case 7 - 8

Question 1

case 7 - mid thoracic IVJ disorder

Answer 1

• 35 y/o male lab technician
• pa. btwn shldr blades over past few weeks w/ using microscope
• sustained flx + repetitive twisting of thorax
• anxious
• cyclist > pa. w/ cycling

Question 2

case 7 - mid thoracic IVJ disorder

Ax

Answer 2

Standing: Observation, scapular assessment/correction* - likely rounded & downwardly rotated
o Functional positions with microscope and bike
o Sitting: ROM, postural assessment/correction
o Prone: PAIVMS, scap holds - pain between shoulder blades - endurance problem likely - might be muscle fatigue of lower trap/serratus
o Sidelye: PIIVMS (if time)
o Supine:

Question 3

case 7 - mid thoracic IVJ disorder

Tx - A&E

Answer 3

reassure = common form of ‘mechanical pa.” > non-optimal posis for prolonged periods of time puts strain on structures & muscle fatigue > source of pa. or cause pa.
- has good prognosis if follow treatment
PT = posture correction & ergo ax of workplace for modifications
mods = change side writing notes to prevent twisting in one range.
Shldr blade/posture awareness. Regular work and cycling breaks.
Pa. relief

Question 4

case 7 - mid thoracic IVJ disorder

Tx - other

Answer 4

o Postural correction exercises/revision of ergonomic set up - change post., sides writing (twisting - not one side dominant) . Recorrect posture every 15 min for 15s - cues. Timer or sticky note
o Scapular correction exercises - start side lye
Thoracic exercises
o MT: Central PA for bilat effect 30s - grade 3 for range and pain, unless v irritable but doesn’t appear so.
Ext MWM (x6), Thoracic manip, transverse glide?, less likely to do piivm bc not unilat pain. Teach Tx SNAG - apparently is a thing

Question 5

case 7 - mid thoracic IVJ disorder

HEP

Answer 5

HEP: postural correction exercises (dose above), scap exercises (dose above), SNAGs if possible? (6)

Question 6

Case 8 - mid-thoracic costo-transverse joint disorder

Answer 6

• 35 y/o F w/ r) thorax pa.
• acute - 1 week ago w/ flu and coughing
• pa. w/ deep breathing, lifting arm high above head, picking up daughter w/ r) arm

Question 7

Case 8 - mid-thoracic costo-transverse joint disorder

AX

Answer 7

Assessment:
o Standing: Observation, scapular assessment/correction, functional movements
o Sitting: ROM, postural assessment/correction
o Prone: PAIVMS (esp unilat costotransverse) ribs gently
Sidelye: PIIVMS
Supine: costosternal and costochondral glides?

Question 8

Case 8 - mid-thoracic costo-transverse joint disorder

Tx - A& E

Answer 8

reassure - result of the flu and prolonged coughing > strain on joints that connect the ribs & ribs to spine
- repetitive coughing > stiffness, dec. ROM and pa. - particularly on deep breaths
prognosis - should resolve quickly - w/in next few weeks
- stay mobile w/in limits of pa. and modify picking up baby to l) side

Question 9

Case 9 - mid-thoracic costo-transverse joint disorder

Tx - other

Answer 9

o   Postural exercises?
Breathing exercises
Heat?
o   Scap exercises?
o   PAIVMS unilat* in caudad 
transverse?
o   Manip??