Evaluating for a correlation between osteopathic examination and ultrasonography on thoracic spine asymmetry

Shirley Chang, Jason Maddox, Erich Berg, Karen Kim, Scott Messier, Loren Swanson, Richard Dobrusin, Amy B Stein, G Nathan Nakken, Jeannine Noble, Randall Nydam, Shirley Chang, Jason Maddox, Erich Berg, Karen Kim, Scott Messier, Loren Swanson, Richard Dobrusin, Amy B Stein, G Nathan Nakken, Jeannine Noble, Randall Nydam

Abstract

Context: The 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 (TPs). Previous studies reveal that instead of following the rule of threes, the TPs of a given thoracic vertebra generally align with the spinous process (SP) of the vertebra above. Ultrasonography has been widely utilized as a diagnostic tool to monitor musculoskeletal conditions; it does not utilize ionizing radiation, and it has comparable results to gold-standard modalities. In the case of thoracic somatic dysfunction, ultrasound (US) can be utilized to determine the location of each vertebral TP and its relationship with the SP. Previous studies have investigated the correlation between OMM and ultrasonography of the cervical, lumbar, and sacral regions. However, there has been no study yet that has compared osteopathic structural examination with ultrasonographic examination of the thoracic vertebral region.

Objectives: To examine the relationship between osteopathic palpation and ultrasonographic measurements of the thoracic spine by creating a study design that utilizes interexaminer agreement and correlation.

Methods: The ClinicalTrials.gov study identifier is NCT04823637. Subjects were student volunteers recruited from the Midwestern University (MWU)-Glendale campus. A nontoxic, nonpermanent marker was utilized to mark bony landmarks on the skin. Two neuromusculoskeletal board-certified physicians (OMM1, OMM2) separately performed structural exams by palpating T2-T5 TPs to determine vertebral rotation. Two sonographers (US1, US2) separately scanned and measured the distance from the tip of the SP to the adjacent TPs of the vertebral segment below. Demographic variables were summarized with mean and standard deviation. Interexaminer agreement was assessed with percent agreement, Cohen's Kappa, and Fleiss' Kappa. Correlation was measured by Spearman's rank correlation coefficient. Recruitment and protocols were approved by the MWU Institutional Review Board (IRB).

Results: US had fair interexaminer agreement for the overall most prominent segmental rotation of the T3-T5 thoracic spine, with Cohen's Kappa at 0.27 (0.09, 0.45), and a total agreement percentage at 51.5%. Osteopathic palpation revealed low interexaminer agreement for the overall most prominent vertebral rotation, with Cohen's Kappa at 0.05 (0.0, 0.27), and 31.8%. Segment-specific vertebral analysis revealed slight agreement between US examiners, with a correlation coefficient of 0.23, whereas all other pairwise comparisons showed low agreement and correlation. At T4, US had slight interexaminer agreement with 0.24 correlation coefficient, and osteopathic palpation showed low interexaminer (OMM1 vs. OMM2) agreement (0.17 correlation coefficient). At T5, there was moderate agreement between the two sonographers with 0.44 (0.27, 0.60) and 63.6%, with a correlation coefficient of 0.57, and slight agreement between OMM1 and OMM2 with 0.12 (0.0, 0.28) and 42.4%, with 0.23 correlation coefficient.

Conclusions: This preliminary study of an asymptomatic population revealed that there is a low-to-moderate interexaminer reliability between sonographers, low-to-slight interexaminer reliability between osteopathic physicians, and low interexaminer reliability between OMM palpatory examination and ultrasonographic evaluation of the thoracic spine.

Keywords: interexaminer reliability; osteopathic structural exam; spinous process; thoracic spine; transverse process; ultrasound.

© 2021 Shirley Chang et al., published by De Gruyter, Berlin/Boston.

References

    1. Heo, JY, Lee, JW, Kim, CH, Lee, SM, Choi, YS. The validation of ultrasound-guided target segment identification in thoracic spine as confirmed by fluoroscopy. Clin Orthop Surg 2017;9:472. .
    1. Leboeuf-Yde, C, Nielsen, J, Kyvik, KO, Fejer, R, Hartvigsen, J. Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20–71 years of age. BMC Musculoskelet Disord 2009;10:39. .
    1. Lenehan, KL, Fryer, G, McLaughlin, P. The effect of muscle energy technique on gross trunk range of motion. J Osteopath Med 2003;6:13–8. .
    1. Licciardone, JC, Nelson, KE, Glonek, T, Sleszynski, SL, Cruser, DA. Osteopathic manipulative treatment of somatic dysfunction among patients in the family practice clinic setting: a retrospective analysis. J Am Osteopath Assoc 2005;105:537–44.
    1. Minarini, G, Ford, M, Esteves, J. Immediate effect of T2, T5, T11 thoracic spine manipulation of asymptomatic patient on autonomic nervous system response: single-blind, parallel-arm controlled-group experiment. Int J Osteopath Med 2018;30:12–7. .
    1. Campbell, SM, Winkelmann, RR, Walkowski, S. Osteopathic manipulative treatment: novel application to dermatological disease. J Clin Aesthetic Dermatol 2012;5:24–32.
    1. DiGiovanna, EL, Amen, CJ, Burns, DK. An osteopathic approach to diagnosis and treatment, 4th ed. Philadelphia, PA: Wolters Kluwer; 2020.
    1. Seffinger, MA. American Osteopathic Association, editors. Foundations of osteopathic medicine: philosophy, science, clinical applications, and research, 4th ed. Philadelphia: Wolters Kluwer; 2018.
    1. Brindise, J, Nelson, K, Kappler, R. Association between cervical and thoracic somatic dysfunction among second-year osteopathic medical students. J Am Osteopath Assoc 2014;114:540–8. .
    1. Degenhardt, BF, Johnson, JC, Snider, KT, Snider, EJ. Maintenance and improvement of interobserver reliability of osteopathic palpatory tests over a 4-month period. J Am Osteopath Assoc 2010;110:579–86.
    1. Snider, EJ, Pamperin, K, Pazdernik, V, Degenhardt, BF. Influence of transverse process landmark localization on palpation accuracy of lumbar spine models. J Am Osteopath Assoc 2018;118:151. .
    1. Bengaard, K, Bogue, RJ, Crow, WT. Reliability of diagnosis of somatic dysfunction among osteopathic physicians and medical students. Osteopath Fam Physician 2012;4:2–7. .
    1. Oakley, CK, Janssen, SAK, Pankratz, JP, McCumber, TL, Treffer, KD, Olinger, AB. Validity of the rule of threes and anatomical relationships in the thoracic spine. J Am Osteopath Assoc 2018;118:645. .
    1. Mitchell, F, Moran, P, Pruzzo, N. An evaluation and treatment manual of osteopathic muscle energy procedures, 1st ed. Valley Park, MO: Mitchell, Moran, and Pruzzo Associates; 1979.
    1. Geelhoed, MA, McGaugh, J, Brewer, PA, Murphy, D. A new model to facilitate palpation of the level of the transverse processes of the thoracic spine. J Orthop Sports Phys Ther 2006;36:876–81. .
    1. Chin, KJ, Karmakar, MK, Peng, P. Ultrasonography of the adult thoracic and lumbar spine for central neuraxial blockade. Anesthesiology 2011;114:1459–85. .
    1. Willems, J, Jull, G, Ng, J-F. An in vivo study of the primary and coupled rotations of the thoracic spine. Clin Biomech 1996;11:311–6. .
    1. Lockwood, MD, Kondrashova, T, Johnson, JC. Feasibility of using ultrasonography to establish relationships among sacral base position, sacral sulcus depth, body mass index, and sex. J Am Osteopath Assoc 2015;115:648. .
    1. Czyrny, Z. Standards for musculoskeletal ultrasound. J Ultrason. 2017;17:182-7. .
    1. Ahmed, AS, Ramakrishnan, R, Ramachandran, V, Ramachandran, SS, Phan, K, Antonsen, EL. Ultrasound diagnosis and therapeutic intervention in the spine. J Spine Surg 2018;4:423–32. .
    1. Ledsome, JR, Lessoway, V, Susak, LE, Gagnon, FA, Gagnon, R, Wing, PC. Diurnal changes in lumbar intervertebral distance, measured using ultrasound. Spine 1996;21:1671–5. .
    1. Patil, P, Dasgupta, B. Role of diagnostic ultrasound in the assessment of musculoskeletal diseases. Ther Adv Musculoskelet Dis 2012;4:341–55. .
    1. Flaum, TB, Rusnack, FM, Mirza, A, Apoznanski, TE, Munarova, A, Mazzie, JP, et al.. An observational study of ultrasound to confirm cervical spine segmental positional rotation. Int J Osteopath Med 2017;25:1–5. .
    1. Winter, J, Kimber, A, Montenegro, S, Gao, J. Ultrasonography to assess the efficacy of osteopathic manipulative treatment for lumbar spine asymmetry. J Am Osteopath Assoc 2020;120:761. .
    1. Shaw, KA, Dougherty, JJ, Treffer, KD, Glaros, AG. Establishing the content validity of palpatory examination for the assessment of the lumbar spine using ultrasonography: a pilot study. J Am Osteopath Assoc 2012;112:775. .
    1. Snider, KT, Redman, CL, Edwards, CR, Bhatia, S, Kondrashova, T. Ultrasonographic evaluation of the effect of osteopathic manipulative treatment on sacral base asymmetry. J Am Osteopath Assoc 2018;118:159. .
    1. Beynon, AM, Hebert, JJ, Walker, BF. The interrater reliability of static palpation of the thoracic spine for eliciting tenderness and stiffness to test for a manipulable lesion. Chiropr Man Ther 2018;26:49. .
    1. Morita, D, Yukawa, Y, Nakashima, H, Ito, K, Yoshida, G, Machino, M, et al.. Range of motion of thoracic spine in sagittal plane. Eur Spine J 2014;23:673–8. .
    1. Savarese, RG, Capobianco, JD, Adesina, AT, Reed, G. OMT Review: a comprehensive review in osteopathic medicine, 4th ed. Florida, USA: OMT Review LLC; 2018.
    1. Moore, KL, Agur, AMR, Dalley, AF. Clinically oriented anatomy, 8th ed. Philadelphia: Wolters Kluwer; 2018.
    1. Stroud, L, Herold, J, Tomlinson, G, Cavalcanti, RB. Who you know or what you know? Effect of examiner familiarity with residents on OSCE scores. Acad Med 2011;86:S8–11. .
    1. Csernátony, Z, Molnár, S, Hunya, Z, Manó, S, Kiss, L. Biomechanical examination of the thoracic spine-the axial rotation moment and vertical loading capacity of the transverse process: transverse process loading capacity. J Orthop Res 2011;29:1904–9. .
    1. Akoglu, H. User’s guide to correlation coefficients. Turk J Emerg Med 2018;18:91–3. .
    1. Lam, GC, Hill, DL, Le, LH, Raso, JV, Lou, EH. Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods. Scoliosis 2008;3:16. .
    1. Consorti, G, Basile, F, Pugliese, L, Petracca, M. Interrater reliability of osteopathic sacral palpatory diagnostic tests among osteopathy students. J Am Osteopath Assoc 2018;118:637. .
    1. Walker, BF, Koppenhaver, SL, Stomski, NJ, Hebert, JJ. Interrater reliability of motion palpation in the thoracic spine. Evid Based Complement Alternat Med 2015;2015:1–6. .
    1. Pagé, I, Descarreaux, M, Sobczak, S. Development of a new palpation method using alternative landmarks for the determination of thoracic transverse processes: an in vitro study. Musculoskelet Sci Pract 2017;27:142–9. .
    1. Wilke, H-J, Herkommer, A, Werner, K, Liebsch, C. In vitro analysis of the segmental flexibility of the thoracic spine. PLoS one 2017;12:e0177823. .
    1. Stochkendahl, MJ, Christensen, HW, Hartvigsen, J, Vach, W, Haas, M, Hestbaek, L, et al.. Manual examination of the spine: a systematic critical literature review of reproducibility. J Manip Physiol Ther 2006;29:475–85. e10. .
    1. Vaughan, B. Inter-examiner reliability in detecting cervical spine dysfunction: a short review. J Osteopath Med 2002;5:24–7. .
    1. Mancini, D, Cesari, M, Lunghi, C, Benigni, AM, Antonelli Incalzi, R, Scarlata, S. Ultrasound evaluation of diaphragmatic mobility and contractility after osteopathic manipulative techniques in healthy volunteers: a prospective, randomized, double-blinded clinical trial. J Manip Physiol Ther 2019;42:47–54. .
    1. Haneline, MT, Young, M. A review of intraexaminer and interexaminer reliability of static spinal palpation: a literature synthesis. J Manip Physiol Ther 2009;32:379–86. .
    1. Potter, L, McCarthy, C, Oldham, J. Intraexaminer reliability of identifying a dysfunctional segment in the thoracic and lumbar spine. J Manip Physiol Ther 2006;29:203–7. .
    1. Lucas, N, Bogduk, N. Diagnostic reliability in osteopathic medicine. Int J Osteopath Med 2011;14:43–7. .
    1. Walkowski, S, Baker, R. Osteopathic manipulative medicine. In: pain procedures in clinical practice. Philadelphia: Elsevier; 2011:155–71 pp.
    1. Gibbons, P, Tehan, P. Muscle energy concepts and coupled motion of the spine. Man Ther 1998;3:95–101. .
    1. Porto, AB, Okazaki, VHA. Thoracic kyphosis and lumbar lordosis assessment by radiography and photogrammetry: a review of normative values and reliability. J Manip Physiol Ther 2018;41:712–23. .
    1. Øverås, CK, Myhrvold, BL, Røsok, G, Magnesen, E. Musculoskeletal diagnostic ultrasound imaging for thickness measurement of four principal muscles of the cervical spine -a reliability and agreement study. Chiropr Man Ther 2017;25:2. .

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