A radiologic analysis: Relationships of the thoracic spine to aid palpation of the thoracic transverse processes

Christopher Baker, Darshan Patel, Michael B. Roberts, Kristie Petree, Randall L. McGill

Research output: Contribution to conferencePoster


Introduction: In the field of osteopathic manipulative medicine, palpation is an important skill used by physicians to localize structures to diagnose and treat patients with somatic dysfunction throughout the musculoskeletal system. Specifically, in the thoracic spine, physicians can use the more superficial spinous process of each vertebra to assist in locating the deeper, more challenging to palpate, transverse process of the vertebra. Historically, the “rule of threes”, proposed by Mitchell et al in 1979, describing the relationships between spinous processes and transverse processes of the thoracic spine has been taught in osteopathic medical schools. However, another model was more recently proposed by Geelhoed et al in 2006. To our knowledge, these models have never been analyzed radiologically using computed tomography in patients.

Objectives: To evaluate the accuracy of several proposed models, including the rule of 3’s and Geelhoed’s rule, which aid in palpation of the transverse processes of the thoracic spine based on their relation to the spinous processes. Furthermore, the study aims to analyze the intervertebral and intravertebral relationships of the transverse processes and spinous processes of the thoracic spine.

Methods: This was an observational study with retrospective analysis of high-resolution computed tomography of the chest in the prone position. Four measurements were taken per thoracic vertebra in the coronal plane during inspiration. Based on the measurements, it was determined whether each individual vertebra followed the models or not. The measurements were further analyzed to define additional intervertebral and intravertebral relationships between the transverse and spinous processes of the thoracic spine.

Results: We predict that the high-resolution computed tomography will reveal the intervertebral and intravertebral relationships as well as the aid in defining the accuracy of the relationships between the spinous processes proposed in osteopathic manipulative models.

Conclusion: We conclude that retrospective radiological studies using state of the art images has the ability to confirm and/or expand our ability to utilize osteopathic principles and models in diagnosing and treating patients.

Original languageAmerican English
StatePublished - May 9 2023

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