Somatic Dysfunction: Thoracic and Lumbar Spine (Screening/AGR, Long Lever, Short Lever)

[@FindNShare]

You sir are a hero to osteopath

[@frantrisko3091]

❤ te acabo de encontrar. Informativo y relajante....

[@brandoutmusic]

For an AGR screening using short lever technique, is there a method to confirm the sidebending component of the diagnosis other than deducing from Fryette's principles? Or could you only confirm via long lever sidebending?

[@OsteopathicClinicalSkills]

You can also contact the transverse processes and directly translate the segment to induce sidebending. This is a short-lever type motion that looks similar to cervical spine diagnosis. Translation left = sidebending right; Translation right = sidebending left. For thoracic and lumbar spine it is a little more challenging than long lever motion testing, especially when first developing your palpatory skills, but the more you practice, the better you’ll get at it!

[@richardroyster6631]

Great techniques when working with a person 50 to 100 lbs lighter and several inches small than the therapist. But not effective when the patient is larger than the therapist. AGR dx will be less accurate when struggling to manage the weight and size of a larger patient. I notice that all the demostrations in this series use small models. How do you manage the typical American 30-50% over ideal weight when using a sitting position. ALSO How do you manage large brested women when testing for AGR.

[@OsteopathicClinicalSkills]

You make a good point, and I will make an effort to find mock patients with more diverse body types. Most of the demonstrations on this channel have the mock patients you’ve seen for two reasons: 1. Ease of demonstration for beginner learners 2. Most of the mock patients are medical students or residents All of these skills apply to larger patients, though some slight modifications may be needed depending on the size mismatch between doctor and patient. I teach many students who are of much shorter stature that become very capable at performing these treatment techniques on patients of all sizes. I will find more opportunities to showcase adaptations for more challenging size mismatches.

[@nishkapatel4667]

If you diagnosis lets say, T3 as being neutral, and you diagnose the curve (T2-T4), is T2-T4 expected to be neutral as well? What do you do if T2 or T4 is non-neutral? Would you just treat T3?

[@OsteopathicClinicalSkills]

You would check the neutral/non-neutral state of each segment before you finalize the range of your group. If you notice several segments rotated the same direction, you might suspect that all the segments would be neutral, but you cannot assume that. You must check each segment to confirm where the group starts and ends. You can have any number of segments involved in a group. But if you have a neutral group, and there is a non-neutral segment adjacent to it, a question to consider is whether that non-neutral segment is leading to a motion restriction that is causing the neutral group (as a form of compensation). In that case, I would treat the non-neutral segment. If instead there is a true group curve (all neutral), then I would treat as close to the apex/center of the curve as possible. Hope that helps!

[@nishkapatel4667]

@@OsteopathicClinicalSkills So basically in thoracic diagnosis, you can diagnose a group curve in which all 3 segments are neutral, or there is also the possibility of only 1 segment being neutral, and the rest being non-neutral. But nevertheless, if you diagnose a segment as neutral, then you must check the segment above and below it, if I am understanding you correctly?

[@OsteopathicClinicalSkills]

That’s about right. Thoracic and Lumbar diagnoses are usually noted as single segments or group curves. Neutral dysfunctions (type 1 fryette’s) are usually found in groups (2 or more in a row with the exact same diagnosis), and are less commonly found alone. Non-neutral dysfunctions (type 2 fryette’s) are usually found in single segments. While non-neutral segments can sometimes be found next to each other, they are not noted as a group and are still considered single segments.

[@nishkapatel4667]

@@OsteopathicClinicalSkills Thank you so much for taking the time to respond, it means a lot. Your videos are so useful for DO students