title: Locating the Seventh Cervical Spinous Process: Accuracy of the Thorax-Rib Static Method and the Effects of Clinical Data on Its Performance.
abstract: The aim of this study was to assess the thorax-rib static method (TRSM), a palpation method for locating the seventh cervical spinous process (C7SP), and to report clinical data on the accuracy of this method and that of the neck flexion-extension method (FEM), using radiography as the gold standard.
  
  
  
  A single-blinded, cross-sectional diagnostic accuracy study was conducted. One hundred and one participants from a primary-to-tertiary health care center (63 men, 56 ± 17 years of age) had their neck palpated using the FEM and the TRSM. A single examiner performed both the FEM and TRSM in a random sequence. Radiopaque markers were placed at each location with the aid of an ultraviolet lamp. Participants underwent chest radiography for assessment of the superimposed inner body structure, which was located by using either the FEM or the TRSM.
  
  
  
  Accuracy in identifying the C7SP was 18% and 33% (P = .013) with use of the FEM and the TRSM, respectively. The cumulative accuracy considering both caudal and cephalic directions (C7SP ± 1SP) increased to 58% and 81% (P = .001) with use of the FEM and the TRSM, respectively. Age had a significant effect on the accuracy of FEM (P = .027) but not on the accuracy of TRSM (P = .939). Sex, body mass, body height, and body mass index had no significant effects on the accuracy of both the FEM (P = .209 or higher) and the TRSM (P = .265 or higher).
  
  
  
  The TRMS located the C7SP more accurately compared with the FEM at any given level of anatomic detail, although both still underperformed in terms of acceptable accuracy for a clinical setting.
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Bonsucesso, Brazil.
authors.forename: Ana Paula A
authors.initials: APA
authors.lastname: Ferreira
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Bonsucesso, Brazil.
authors.forename: Luciana C
authors.initials: LC
authors.lastname: Póvoa
authors.affiliation: Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: José F C
authors.initials: JFC
authors.lastname: Zanier
authors.affiliation: Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta (UNISUAM), Bonsucesso, Brazil. Electronic address: arthurde@unisuamdoc.com.br.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D010173:Palpation / Q000379:methods*; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012272:Ribs / Q000000981:diagnostic imaging*; D016037:Single-Blind Method; D013909:Thorax / Q000000981:diagnostic imaging*
keywords: Cervical Vertebrae; Diagnostic Errors; Palpation; Physical Examination; Physical Therapy Specialty; Rehabilitation