patients were assessed by the manipulative therapist, without knowledge of the medical diagnosis. Another nine patients were first seen by the manipulative therapist whose diagnosis was then evaluated by means of diagnostic blocks.

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Motion Palpation of the Cervical Spine

By Frank M. Painter|October 7, 2009|Cervical Spine, Diagnosis, Education, Motion Palpation|

Motion Palpation of the Cervical Spine

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 3 from RC’s best-selling book:

“Motion Palpation”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 3: The Cervical Spine

This chapter describes the basic biomechanical, diagnostic, and therapeutic considerations related to motion palpation and the cervical spine. Emphasis will be on relating the general concepts previously explained about the chiropractic fixation-subluxation complex to specific entities that can be revealed by motion palpation and frequently corrected by dynamic chiropractic. Some aids to differential diagnosis are also included.

APPLIED ANATOMY CONSIDERATIONS

There are seven sites of possible “articular” fixation in the cervical spine. They are at the bilateral apophyseal joints, the bilateral covertebral joints, the superior and inferior intervertebral disc (IVD) interfaces, and the odontal-atlantal articulation (Table 3.1).

Table 3.1. The 27 Sites of Possible Spinopelvic Articular Fixation

In the cervical spine (7 possible sites of fixation)
Bilateral apophyseal joints	2
Bilateral covertebral joints	2
Superior and inferior IVD interfaces	2
Odontal-atlantal articulation	1
In the thoracic spine (8 possible sites of fixation)
Bilateral apophyseal joints	2
Superior and inferior IVD interfaces	2
Bilateral costovertebral joints	2
Bilateral costotransverse joints	2
In the lumbar spine (4 possible sites of fixation)
Bilateral apophyseal joints	2
Superior and inferior IVD interfaces	2
In the pelvis (8 possible sites of fixation)
Bilateral superior sacroiliac joints	2
Bilateral inferior sacroiliac joints	2
Sacrococcygeal joint	1
Pubic joint	1
Bilateral acetabulofemoral joints	2

The Apophyseal Joints of the Spine

Throughout the spine, paired diarthrodial articular processes (zygapophyses) project from the vertebral arches. The superior processes (prezygapophyses) of the inferior vertebra contain articulating facets that face somewhat posteriorly. They mate with the inferior processes (postzygapophyses) of the vertebra above that face somewhat anteriorly. Each articular facet is covered by a layer of hyaline cartilage that faces the synovial joint. The angulation of vertebral facets normally varies with the level of the spine and can be altered by wear and pathology.

In visualizing the motion of any joint, it is helpful to keep in mind that the hyaline-coated articulating surface is not the shape of the often flat bony surface exhibited on an x-ray film. Most apophyseal joints of the spine have a convex-concave shape.

Fisk states that the posterior joints of the spine are more prone to osteoarthritic changes than any other joint in the body: “Evidence of disc degeneration precedes this arthritis in the lumbar spine, but there is no such relationship in the cervical spine.” However, most authorities agree with Grieve that the presence of arthrotic changes in the facet planes does not, of itself, necessarily have any effect on ranges of movement, neither does the presence of osteophytosis.

Regional Structural Characteristics

Review the complete Chapter (including sketches and Tables) at the ACAPress website

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