Lecture 30 - (Thoracic Spine II)

Question 1

Examination

Answer 1

1) observation
2) ROM testing
3) Neurologic testing (resting testing- hyperreflexia & hyporeflexia; strength testing of arms/legs; sensation testing
4) Palpation of bony stuff
5) palpation of muscles

Question 2

Consider imaging if:

Answer 2

• There is a history of trauma
• The patient is extremely sensitive to palpation during the structural exam
• There is significant pain with range of motion
• There is an abnormal neurologic evaluation

Question 3

X-rays for

Answer 3

• trauma/injury or suspected bone disease
• Chronic pain (>3 months and not improving with appropriate treatments)
• History of Cancer
• Deformities (scoliosis, kyphosis, etc.)
• Which need further evaluation in their standard of care or
• Associated with symptoms that do not resolve with appropriate treatments

Question 4

MRI for

Answer 4

evaluation of discs, spinal cord, or tumors (with and without contrast)

Question 5

CT scan for

Answer 5

more in-depth bone imaging, or if MRI cannot be used because of magnetic metal in body.

Question 6

Bone scan for:

Answer 6

difficult to see fractures or tumors

Question 7

Short Restrictors injury type?

Answer 7

Type II

Question 8

Long Restrictor injury type?

Answer 8

Type I

Question 9

Rotatores, Intertransversarii and Multifidi are responsible for?

Answer 9

• Often responsible for maintaining non-neutral somatic dysfunction of the vertebral units
• Osteopathic Theory states that these muscles are often involved in viscero-somatic and somato-somatic reflexes through type II SDs
• So these muscles can be reflexively affected by organ dysfunction

Question 10

Some Sources of Thoracic Spine Dysfunction

Answer 10

• Intrinsic Mechanical Asymmetries (scoliosis, kyphosis, etc.)
• Trauma (ex: whiplash, lifting injuries, falls)
• Visceral Disease
• Neurologic: Myelopathy (spinal cord dysfunction); Shingles; Radiculopathy (not common in T-spine)

Question 11

Bilateral flexion

Answer 11

• Segment moves freely in flexion, will not extend
• No rotational or sidebending component
• Spinous process will be close to the segment above it, when the patient is in extension.
• The inferior articular facets are open

Question 12

Bilateral extension

Answer 12

• Segment moves freely in extension, will not flex
• No rotational or sidebending component
• Spinous process will be close to the segment below it, when the patient is in flexion.
• The inferior articular facets are closed.