2a - TSpine Exam Flashcards
what are 2 differential dx for interscapular pain other than thoracic spine pain
- what are f/u Qs to differentiate
gallbladder
- worse w eating (fatty food)
cardiac
- PMH
- worse w exertion?
what are 3 differential dx for for general thoracic spine pain
cancer
infection
fx
what are signs it is cancer and not thoracic spine pain
PMH
bone mets common
unexplained wt loss
night sweats
what are signs it is infection and not thoracic spine pain
fever
constitutional sx
what are signs it is a fx and not thoracic spine pain
OP
trauma
corticosteroid use
what are 3 functional outcome measures
NDI
oswestry low back disability Q
roland morris low back disability Q
functional outcomes to use in upper tspine vs lower tspine
upper tspine = NDI
lower tspine = lumbar tools
what are 2 components of the clinical exam specific to the tspine
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
what is an important thing to not confuse when assessing the tspine and scap in the posture assessment
don’t confuse protracted scap w inc thoracic kyphosis
why do we look at the skin during a tspine posture assessment
for shingles
- unilateral blisters/lesions on skin along dermatome
- can occur in older pts
how is scoliosis described
rib hump
most common in tspine
described where primary curve is, location of convex side
why is it important to do a shoulder screen w a tspine exam
shoulders and tspine are closely related biomechanically
- get thoracic ext and rotation w full shoulder flex
describe the difference in mobility in tspine vs c and lumbar and why? what are resulting problems?
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)
normal amt of flexion of tspine
20-45deg
normal amt of ext of tspine
15-20deg
normal amt of rotation of tspine
35-50deg
normal amt of SBing of tspine
25-45deg
when is a repeated mvmt assessment appropriate
suspected disc problem
what are considerations to isolate the tspine as much as possible
feet on floor - stabilize lumbar
flexion w arms crossed to help isolate mvmt to tspine
what population is an lumbar locked thoracic rotation test
athletes whose sports entail repetitive rotation
- golfers
- rowers
- gymnasts
- throwers
- swimmers
what does a lumbar locked rotation test assess and what is the norm
isolated thoracic rotation
- locks lumbar spine out
norm: elbow perp to ceiling
what does chest expansion measurements assess and what is the norm? what is a condition that might result in dec expansion
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
what are locations of measurement for chest expansion
method 1: 4th intercostal space
method 2:
- axilla
- xyphoid process
- 10th rib
what are 2 examples of neurodynamic testing
slump test
straight leg raise
while T3-12 dermatomes are mostly segmental, what are 4 landmarks
T6: level w xyphoid
T10: level w umbilicus
T11: b/w T10 and upper groin
T12: level w upper groin
how and which myotomes can be assessed
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
what are types of provocation testing and what does research say
compression
distraction
quadrant
no research on tests for tspine, so not in lab packet
what is a rib flare - how is this a deviation from normal and what is this often associated with
norm: when inhale ribs elevate and little ER
- flare: if not exhaling well, ribs stay elevated
often associated w inc lumbar lordosis
when is rib springing contraindicated and who is most appropriate
OP - can easily fx rib
done in young healthy people
why are there specific 1st rib assessments
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
what does a cervical lateral flexion test assess and what is a (+)
assess for presence of elevated first rib
(+) SB mvmt limited or blocked
- suggests elevated 1st rib on opposite side to rotation
what is dysfunctional breathing (DB), what population is this common in and what is this often related to
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
what is a normal breathing pattern
outwards motion during inhalation
what is paradoxical breathing pattern
contraction, inwards motion during inhalation
- outward movement during exhalation
what are common reasons/results of upper chest dominant breathing pattern
use a lot of upper chest
-> use scalenes
–» tight and elevated 1st rib
what are 4 abnormal breathing patterns
paradoxical
upper chest dominant
diaphragm dominant
mouth breather
what are good screening tools for breathing dysfunction
breath hold time
breathing questionnaires
- nijmegen Qs
- self eval of breathing sx Q
what is the breath hold time test, what is the norm, and what does it screen for
how long subject can hold breath starting at end of normal exhale, until first involuntary ms activity
<25sec screens for DB
what is the hi low breathing assessment, what is normal, what can this screen for, and what is a consideration
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
what is a MARM (manual assessment of resp motion) breathing assessment, what does it assess and what is normal
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
what is a primary thoracic spine dx
hypomobility
facet joint
discogenic
rib
myofascial
postural
similar paths to cervical
what is a regional interdependence thoracic spine dx
thoracic hypomobility w:
- shoulder
- neck
- lumbar
- lateral epicondylalgia
what is a more vs less common tspine dx
more common for regional interdependence
- ex: when treat tspine, helps w neck and shoulder pain
less common for a primary tspine dx
what does regional interdependence mean
concept that seemingly unrelated impairments in a remote anatomical region (ie tspine) may contribute to or be associated w pts primary complaint
what does evidence say about tspine manip with what the results/outcomes are in pts
results in neurophysiological changes which may lead to improved pain in outcomes in individuals w MSK disorders
what does evidence say about a thoracic manip in a pt w neck pain, what concept is this based on
adding thoracic manip to EBP strengthening program improves pt outcomes w neck pain
- not able to validate
based on concept of regional interdependence
what are 3 main examples of regional interdependence w the spine
neck pain and thoracic hypo
cervical spine and lateral epicondylagia
wrist, elbow, and hand conditions
what 3 wrist, elbow, and hand conditions can be treated using the concept of regional interdependence
- cervico-brachial pain
- double crush syndrome
- nerve sensitive in multiple areas (ie cubital tunnel and compression at guyons) - carpal tunnel syndrome
what is a guideline for treatment using the concept of regional interdependence
examine and treat areas above and below area of CC
what are 3 manual therapy techniques for tspine
STM:
- multifidi, rotatores, paraspinals of involved segment
joint mob/manips
ms energy to involved segment to reduce associated rotatores and multifidi ms guarding
what are 4 strategies to include in exercises
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
what is the purpose of proprioceptive taping
use strong tape that if you don’t want someone flexing a lot, it gives feedback to ext when flexing
what are considerations w the use of a foam roller
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
how can arms be utilized to facilitate thoracic motion
shoulder flex -> t ext
shoulder ext -> t flex
what is a breathing exercise you can do w pts
4-7-8 breathing
- relaxing breath
- breath in for 4sec
- hold for 7sec
- exhale for 8sec
what are cues for someone breathing in hooklying
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
what are cues for breathing in sitting/standing/high kneeling
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”
