L25: Skills Prac (Tsp)

Question 1

What are the 3 main skills for the thoracic (assessment)?

Answer 1

1. Examination of the thoracic movements
2. Passive Physiological Intervertebral Movements (PPIVMS T4-12 - Rot) (Lateral flexion in sitting)
3. Passive accessory intervertebral movements (PAIVMS – thoracic segments T4-12)
   
   1. Central and Unilateral PAs
   2. Transverse glides
   3. CV/CT joint mobilisation
   4. Rib mobilisation
   5. S/C joint mobilisation

Question 2

What is the surface anatomy of the thoracic spine?

Answer 2

Question 3

What is the surface anatomy of the anterior thorax?

Answer 3

Question 4

What population have more kyphotic thoracic spine?

Answer 4

More kyphotic thoracic spine: young men (Schuman’s disease)

Question 5

What are 3 characteristics of the assessment of thoracic active movements? What is the recording like? What is the nominate like?

Answer 5

1. Pain and other symptoms:
   
   1. reproduction of patient’s presenting symptoms
   2. where in range it occurs
   3. intensity of symptoms
2. Analyse pattern of spinal and rib movement
3. Overpressure
   
   1. apply only when there is apparent full ROM and no pain to ‘clear’ the direction of movement
   2. When going into flexion –> think about a neurodynamic component (knee extension)

• Recording: Direction, Range, Pain response, comment on pattern or √√ if full range and painfree
  
  • 2nd tick: overpressure
• Nominate: which direction (s) will be outcome measures

Question 6

What are 7 characteristics of thoracic flexion and extension?

Answer 6

1. movement is limited by rib approximation
2. Flexion – instruction: curl shoulders towards groin
3. Extension - instruction: arch in mid back
4. observe the smooth ‘curl’ of the thoracic region in flexion (“bring shoulders to hips” (not hip flexion))
5. observe the separation of spinous processes in flexion and their approximation in extension
6. can be hypomobility in a block of segments or at one or two segments
7. palpate:
   
   1. anterior rotation of the ribs in flexion
   2. posterior rotation in extension

Question 7

What are 8 characteristics of thoracic lateral flexion and rotation?

Answer 7

1. LF is limited by rib approximation
2. Instruction: curl shoulders sideways towards hips
3. observe the ‘curl’ of the thoracic region into LF
4. can be hypomobility in a block of segments or at one or two segments
   
   1. Abnormal: block movement or overactivity of contralateral muscles
   2. More vertical orientation
5. Rotation is the principal movement of the thoracic region
6. Instruction: look behind you and turn your trunk
7. observe the shape of the spine in rotation
8. observe for regions which interrupt the shape of the curve

Question 8

What are 2 specific movements in the examination of cervico-thoracic region?

Answer 8

Examined with movements of the cervical region

Specific movements

1. Retraction action with neutral cranio-cervical region for C/Th extension
2. Cervical rotation – the physiotherapist simultaneously performs transverse pressures on the upper thoracic spinous processes to palpate/produce the segmental movement

Cervico-thoracic junction stiffness

Question 9

What are 6 clinical pointers of Passive Physiological Intervertebral Movements (PPIVMS T4-12 - Rotation)?

Answer 9

1. Testing position is side lying
2. Palpating finger is placed on the underside of the spinous process and palpates interspinous space
3. Stability is provided with this finger/hand/ forearm distal to the segment under examination
4. Movement is produced by forearm placed on the sternum. A towel can be place over the patient for this purpose
5. Palpating finger feels for the downward movement of the spinous process of the vertebra above on the spinous process below (which is stabilised by the therapist’s finger)
6. Assessing for loss of rotation movement at a segmental level

Question 10

What are 5 clinical pointers of passive accessory intervertebral motion?

Answer 10

Start in the middle (T7) –> work up or down; Use thumbs for assessment

1. For central PAs, the pisaform grip (as in the lumbar spine) is usually used as it is more comfortable that than use of the thumbs, though use of the thumbs is a legitimate technique
2. Movement is produced by a body action (use elbow for force), there should be no loss of contact between the hand and the spinous process
3. The zygapophyseal joints are located just lateral to the spinous process
4. Concentrate on ‘springing’ the segment via body movement and assessing the motion, resistance to the induced movement and pain response
5. Poor handling provides false positive results

Question 11

What is the treatment of passive accessory intervertebral motion like?

Answer 11

Can angle force more caudal or cephalad

• Depends on kyphosis and angle

Question 12

What does T4-T12 central assessment in PAIVMS look like?

Answer 12

Question 13

What are 2 clinical pointers of costo-transverse/costo-vertebral joints?

Answer 13

1. Unilateral PAs for the CT/CV joints are performed on rib, as close as possible to the TV process
2. The unilaterals can be directed in a:
   
   1. cephalad direction (anterior rotation)
   2. caudad direction (posterior rotation)

Question 14

What are 3 clinical pointers of ribs?

Answer 14

1. Examine ribs with the flat of thumbs (ribs can fracture especially in older persons if forces are too strong)
2. The PAs can be directed in a cephalad direction (anterior rotation) or a caudad direction (posterior rotation)
3. For the upper ribs, position the patient with their hand behind their back which will lift the scapula off the chest wall to permit access to the ribs

Care with osteoporotic patient

Question 15

What are 3 clinical pointers of examination of the sternocostal joints?

Answer 15

1. S/C joints in women
   
   1. explain technique and ask permission for hand placement
   2. male physios on female patients especially,
   3. perform technique through a towel or through the patient’s own hand
      
      • Modesty and sensitive technique