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MSK 2 > 2a - TSpine Exam > Flashcards

2a - TSpine Exam Flashcards

1
Q

what are 2 differential dx for interscapular pain other than thoracic spine pain
- what are f/u Qs to differentiate

A

gallbladder
- worse w eating (fatty food)

cardiac
- PMH
- worse w exertion?

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2
Q

what are 3 differential dx for for general thoracic spine pain

A

cancer
infection
fx

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3
Q

what are signs it is cancer and not thoracic spine pain

A

PMH
bone mets common
unexplained wt loss
night sweats

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4
Q

what are signs it is infection and not thoracic spine pain

A

fever
constitutional sx

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5
Q

what are signs it is a fx and not thoracic spine pain

A

OP
trauma
corticosteroid use

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6
Q

what are 3 functional outcome measures

A

NDI
oswestry low back disability Q
roland morris low back disability Q

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7
Q

functional outcomes to use in upper tspine vs lower tspine

A

upper tspine = NDI
lower tspine = lumbar tools

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8
Q

what are 2 components of the clinical exam specific to the tspine

A

rib exam
- rib mobility assessment thru breathing, PPIVMs, and PAIVMs (spring testing)
- 1st rib CRLF test
- 1st rib PAIVM

breathing assessment
- visual and palpation
- Hi-Lo, MARM
- resp rate
- breath hold time
- breathing Q

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9
Q

what is an important thing to not confuse when assessing the tspine and scap in the posture assessment

A

don’t confuse protracted scap w inc thoracic kyphosis

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10
Q

why do we look at the skin during a tspine posture assessment

A

for shingles
- unilateral blisters/lesions on skin along dermatome
- can occur in older pts

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11
Q

how is scoliosis described

A

rib hump
most common in tspine
described where primary curve is, location of convex side

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12
Q

why is it important to do a shoulder screen w a tspine exam

A

shoulders and tspine are closely related biomechanically
- get thoracic ext and rotation w full shoulder flex

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13
Q

describe the difference in mobility in tspine vs c and lumbar and why? what are resulting problems?

A

tspine isn’t as mobile as c and lumbar
- ribs are there & provide stability to protect organs

can see problems at junctional areas (ie cervicothoracic junction)

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14
Q

normal amt of flexion of tspine

A

20-45deg

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15
Q

normal amt of ext of tspine

A

15-20deg

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16
Q

normal amt of rotation of tspine

A

35-50deg

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17
Q

normal amt of SBing of tspine

A

25-45deg

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18
Q

when is a repeated mvmt assessment appropriate

A

suspected disc problem

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19
Q

what are considerations to isolate the tspine as much as possible

A

feet on floor - stabilize lumbar

flexion w arms crossed to help isolate mvmt to tspine

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20
Q

what population is an lumbar locked thoracic rotation test

A

athletes whose sports entail repetitive rotation
- golfers
- rowers
- gymnasts
- throwers
- swimmers

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21
Q

what does a lumbar locked rotation test assess and what is the norm

A

isolated thoracic rotation
- locks lumbar spine out

norm: elbow perp to ceiling

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22
Q

what does chest expansion measurements assess and what is the norm? what is a condition that might result in dec expansion

A

costovertebral joint mvmt

norm: 1-3’’ difference b/w inhale and exahle

ankylosing spondylitis (arthritis)
- fusing in end ranges that can cause stiffness in end range

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23
Q

what are locations of measurement for chest expansion

A

method 1: 4th intercostal space
method 2:
- axilla
- xyphoid process
- 10th rib

24
Q

what are 2 examples of neurodynamic testing

A

slump test
straight leg raise

25
Q

while T3-12 dermatomes are mostly segmental, what are 4 landmarks

A

T6: level w xyphoid
T10: level w umbilicus
T11: b/w T10 and upper groin
T12: level w upper groin

26
Q

how and which myotomes can be assessed

A

non-specific
T7-12 test w a crunch
- 7-9 = upper
- 10-12 = lower

watch umbilicus
- any deviation from midline suggests weakness in opposite quadrant

27
Q

what are types of provocation testing and what does research say

A

compression
distraction
quadrant

no research on tests for tspine, so not in lab packet

28
Q

what is a rib flare - how is this a deviation from normal and what is this often associated with

A

norm: when inhale ribs elevate and little ER
- flare: if not exhaling well, ribs stay elevated

often associated w inc lumbar lordosis

29
Q

when is rib springing contraindicated and who is most appropriate

A

OP - can easily fx rib

done in young healthy people

30
Q

why are there specific 1st rib assessments

A

different anatomy to other ribs

thought to be associated w pain in cervical thoracic region

can also get in slightly elevated position w tight scalenes which can cause pain

31
Q

what does a cervical lateral flexion test assess and what is a (+)

A

assess for presence of elevated first rib

(+) SB mvmt limited or blocked
- suggests elevated 1st rib on opposite side to rotation

32
Q

what is dysfunctional breathing (DB), what population is this common in and what is this often related to

A

individuals who display divergent/abnormal breathing patterns and have breathing problems that can’t be attributed to specific med/CVP dx (ie asthma)

common in athletes

related to core ms dysfunction

33
Q

what is a normal breathing pattern

A

outwards motion during inhalation

34
Q

what is paradoxical breathing pattern

A

contraction, inwards motion during inhalation
- outward movement during exhalation

35
Q

what are common reasons/results of upper chest dominant breathing pattern

A

use a lot of upper chest
-> use scalenes
–» tight and elevated 1st rib

36
Q

what are 4 abnormal breathing patterns

A

paradoxical
upper chest dominant
diaphragm dominant
mouth breather

37
Q

what are good screening tools for breathing dysfunction

A

breath hold time
breathing questionnaires
- nijmegen Qs
- self eval of breathing sx Q

38
Q

what is the breath hold time test, what is the norm, and what does it screen for

A

how long subject can hold breath starting at end of normal exhale, until first involuntary ms activity

<25sec screens for DB

39
Q

what is the hi low breathing assessment, what is normal, what can this screen for, and what is a consideration

A

manual assessment hand on sternum and upper abdomen

norm: outward motion during inhale

screen for: paradoxical, upper chest dom, diaphragm dom

consideration: better for pt to do themselves, if we do it more likely to change breathing pattern

40
Q

what is a MARM (manual assessment of resp motion) breathing assessment, what does it assess and what is normal

A

hands over lower rib cage
- thumbs parallel to spine
- little finger horizontal

assess vertical motion of hands relative to lateral
assess overall magnitude of rib motion

norm: bucket handle motion
- ribs move laterally and slight elevation

41
Q

what is a primary thoracic spine dx

A

hypomobility
facet joint
discogenic
rib
myofascial
postural

similar paths to cervical

42
Q

what is a regional interdependence thoracic spine dx

A

thoracic hypomobility w:
- shoulder
- neck
- lumbar
- lateral epicondylalgia

43
Q

what is a more vs less common tspine dx

A

more common for regional interdependence
- ex: when treat tspine, helps w neck and shoulder pain

less common for a primary tspine dx

44
Q

what does regional interdependence mean

A

concept that seemingly unrelated impairments in a remote anatomical region (ie tspine) may contribute to or be associated w pts primary complaint

45
Q

what does evidence say about tspine manip with what the results/outcomes are in pts

A

results in neurophysiological changes which may lead to improved pain in outcomes in individuals w MSK disorders

46
Q

what does evidence say about a thoracic manip in a pt w neck pain, what concept is this based on

A

adding thoracic manip to EBP strengthening program improves pt outcomes w neck pain
- not able to validate

based on concept of regional interdependence

47
Q

what are 3 main examples of regional interdependence w the spine

A

neck pain and thoracic hypo

cervical spine and lateral epicondylagia

wrist, elbow, and hand conditions

48
Q

what 3 wrist, elbow, and hand conditions can be treated using the concept of regional interdependence

A
  1. cervico-brachial pain
  2. double crush syndrome
    - nerve sensitive in multiple areas (ie cubital tunnel and compression at guyons)
  3. carpal tunnel syndrome
49
Q

what is a guideline for treatment using the concept of regional interdependence

A

examine and treat areas above and below area of CC

50
Q

what are 3 manual therapy techniques for tspine

A

STM:
- multifidi, rotatores, paraspinals of involved segment

joint mob/manips

ms energy to involved segment to reduce associated rotatores and multifidi ms guarding

51
Q

what are 4 strategies to include in exercises

A

stabilize: external tape, body mechanics training

NM rehab

cues to facilitate optimal thoracic biomechanics and motor control in tasks that require thoraco-pelvic rotational control
-> key for most functional activity and sport

breathing biomechanics and cues for optimal breathing

52
Q

what is the purpose of proprioceptive taping

A

use strong tape that if you don’t want someone flexing a lot, it gives feedback to ext when flexing

53
Q

what are considerations w the use of a foam roller

A

make sure neck well supported, otherwise may see hyperext of cspine and develop neck probs

also need good lumbo pelvic control to keep lumbar in neutral

54
Q

how can arms be utilized to facilitate thoracic motion

A

shoulder flex -> t ext
shoulder ext -> t flex

55
Q

what is a breathing exercise you can do w pts

A

4-7-8 breathing
- relaxing breath
- breath in for 4sec
- hold for 7sec
- exhale for 8sec

56
Q

what are cues for someone breathing in hooklying

A

tactile: push on lower ribs during exhale and maintain position during inhale

“keep back flat on mat”
“press ribs into mat”

have pt place hand on stomach and chest to practice minimizing chest breathing

57
Q

what are cues for breathing in sitting/standing/high kneeling

A

tactile cues: lateral ribs and diaphragm to encourage diaphragmatic breating
- for good posture

“breath in w nose and exhale w mouth”
“breath w stomach and not chest”
“keep shoulders down and back straight”

MSK 2 (20 decks)

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