thoracic spine landmarks

Excerpts from the book “A Mini Manual for Manual Therapy Procedures”
By Sandro Strix S. Toledo, M.D.
Manual Medicine Integrated Solutions
Thoracic Somatic Dysfunctions: Diagnoses and Treatments
strixmd@yahoo.com
assist@truecaremed.com
Reproduction without permission is in violation of intellectual property laws.

For notes and billing, the ICD-9 code for Thoracic Somatic Dysfunction is 739.2

Anatomic Landmarks for the Thoracic spine
1) Slowly flex the neck to engage the cervico-thoracic junction. T1 does not lock into flexion with the cervical spine. It lags behind C7 and remains protruding posteriorly when the cervical spine is engaged in flexion.
2) T3 is at about the level of the scapular spine.
3) T5 is at about mid-scapular level.
4) T1-3 spinous processes project posteriorly and lie directly at level with their corresponding transverse processes.
5) T4-6 spinous processes project postero-inferiorly to halfway between its level's transverse processes and the transverse processes of the the vertebra inferior to it.
6) T7-9 spinous processes project even more inferiorly than T4-6. They lie at the level of the inferior vertebrae's transverse processes.
7) The transverse processes lie lateral to the longissimus muscle bundles at about an inch from midline.

The “Rule of Threes” for the Thoracic Transverse Processes Leveling states:
1) T1-3 (and T12) transverse processes are at the level of the corresponding thoracic spine.
2) T4-6 (and T11) transverse processes lie superiorly between its level's spine and the spine of the thoracic segment above it.
3) T7-9 (and T10) transverse processes lie superiorly at the level of the superior segment's spine.
4) T10 transverse processes are at the level of the T9 spine.
5) T11 transverse processes are midway between the T10 and T11 spine.
6) T12 transverse processes are at level with its spine.