Ortho III Final- T/S Flashcards
In the T/S the spinous processes _ _, and in general _ in size from superior to inferior. The vertical facet joints are in the _ _, and there are facet joints on _ and _ for _ _.
Spinous processes SLOPE DOWNWARD, and in general INCREASE in size from superior to inferior.
The vertical facet joints are in the CORONAL PLANE and there are facet joints on BODY AND TP’S FOR RIB ARTICULATION
According to research article ‘new model for palpation of TP’S’: TP’s in the thoracic spine are anatomically located at the level of the _ _ _ of the _ of the vertebrae _ _ _. Except for? How do you confirm which level you are on?
TP’s in the t/s are anatomically located at the level of the MOST PROMINENT POINT of the SP of the vertebrae ONE LEVEL ABOVE.
- except for T11 AND T12 which were highly variable
To confirm: use a unilateral PA on the TP below (or even with the SP) and confirm if movement of SP occurs
Humans have _ _ of true ribs each with it’s own connection to the _. The _, _ and _ ribs join with the costal cartilages of the ribs above and are known as _ _. The _ and _ ribs, or _ _, do not have any connection anteriorly.
Humans have 7 ROWS of true ribs each with its own connection to the the STERNUM
The 8th, 9th, and 10th ribs join with the costal cartilages of the ribs above and are known as FALSE RIBS
The 11th and 12th ribs, or FLOATING RIBS do not have any connection ANTERIORLY
The _ of the rib is the end closest to the vertebral column.
The HEAD of the ribs the end closest t other vertebral column
Typical ribs (ribs 3-9) have _ _ for attachment to the corresponding _ on the vertebral bodies. _ _ _ attaches to other superior vertebral body, and the _ _ _ attaches to the inferior vertebral body.
Typical ribs (ribs 3-9) have TWO FACETS for attachments to the corresponding DEMIFACETS on the vertebral bodies.
SUPERIOR RIB FACET attaches to the superior vertebral body, and the INFERIOR RIB FACET attaches to the inferior vertebral body.
Ribs 3-9: have _ _ on head, and an _ _ for the costotranverse joint.
Have 2 FACETS on head and an ARTICULAR TUBERCLE for the costotranverse joint
The first rib has a shaft that is _ and nearly _ and has the _ _ of the 7 true ribs. It’s head has a _ _ to articulate with the T1. It also has _ _ for the subclavian vessels which are separated by the _ _.
Has a shaft that is WIDE and nearly HORIZONTAL and has the SHARPEST CURVE of the 7 true ribs.
It’s head has a SINGLE FACET to articulate with T1
It also has TWO GROOVES for the subclavian vessels which are separated by the SCALENE TUBERCLE
The second rib is _, _ _, and _ than the first rib. It has _ _ to articulate with _ and _ and a _ for muscles to attach to. It is atypical due to its attachment anteriorly to both the _ and _.
The second rib is THINNER, LESS CURVED, AND LONGER than the first rib. It has TWO FACETS to articulate with T1 and T2 and a TUBERCLE for muscles to attach too.
It is atypical due to it’s attachment anteriorly to both the STERNUM AND MANUBRIUM
Which ribs only have 1 facet on their head? (4)
Rib 1, 10, 11, 12
The 11th and 12th ribs are _, with no _ or _ and terminate in the _ _ before fusing with the _ _.
The 11th and 12th ribs are SHORT, with no NECKS OR TUBERCLES and terminate in the ABDOMINAL WALL before fusing wit the COSTAL CARTILAGES
Which ribs have double costovertebral facets? Which have demifacets on the vertebral bodies?
Which ribs have double costovertebral facets- Ribs 2-9
Which have demifacets- Ribs 1-9
Ribs 1-10 attach to the corresponding _ _, unlike ribs 11 and 12 which do not have an attachment.
Ribs 1-10 attach to the corresponding TRANSVERSE PROCESSES
Ribs 1-5/6 are _ and TP is _ allowing for rotation or flexion in the Sagittal plane during _.
Ribs 1-5/6 are CONCAVE and the TP’s are CONVEX allowing for rotation or flexion in the Sagittal plane during INSPIRATION
Lower ribs (7-12) the costotranverse joint is _ allowing for _ or _ in the frontal plane
Joint is PLANAR allowing for WIDENING OR ABDUCTION in the frontal plane.
What is the angle of the zygoapophyseal joints in the thoracic and lumbar spine?
Thoracic- 60 degrees
Lumbar- 90 degrees
The facet joints of the t/s (zygoapophyseal) allow for considerable _ and _. Injuries occur with excessive amounts of _ and _.
Allow for considerable FLEXION AND EXTENSION
Injuries occur with excessive amounts of ROTATION AND EXTENSION
Facet joint irritation can cause _ _ _
Facet joint irritation can cause SHARP LOCALIZED PAIN
The T/S _ are less likely to be injured, making up less than 1% of _ _. Why?
T/S DISCS are less likely to be injured, making up less than 1% of DISC HERNIATIONS.
Why: because the rib articulations increase the stability
Thoracic spinal nerves exit openings _ _ _ _, and innervate _ of _ as well as _ _. Irritation of the spinal nerves can lead to _ pain, and _ _ _ along the _ of the ribs.
Thoracic spinal nerves exit openings BETWEEN ADJACENT THORACIC VERTEBRAE, and innervate MUSCLES of THE BACK, as well as VISCERA ORGANS.
Irritation of the spinal nerves can lead to INTERCOSTAL pain, and SHARP SHOOTING PAINS along the PATH of the ribs
The T/S spinal nerves have an increased susceptibility to _, usually attacks _ _ spinal nerve root.
Have an increased susceptibility to SHINGLES, usually attacks ONLY ONE spinal nerve root
There are _ _ _ responsible for the majority of trunk movements and they are a common source of _ and _. Symptoms are usually characterized by a _ _ _.
There are MANY SMALL MUSCLES responsible for the majority of trunk movements and they are a common source of PAIN AND INJURY
Symptoms are usually characterized by a DULL GENERALIZED ACHE
Thoracic musculature: muscles in spasm produce excess _ _ that excess causes a _ _. _ _ _ carries it away from the muscle. How is this induced?
Muscles in spasm produce an excess of LACTIC ACID, that excess causes a BURNING SENSATION.
FRESH FLOWING BLOOD carries the lactic acid away from the muscle.
Can be induced by heat, manual pressure, other modalities that cause the muscle to relax which allows the blood vessels to open up
What are some special questions that would be important to ask? (4 examples)
Do you have bilateral tingling in the feet or disturbance of gait?
Medical history regarding cancer/ diseases or any recent weight loss?
Recent X-rays taken? If so when and why?
Taking any medications? (Osteoporosis or steroids can make manipulation contraindicated)
An MI can cause _ _ pain or _, _ and pain radiating to the _ and _.
An MI can cause ANTERIOR CHEST PAIN or HEAVINESS and pain radiating to the BACK AND ARM
What possible visceral pathology/ emergency can cause: pain in the jaw, neck, chest, and upper back; pain that is severe, unrelenting and comes on suddenly; pain that is not relieved by change in position; can also be accompanied by coughing, hoarseness or difficulty breathing? Associated %?
Dissecting thoracic aneurysm
50% of pts’ die
What can cause a boring pain from epigastric to middle T/S, can cause T/S pain triggered by eating? Can be caused by prolonged _ _.
Peptic Ulcer
Can be caused by prolonged NSAID USE
What visceral pathology can cause right upper quadrant pain and tenderness with inspiration; right infra scapular pain; moderate fever, nausea and vomitting; symptoms occuring 1-2 hours after a heavy meal
GALL BLADDER
What can cause abdominal pain that radiates to the thoracolumbar junction; abdominal pain and tenderness that worsens with eating but eases by leaning forward or curling in a ball; nausea and vomitting
Pancreatitis
_ or _ _ can cause pain in the costovertebral angle or flank area; pain accompanied by fever, nausea, vomitting; flank pain accompanied by lower abdominal pain that spreads to the labia/ testes (aka _ _). Patients will often have a history of _ _.
KIDNEY OR RENAL PATHOLOGY . . . .
Flank pain accompanied by lower abdominal pain that spreads to the labia/ testes (aka RENAL COLIC)
Patients will often have a history of ONGOING UTI’S
Red flags to consider? (4)
FINI
- fractures (traumatic or osteoporotic)
- inflammation (ankylosing spondylitis)
- Neoplasm (uncommon- check for previous HX of cancer)
- infection (uncommon- fever is the hallmark sign)
What is a deformity that causes protrusion ofthe chest wall at the sternum? also known as? (3)
Pectus Carinatum
AKA:
Keel chest, pigeon chest, bird chest
Pectus Carinatum occurs 75% of the time in , may affect _ () and cause _ affects.
Occurs 75% ofthe time in BOYS, may affect RESPIRATION (EXHALATION) and cause PSYCHOSOCIAL affects
What is cavitation (hollowing) of the sternal costal joint called? AKA? (4)
Pectus Excavatum
AKA:
Hollow, cobblers, sunken, funnel chest
Pectus Excavatum can have _ (_) and _ implications and _ effects.
Can have RESPIRATORY (INSPIRATION) and CARDIAC implications and PSYCHOSOCIAL EFFECTS
2 treatment suggestions for patients with a barrel chest deformity: _ _ breathing, and avoiding _ _.
TRIPOD POSITION breathing
And avoiding BRONCHIAL IRRITANTS
Flexed position fault in the t/s will cause: SP and TP’s to be _ at the level of the flexed segment; a _ space between the SP of the flexed segment and the segment below; a _ space between the SP of the flexed segment and the segment above
Flexed positional fault:
- SP and TP’s to all be ELEVATED at the level of the flexed segment
- an INCREASED space . . . BELOW
- a DECREASED space . . . ABOVE
Extended positional fault will cause: SP and TP to be _ at the level of the extended segment; will cause a _ space between the extended segment and the segment above; will cause a _ space between the extended segment and the segment below
Extended positional fault:
-SP and TP to be DEPRESSED
- INCREASED space . . . ABOVE
- DECREASED space . . . BELOW
Rotated left positional fault (vertebral body turned left) will cause: SP to move _ of midline; _ TP is elevated towards and deeper than the TP of the segment _; _ TP is depressed away and more superficial than the TP of the segment _.
Rotated left positional fault:
-SP to move RIGHT of midline
- RIGHT TP is elevated towards and deeper . . . Segment ABOVE
- LEFT TP is depressed and more superficial . . . Segment BELOW
Dermatomes in the thoracic spine follow? Myotomes?
Follow the level of the ribs
Myotomes don’t have corresponding muscles to test
UNLT is performed for? LLNT is performed for?
UNLT- upper T/s
LLNT- lower t/s
PAIVM: Central PA’s apply force to _ _. Unilateral PA’s? Rib PA? (3) Transverse pressure?
Central PA’s- BILATERAL LAMINATE
Unilateral PA’s- TRANSVERSE PROCESSES
Rib PA’s- COSTOVERTEBRAL JOINT, COSTOTRANSVERSE JOINT, RIB ANGLE
Transverse PA’s- SPINOUS PROCESS
Which muscle is being described: originates on the upper borders of ribs 6-12 and inserts on the lower borders of ribs 1-6; actions include bilateral extension, erect posture, unilateral lateral flexion and Ipsilateral rotation? What are the two associated pain referral patterns?
Iliocostalis Thoracis
Pain referral pattern: T6 and T11 (can be felt anteriorly and posteriorly around the given spinal level)
Which muscle is being described: originates on the common tendon origin in sacrum, illiac crest and lumbar vertebrae; inserts at the T1-T12 TP’s; Actions are the same as iliocostalis. 3 common pain referral patterns
Longissimus Throacic
Pain referral patterns: L1, T10, T11 (all pain is posterior lower Throacic into buttock)
Which muscle is being described: originates in the commons tendon origin of the sacrum illiac crest and lumbar vertebrae; inserts in the T3-T8 spinous processes and has the same action as both iliocostalis, and longissimus.
Spinalis Thoracis
What disease is being described: local anterior chest wall pain at the bony cartilaginous junction, may radiate down arm, usually affects ribs 2-5, has occasional swelling, idiopathic onset, can occur at any age? AKA? It is _ a _ disease, but _ _ _ diseases. What can put you at an increased risk? (3)
COSTOCHONDRITIS
It is NOT A SERIOUS disease, but MIMICS OTHER SERIOUS diseases.
AKA: Teitze’s disease
At an increased risk if you have ANKYLOSING SPONDYLITIS, RA, REITERS SYNDROME
Scoliosis is a lateral curvature of the spine greater than _ _ accompanied by _ _. _ scoliosis is a multi-gene dominant condition with variable phenotypic expression and no clear cause. Multiple causes exist for _ _.
Scoliosis is a lateral curvature of the spine greater than 10 DEGREES
IDIOPATHIC scoliosis is a multi-gene . . . .
Multiple causes exist for SECONDARY SCOLIOSIS
Homocystinuria, Marfan syndrome and Ehler’s Danlos Syndrome are all examples of _ _ for _ due to _ _ _ disorders.
Are all examples of SECONDARY CAUSES FOR SCOLIOSIS due to INHERITED CONNECTIVE TISSUE DISORDERS
Ehler’s Danlos syndrome is characterized by _ skin and _ joints and is treated with _. What other inherited tissue disorder has _ joints?
Is characterized by STRETCHY skin and HYPERMOBILE joints and it tested with STABILIZATION
MARFAN SYNDROME also has HYPERFLEXIBLE joints (Michael phelps)
Tethered cord syndrome, syringomyelia, spinal tumor, neurofibromatosis, muscular dis trophy, CP, polio, friedeich’s ataxia, familial dysatonomia, and Werdnig-Hoffman’s disease are all examples of _ _ that can be?
All expanses of NEUROLOGICAL DISORDERS that can be SECONDARY CAUSES FOR SCOLIOSIS
Leg length discrepancy, developmental hip dysplasia, osteogenesis imperfecta, and Klippel Feil syndrome are all examples of?
All examples of MUSCULOSKELETAL DISORDERS that can cause SECONDARY SCOLIOSIS
Idiopathic scoliosis occurs in about -% of kids ages 10-16 years old. Ratio of girls to boys with small curves (less than 10 degrees) is? Larger curves (greater than 30 degrees)? Scoliosis tends to progress more often in _.
Occurs in about 2-4% of kids aged 10-16
Ratio of girls: boys
- small curve the ratio is approx. equal
- larger curves 10:1
Scoliosis tends to progress more often in GIRLS
Of adolescents with scoliosis on 10% have a curve progression that requires medical intervention- the 3 determinants are: patient _, future _ _, and _ _ at the time of diagnosis.
3 Determinants:
-patient GENDER, future GROWTH POTENTIAL and CURVE MAGNITUDE at the time of diagnosis
What is the old and new method of grading scoliosis and how do each of them work?
New- Risser Grade (measures progression of bony fusion of the ilia apophysis
Old- Tanner stages (looks at breast growth to determine stage of puberty)
Range and meaning for Risser grades of scoliosis
Range: 0-5 (no ossification to complete bony fusion at the Apophysis)
The lower the grade the higher the potential for progression
Back pain _ _ _ _ in patients with scoliosis.
Back pain IS NOT SIGNIFICANTLY HIGHER in patients with scoliosis
Curves in untreated adolescents with curves at the time of maturity _ than _ _ are _ to progress.
With curves at the time of maturity LESS THAN 30 DEGREES are UNLIKELY to progress
Curves _ than _ _ at maturity progress _ _ _ _ . Up to _% of females with curves _ than _ _ have significant _ _.
Curves GREATER THAN 50 DEGREES at maturity progress 1 DEGREE PER YEAR
Up to 19% of females with curves GREATER THAN 40 DEGREES have significant PSYCHOLOGICAL ISSUES
Life threatening effects on pulmonary function do not occur until?
Do not occur until curve is GREATER THAN 100 DEGREES
According to the American academy of Orthopedic surgeons girls should be screened at _ and _; boys should be screened at _ or _ for scoliosis.
Girls should be screened at 11 AND 13; boys should be screened at 13 OR 14
According to the American Academy of Pediatrics children should be screened at _, _, _, and _ years of age.
Children should be screened at 10, 12, 14, and 16 years of age
What test is being described: The patient (without shirt, sports bra) is asked to lean forward with his or her feet together and bend 90 degrees at the waist. Examiner observes for any Assymetry in the trunk or abnormal spinal curves
Adams forward bend test
Screening hints when checking for scoliosis: shoulders are _ _, or one is more _ than the other; head is _ _ _ above the pelvis; appearance of a _ or _ _; _ _ are at different heights
Shoulders are DIFFERENT HEIGHTS, or one is more PROMINENT than the other
Head is NOT CENTERED above the pelvis
Appearance of a RAISED OR PROMINENT HIP
RIB CAGES are at different heights (rib hump)
Screening hints for scoliosis: uneven ; changes in _ or _ of _ overlying the spine (, _ patches, _ changes); leaning of _ _ to _ _.
Uneven WAIST
Changes in LOOK or TEXTURE of SKIN overlying the spine (DIMPLES, HAIRY patches, COLOR changes)
Leaning of ENTIRE BODY to ONE SIDE
What are the 2 ways to measure scoliosis and how are they performed?
Scoliometer (inclinometer)
-pt bends over until curve is observed, scoliometer is placed on the back and measures the highest point of the curve of the upper back, pt continues to bend until the curve can be seen in the lower back, measures that apex
Cobb Method
-using an X-Ray image the most tilted vertebrae above and below the apex of the curve is chosen and the an angle between intersecting lines is drawn perpendicular to the superior and inferior vertebrae
Red flags on Physical Exam for scoliosis: _ _ thoracic curve (may affect _ _), _, significant _, and abnormal _ _.
LEFT SIDED thoracic curve (may affect CARDIAC FUNCTION)
PAIN
Significant STIFFNESS
Abnormal NEUROLOGIC FINDINGS
When should you refer out: curve in degrees? Associated Risser grades? (3)
20-29 DEGREES, Risser grade 0-1 and 2-4
29-40 DEGREES, Risser grade 0-1 and 2-4
Greater than 40 DEGREES, Risser grade 0-4
When is surgery often required as a treatment for scoliosis?
If curve is GREATER THAN 40 DEGREES
Most common type of brace for scoliosis? AKA? Braces have a _% _ _ at _ curve progression. Does _ _ scoliosis, but may _ _ _. Usually worn until the patient reaches a Risser grade of _ or _.
Most common type of brace: BOSTON BRACE
AKA: THORACO-LUMBAR-SACRAL orthosis
Braces have a 74% SUCCESS RATE at HALTING curve progression
Does NOT CORRECT scoliosis, but may PREVENT SERIOUS PROGRESSION
Usually worn until the patient reaches a Risser grade of 4 OR 5
Bracing for scoliosis: length of wearing time _ with _. At least _ _ per _ leads to best chance of preventing curve progression.
Length of wearing time CORRELATES WITH OUTCOMES
At least 16 HOURS PER DAY leads to the best chance of preventing curve progression
If surgery is required (for curves greater than 40 degrees): skeletally mature patients can be observed until the curve reaches _ _. _ _ _ is the best choice for thoracic curves. _ _ _ is the best treatment for thoracolumbar and lumbar curves
Skeletally mature patients can be observed until the curve reaches 50 DEGREES
POSTERIOR SPINAL FUSION is the best choice for thoracic curves
ANTERIOR SPINAL FUSION is the best treatment for thoracolumbar and lumbar curves
Post op treatment: post fusion _ _ does occur (more common in _ fusions). Usually out of hospital in - days and back in school in _ _. Ok to participate in athletics after - _ (should avoid _ _)
Post fusion BACK PAIN does occur (more common in DISTAL fusions)
Usually out of hospital in 4-5 days and back in school in 2 WEEKS
OK to participate in athletics after 9-12 MONTHS (should avoid CONTACT SPORTS)
A review of the rate of complications from scoliosis surgery states that it has a _ _ _ rate of complications. Recommends _ _ for all spinal implants _ _ _.
Review of the rate of complications from scoliosis surgery states that it has a VARYING BUT HIGH rate of complications
Recommended MANDATORY REPORTING for all spinal implants SHOULD BE ESTABLISHED
In a study looking at specific exercises performed in the period of brace weaning can help _ the _ _ in the brace weaning period for Adolescent Idiopathic Scoliosis (AIS)
Specific exercises performed in the period of brace weaning can help REDUCE THE CORRECTION LOSS in the brace weaning period for AIS
A study on ‘conservative treatment for AIS: can it reduce the incidence of surgical treatment?’ Used bracing (Milwaukee and under arm brace) and which to types of exercises? Describe each.
Side Shift Exercise
- exercises performed to side shift/ side glide torso TOWARD CONCAVITY
The Hitch Exercise
-exercises using the QL to hitch the him on the side of LUMBAR CONVEXITY
Results from stay on conservative treatment for AIS: part time bracing (full time better) plus _ is _ in _ _ intervention. Patients who need surgical intervention presented with Cobb angles of _ _ _ _.
Part time bracing (full time better) plus PT IS EFFECTIVE IN PREVENTING SURGICAL intervention
Patients who need surgical intervention presented with Cobb angles of AT LEAST 45 DEGREES
Conclusions from study on ‘The significance of posture re-education in scoliosis’ found: _% of kids with scoliosis _ _ require surgical intervention. _ are much more likely than _ to require intervention. _ _ _ is recommended for curves greater than 45-50 degrees.
- 90% of kids with scoliosis WILL NOT require surgical intervention
- GIRLS are much more likely than BOYS to require intervention
- SPINAL FUSION SURGERY is recommended for curves greater than 45-50 degrees
Conclusions from study titled ‘The significance of posture re-education in scoliosis’: _ can _ _ of many curves and significantly _ _ for surgery. _ can help avoid _ of _ _ by bracing.
BRACING can SLOW PROGRESSION of many curves and significantly REDUCE NEED for surgery
EXERCISE can help avoid LOSS OF CORRECTION GAINED by bracing.
_ _ is a chronic inflammatory joint disease of axial joints, especially the SI joints. AKA? Usually occurs in _ and begins in _.
ANKYLOSING SPONDYLITIS is a chronic inflammatory . . .
AKA: MARIE-STUMPELL disease
Usually occurs in MALES and begins in ADOLESCENCE
Ankylosing spondylitis has a strong tendency to _ _ and association with the - (_% positive). Reported prevalence is _%
Has a strong tendency to FAMILIAL AGGREGATION and association with HLA- B27 (90% positive)
Reported prevalence is .2%
Ankylosing spondylitis is characterized by _ and _ of the back, with variable involvement of the _ and _. Gradual loss of _ _. Symptoms are typically worse in the _ and in the _ of the _.
Characterized by PAIN AND STIFFNESS of the back, with variable involvement of the HIPS AND SHOULDERS
Gradual loss of SPINAL MOBILITY
Symptoms are typically worse in the MORNING and in the MIDDLE OF THE NIGHT
Pathology- Synovitis: affects _ and _ _ joints; causes destruction of _ _ and _ _; leads to _ _; _ involvement can lead to diminished _ _.
Affects SI and VERTEBRAL FACET joints; causes destruction of ARTICULAR CARTILAGE and PERIARTICULAR BONE
Leads to BONY ANKYLOSIS
COSTOVERTEBRAL involvement can lead to diminished RESPIRATORY EXCURSION
AS- pathology: inflammation of the - _ of _ joints and tendons ( affects _ _, _ ligaments, _ _, _ _ and bony insertion of _ _.
Inflammation of FIBRO-OSSEOUS JUNCTION OF SYNDESMOTIC joints and tendons (affects IV DISCS, SI ligaments, SYMPHYSIS PUBIS, MANUBRIUM STERNI and bony insertion of LARGE TENDONS.
Clinical features of Ankylosing Spondylitis: disease starts _; teenager/ young adults complains of _ and _; symptoms are worse in the __ and after _. In later stages there will be diminished _ _, increased _ _, may be FFD of _ and _ and marked loss of _ _.
Disease starts INSIDIOUSLY; teenager/ young adult complains of BACKACHE AND STIFFNESS; symptoms are worse in the MORNING and after INACTIVITY
In later stages there will be diminished SPINAL MOVEMENT, increased THORACIC KYPHOSIS, may be FFD of HIPS AND KNEES, marked loss of CERVICAL EXTENSION
X-RAY findings for patients with AS: _ _ (_ at several levels), _ and _ of the SI joints and later _ _.
BAMBOO SPINE (BRIDGING at several levels), EROSION AND FUZZINESS of the SI joints and later BONY ANKYLOSIS
PT treatment for AS: encourage patients to _ _ (_ but don’t _ _),and _ and _ exercises. _ and _ are contra-indicated.
Encourage patients to REMAIN ACTIVE (EXERCISE but don’t IRRITATE JOINTS) and BACK and POSTURE exercises
REST AND IMMOBILIZATION are contra-indicated.
What are 4 complications seen with Ankylosing spondylitis?
SLuSH
- spinal cord compression
- lumbosacral nerve root compression
- spinal fractures
- hyperkyphosis
What are 5 exams and tests for Ankylosing spondylitis?
G SoCCoR
- Gaenslen’s test (SI joint test)
- Schober’s test
- chin-brow measurement
- chest expansion
- ROM (lumbar flexion, extension, lateral flexion, rotation)
What test is being described: Mark spine 5 cm below and 10 cm above the iliac crest, have pt bend forward as far as possible, measure increase in distance between two points. Should be at least?
Schober’s test
Should be at least 20 cm (gain of 5 cm)
With the chin-brow measurement the _ the _ the _ the condition.
The GREATER THE ANGLE THE WORSE the condition
_ _ _/ _ _ is a clinical pattern that involves UE paresthesia and pain with or without symptoms into the neck and/ or head. Can apply to segments -.
UPPER THORACIC SYNDROME/ T4 SYNDROME is a clinical pattern that involves . . . .
Can apply to segments T3-T7
Upper thoracic or T4 syndrome: the _ remains unclear; symptoms are reproduced or eliminated with _ of an _ _ _ (most commonly _); _ segment may indicate involvement of a _ _ structure. The _ __ may provide a pathway for referral but it is not _ _.
The MECHANISM remains unclear; symptoms are reproduced or eliminated with MOBILIZATION of an UPPER THORACIC VERTEBRAE (most commonly T4)
HYPOMOBILE segment may indicate involvement of a SYNOVIAL JOINT STRUCTURE.
The SYMPATHETIC NERVOUS SYSTEM may provide pathway for referral but it is not CLEARLY UNDERSTOOD.
Typical presentation for T4 syndrome: Age _ than _; presenting posture- _ head with - _ _, thoracic spine may be _; Occupational posture- may demand lots of _ _; possible previous diagnosis of: _ _, _ or _/ _ problems; onset- often follows the onset of a _ _ or _ of _ practice.
- Age GREATER than 35
- Presenting posture: FORWARD head with CERVICO-THORACIC JUNCTION KYPHSIS, thoracic spine may be FLAT
- Occupational posture: may demand lots of FOWARD BENDING
- Possible diagnosis of: THORACIC OUTLET, CARDIAC or STOMACH/ GUT problems
- Onset often follows onset of a NEW JOB or CHANGE of WORK practice
Symptoms of T4 syndrome usually present: may be _ or _; - _; hands feel _/ _ and may actually _ _; arm may feel _; hands feel _ and may actually _ _; aches and pains that are - in _ and/ or _; pains may be _ , _ or feel like a tight band.
- May be UNILATERAL OR BILATERAL
- GLOVE-TYPE PARESTHESIA
- hands feel HOT/ COLD and may actually be so
- arms may feel HEAVY
- hands feel SWOLLEN and may actually BE SO
- aches and pains that are NON-DERMATOMAL in ARM and/ or FOREARM
- pains may be CRUSHING, BURSTING or feel like a tight band
Symptoms of T4 syndrome SOMETIMES present: pain and stiffness radiating around _ _ or _ _ of pain _ or _; _ ache or pain and stiffness; _ _ pain; _ (sensation of _ _ on _); _ will often be positive with typical symptoms; _ _ spine symptoms
- pain and stiffness radiating around CHEST WALL or SMALL AREAS of pain ANTERIORLY OR POSTERIORLY
- INTERSCAPULAR ache or pain and stiffness
- SLEEP INTERRUPTING pain
- FORMICATION (sensation of ANTS CRAWLING on SKIN)
- NEURODYNAMICS will often be positive with typical symptoms
- CONCOMITANT CERVICAL spine symptoms
T4 syndrome- possible observation findings: hands may _ (appearing _ or _ and feel _ or ); “ and _” _
Hands may be DISCOLORED (appearing RED OR PURPLE and feel HOT OR COLD)
“POKE AND STOOP” POSTURE
T4 Syndrome findings: symptoms _ _ by _ _ movements; _ segmental motion on _, may _ or _ symptoms; _ of _ _ may _ symptoms, especially _ _.
Symptoms NOT AFFECTED by ACTIVE spine movements
STIFF segmental motion on PALPATION, may ELICIT OR REDUCE symptoms
PALPATION OF RIB ANGLES may ELICIT symptoms, especially DISTAL TINGLING
Treatment for T4 Syndrome: _ of upper _ _, _ or lower _ _,
_ _ _, _ _, _ retraining, thoracic -, office/ work _.
MOBILIZATIONS of upper THORACIC SPINE, RIB ANGLES, or lower CERVICAL SPINE
HOME EXERCISE PROGRAM, CHIN TUCKS, POSTURAL retraining, thoracic SELF-MOBILIZATIONS, office/ work ERGONOMICS
A study titled ‘Thoracic spine manipulation for the managment of patients with neck pain: a randomized clinical trial’ looked at _ subjects, broken into 2 groups (_ and _; _, _ and _), patients had 5 visits over a _ _ _, _ were performed on the 1st, 3rd, and 5th visits.
- Looked at 45 subjects
- Broken into 2 groups (E-STIM and MODALITIES; E-STIM, MODALITIES, and MANIPULATIONS)
- patients had 5 visits over a 3 WEEK PERIOD
- MANIPULATIONS were performed on the 1st, 3rd and 5th visits
Thoracic spine manipulation for the managment of patients with neck pain study: Used what type of manipulation technique? How many times?
Used thoracic thrust treatment (bear hug technique with patient sitting)
Maximum of 2 attempts per visit (1st, 3rd, 5th)
Results of study on thoracic manipulation for patients with neck pain: those who received thoracic manipulation experienced _ _ in _, cervical _, and _. Results _ for _ _ at the 2 week follow up. And for _ at the 4 week follow up.
Those who recieved thoracic manipulation experienced GREATER IMPROVEMENTS in PAIN, cervical ROM, and DISABILITY
Results PERSISTED for ALL 3 at the 2-week follow up
And for PAIN at the the 4 week follow up.
A study on the ‘effects of thoracic mobilization and manipulation on function no mental state in chronic low back pain’ found: application of _ or _ has a _ effect on _, _ _ and _ in patients with low back pain. How many groups? Describe each.
Application of MOBILIZATION or MANIPULATION has a POSITIVE effect on FUNCTION, MENTAL STATE, and ROM in patients with LBP
3 GROUPS
- A: mobilization group
- B: manipulation group
- C: control group
TOS can be caused by compression of the nerve in the _ _, _ _ _ and/or _ _ _.
Can be caused by compression of the nerve in the SCALENE TRIANGLE, PECTORALIS MINOR SPACE, and/ or COSTO-CLAVICULAR SPACE
Scalene triangle: posterior border of _ _, anterior border of the _ _ and superior border of the _ _. The _ _ in the superior portion houses the _ , _ , _ nerve roots.
Posterior border of the ANTERIOR SCALENE
Anterior border of the MIDDLE SCALENE
Superior border of the 1ST RIB
The CERVICAL OUTLET in the superior portion houses the C5, C6, C7 nerve roots.
What are the 3 components of the pec major space?
PaCT
- pec minor
- coracoid process
- thoracic cage
The costo-clavicular space is made up of: the inferior border of the _ and the superior aspect of the _ _. The _ _ or _ and _ or _ of the _ _ pass through.
- inferior border of the CLAVICLE and the superior aspect of the FIRST RIB
- the SUBCLAVIAN ARTERY or VEIN and DIVISIONS or CORDS of the BRACHIAL PLEXUS pass through it.
What are the 5 tests used to look at thoracic outlet syndrome?
CAH Wants Action
-Costo-clavicular syndrome test
-Adson manuever
-Halstead manuever
-Wright’s maneuver
-Allen manuever
-
Wright’s test looks for compression of vasculature in the _ _ _ and _ _
Compression of vasculature in the PEC MINOR SPACE and COSTO-CLAVICULAR SPACE
Allen’s test, Adson’s manuever and the Halstead maneuver look at compression of vasculature occurring in the _ _.
Occurring in the SCALENE TRIANGLE
The costo-clavicular test looks at compression in the _ _
Compression in the COSTO-CLAVICULAR SPACE
What are possible treatments for TOS? (6)
RC PyGMy’S
- Rib mobilization (1st Rib)
- Cyriax Release manuever (add pillows/ towels under flexed forearms to slowly unweight and elevate shoulders)
- Proximal Neural mobilization (depress 1st rib and have pt laterally flex head towards and away)
- Glenohumeral mobilization
- Manual scalene stretch with 1st rib mobilization
- Self rib mobilization with scalene stretch
