The inferior angle of the scapula as a landmark to locate the seventh thoracic spinous process

M. Tech.Although Chiropractors rely on palpation as a clinical tool, its reliability still remains to be proven (O‟Haire and Gibbons, 2000). Motion palpation is based on the assumption that Chiropractors‟ and other manual medicine practitioners‟ static palpation is performed correctly to identify bony anatomical landmarks (O‟Haire and Gibbons, 2000). The most common method taught to chiropractic students on the location of the seventh thoracic spinous process, is to place the patient‟s hand in the small of their back, forcing the inferior angle of the scapula to become more prominent. The horizontal line from the inferior angle of the scapula to the vertebral column is said to be on the seventh thoracic spinous process (T7). Therefore the scapula is a widely used anatomical landmark. One would therefore expect the literature to all be in agreement to the position of this line, but according to the literature consulted, it seems to vary. This study aimed to determine whether palpation of the inferior angle of the scapula was a reliable, accurate and/or a valid method of determining the location of the seventh thoracic spinous process. Sixty participants were marked by three examiners in the seated position, using the inferior angle of the scapula to locate the seventh thoracic spinous process. After being marked by all three examiners, measurements were then made on CT scan films as well as visual assessments by examiners to assess the location of the markers on the thoracic anatomy. The results demonstrated substantial inter-examiner reliability, and poor accuracy in locating the seventh thoracic spinous process. This is disappointing as the ability to palpate spinal levels is a basic skill and the cornerstone of Chiropractic assessment