PMID- 25729566
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20150302
LR  - 20220316
IS  - 2045-709X (Print)
IS  - 2045-709X (Electronic)
IS  - 2045-709X (Linking)
VI  - 23
DP  - 2015
TI  - The location of the inferior angle of the scapula in relation to the spine in the 
      upright position: a systematic review of the literature and meta-analysis.
PG  - 7
LID - 10.1186/s12998-014-0050-7 [doi]
LID - 7
AB  - Practitioners in several of the health care professions use anatomical landmarks 
      to identify spinal levels, both in order to enhance diagnostic accuracy and to 
      specifically target the site of intervention. Authoritative sources usually state 
      the upright inferior scapular angle (IAS) aligns with the spinous process (SP) of 
      T7, but some specify the T7-8 interspace or the T8 SP. The primary goals of this 
      study were to systematically review the relevant literature; and conduct a 
      meta-analysis of the pooled data from retrieved studies to increase their 
      statistical power. Electronic searching retrieved primary studies relating the 
      IAS to a spinal level, as determined by an imaging reference standard, using 
      combinations of these search terms: scapula, location, landmark, spinous process, 
      thoracic vertebrae, vertebral level, palpation, and spine. Only primary studies 
      were included; review articles and reliability studies related to scapular 
      position but lacking spinal correlations were excluded. Eight-hundred and eighty 
      (880) articles of interest were identified, 43 abstracts were read, 22 full text 
      articles were inspected, and 5 survived the final cut. Each article (with one 
      exception) was rated for quality using the QUADAS instrument. Pooling data from 5 
      studies resulted in normal distribution in which the upright IAS on average 
      aligns closely with the T8 SP, range T4-T11. Since on average the IAS most 
      closely identifies the T8 SP in the upright position, it is very likely that 
      health professionals, both manual therapists and others, who have been diagnosing 
      and treating patients based on the IAS = T7 SP rule (the conventional wisdom), 
      have not been as segmentally accurate as they may have supposed. They either 
      addressed non-intended levels, or made numeration errors in their charting. There 
      is evidence that using the IAS is less preferred than using the vertebra 
      prominens, and may be less preferred than using the iliac crest for identifying 
      spinal levels Manual therapists, acupuncturists, anesthesiologists, nurses, and 
      surgeons should reconsider their procedures for identifying spinal sites in light 
      of this modified information. Inaccurate landmark benchmark rules will add to 
      patient variation and examiner errors in producing spine care targeting errors, 
      and confound research on the importance of specificity in treating spinal levels.
FAU - Cooperstein, Robert
AU  - Cooperstein R
AD  - Palmer West College of Chiropractic, 90 East Tasman Drive, San Jose, CA 94577 
      USA.
FAU - Haneline, Michael
AU  - Haneline M
AD  - University of Western States, 2900 NE 132nd Avenue, Portland, OR 97230 USA.
FAU - Young, Morgan
AU  - Young M
AD  - Palmer West College of Chiropractic, 90 East Tasman Drive, San Jose, CA 94577 
      USA.
LA  - eng
PT  - Journal Article
DEP - 20150227
PL  - England
TA  - Chiropr Man Therap
JT  - Chiropractic & manual therapies
JID - 101551481
PMC - PMC4343265
EDAT- 2015/03/03 06:00
MHDA- 2015/03/03 06:01
PMCR- 2015/02/27
CRDT- 2015/03/03 06:00
PHST- 2014/07/30 00:00 [received]
PHST- 2014/12/26 00:00 [accepted]
PHST- 2015/03/03 06:00 [entrez]
PHST- 2015/03/03 06:00 [pubmed]
PHST- 2015/03/03 06:01 [medline]
PHST- 2015/02/27 00:00 [pmc-release]
AID - 50 [pii]
AID - 10.1186/s12998-014-0050-7 [doi]
PST - epublish
SO  - Chiropr Man Therap. 2015 Feb 27;23:7. doi: 10.1186/s12998-014-0050-7. eCollection 
      2015.