Evaluating for a Correlation Between Osteopathic Examination and Ultrasonography on Thoracic Spine Asymmetry
Evaluating for a Correlation Between Osteopathic Examination and Ultrasonography on Thoracic Spine Asymmetry
Context: Thoracic spine is a common area of focus in osteopathic manipulative medicine (OMM)
 for a variety of conditions. Thoracic spine somatic dysfunction diagnosis is achieved by
 palpating for asymmetry at the tips of the transverse processes. Previous studies reveal
 that, instead of following the rule of threes, the transverse processes of a given thoracic
 vertebra generally align with the spinous process of the vertebra above. Ultrasonography has
 been widely used as a diagnostic tool to monitor musculoskeletal conditions. Ultrasound has
 the advantage of absence of radiation, and has shown comparable results to gold standard
 modalities like MRI in some areas of the spine. In the case of thoracic somatic dysfunction,
 ultrasound can be used to determine the location of each vertebral transverse process and its
 relationship with the spinous process. Previous studies have investigated the correlation
 between osteopathic manipulative medicine and ultrasonography of the cervical, lumbar, and
 sacral regions. However, no study has yet compared osteopathic structural examination with
 ultrasonographic examination of the thoracic vertebral region.

 Objective: To determine whether there is a dependable correlation of osteopathic palpatory
 findings of the thoracic transverse processes with the measurements of ultrasonography.

 Methods: Subjects were student volunteers recruited from the Midwestern University - Glendale
 campus. A non-toxic, non-permanent marker was used to mark bony landmarks on the skin to be
 used by the osteopathic examiners. Two osteopathic physicians (OMM1, OMM2) separately
 performed structural exams by palpating T2-T5 transverse processes to determine vertebral
 rotation. Two trained sonographers (US1, US2) separately scanned and measured the distance
 from the tip of the spinous process to the adjacent transverse processes of the vertebral
 segment below. Demographic variables were summarized with mean and standard deviation.
 Interexaminer reliability was assessed with percent agreement, Cohen's Kappa, and Fleiss'
 Kappa. Recruitment and protocols were approved by the MWU Institutional Review Board.
Inclusion Criteria:

 -  First- and Second-year osteopathic medical students who received an email notification

 -  Masters program students who received an email notification

 Exclusion Criteria:

 - A history of or currently diagnosed with scoliosis, spondylosis, spondylolisthesis,
 herniated disc, spinal fracture, or surgery to the spine