Spinous process palpation using the scapular tip as a landmark vs a radiographic criterion standard

Robert Cooperstein and Michael Haneline

This study aimed at determining the standing spinal landmark that corresponds to the inferior tip of the scapula and determining the accuracy of experienced palpators in locating a spinous process (SP) 3 levels above and below a given SP.  An experienced palpator located the inferior scapular tip on 34 asymptomatic subjects and then positioned a 2-mm lead marker about 5 cm lateral to the nearest SP. Two more markers were placed at levels intended to be 3 levels above and below the first marker placed. The locations of the scapular tip and the spinal targets were determined by comparison with a radiological criterion standard.
Approximately 68% of patients would be palpated to have their inferior scapular tips at T7, T8, or T9. An experienced palpator can quite accurately locate vertebral levels 3 above or below a given landmark. The aithors conclude that chiropractors and other health professionals using the typical rule of thumb linking the inferior scapular tip to the standing T7 SP have likely been applying clinical interventions at spinal locations different from those intended.

Journal of Chiropractic Medicine, 2007, 6(3), 87-93

Link to Abstract

Link to Full Text