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S3- Musculoskeletal > T-Spine and Ribs Examination > Flashcards

T-Spine and Ribs Examination Flashcards

1
Q

INTRO

A

INTRO

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2
Q

What is the order of the differential diagnosis?

A
  1. ) Patient Interview/ Chart Review
  2. ) Visual Inspection
  3. ) Systems Review
  4. ) Elimination Tests
  5. ) Structural Stress Testing
  6. ) Joint Mobility and Palpations
  7. ) Confirmation tests
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3
Q

What are some special considerations done during the patient interview?

A
  • Pain referral from cardiopulmonary/hepatobiliary/gall bladder/esophageal/renal systems
  • Fracture (rib vs. vertebra)
  • Neoplasm
  • Ankylosing Spondylitis
  • Screening for other non-musculoskeletal health condition or musculoskeletal condition where referral is indicated
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4
Q

What are some common functional limitations related to the T-spine and Rib Dysfunction?

A
  • Reaching behind body
  • Reaching overhead
  • Pushing/pulling
  • Lifting
  • Respiration/Exertion
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5
Q
  • What is the Roman’s Cluster for?

- What are the 5 components of it?

A

Osteoporotic Vertebral Compression Fracture (OVCF)

  • Age >52
  • No presence of leg pain
  • BMI = 22
  • Does not exercise regularly
  • Female
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6
Q
  • If <2 Roman Cluster items are positive, is it good for elimination or confirmation?
  • If 4/5 Roman Cluster items are positive, is it food for elimination or confirmation?
A
  • Elimination (-LR 0.16)

- Confirmation (+LR 9.6)

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7
Q
  • With Imaging, the angle of kyphosis is done via the _________ _____ method.
  • Perpendicular extensions of lines drawn from superior border of T_ and inferior border of T_.
  • Cobb method is also used with an anterior view to measure _________ curvature.
A
  • Traditional Cobb
  • superior T4, inferior T9
  • scoliotic
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8
Q

VISUAL INSPECTION

A

VISUAL INSPECTION

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9
Q

What are we looking at with our visual inspection?

A
  • Sitting vs Standing
  • Gross abnormalities
  • Integumentary
  • Resting posture vs ability to correct
  • Posture assessment (symmetry, bony/soft contours)
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10
Q

When performing a visual inspection we want to look at views from appropriate planes (Anterior, Posterior, Each SIde) and assess posture of what areas?

A
  • Head on neck
  • Neck on thorax
  • Thoracolumbar curvature
  • Trunk on pelvis
  • Scapulae on thorax
  • Mandible on cranium
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11
Q

What are some abnormalities we may see in our visual inspection?

A
  • Dowager’s Hump
  • Ankylosing Spondylitis
  • Scheuermann’s Disease
  • Pectus Carinatum
  • Barrel Chest
  • Pectus Excavatum
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12
Q

What is Dowager’s Hump?

A
  • Increased thoracic curvature apex associated with osteoporotic fractures and wedging that can occur with increased age.
  • Cannot address structural changes.
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13
Q

What is Ankylosing Spondylitis?

A

Chin on chest position involving thoracolumbar flexion and straightening of cervical lordosis due to ossification of anterior structures.

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14
Q

What is Scheuermann’s Disease?

A

Accentuated thoracic kyphosis, forward head posture, anteriorly rotated pelvis, extended hips, excessive lumbar lordosis related to wedging of vertebrae as a function of malnutrition and injury to disc plates.

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15
Q

What is Pectus Carinatum?

A

Bird Chest (convex) anteriorly

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16
Q

What is Pectus Excavatum?

A

Concave sternum

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17
Q

What is Barrel Chest?

A

Increased anterior-posterior diameter at rest, common in patients with COPD/CF.

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18
Q

What is the upper cross sign?

A

Forward head and rounded shoulders leading to:

  • Inhibited Neck Flexors
  • Inhibited Rhomboids and Serratus Anterior
  • Tight Pectorals
  • Tight UT and Levator Scap
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19
Q

What is a systems review helpful for?

A
  • Procedures that help aid in determining any other procedures that are necessary.
  • Overall look at patient as a whole and seeing if there is anything else to look at.
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20
Q

ELIMINATION TESTS

A

ELIMINATION TESTS

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21
Q

What screens are done before our special tests?

A
  • UQS
  • LQS
  • Neuro Screening
    • UMN: pathological reflexes, coordination, hyper
    • LMN: diminished sensation, weakness, hypo
  • Other Screening Tests
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22
Q

With Neurological Screening we want to look at what?

A
  • Dermatomes
  • Myotomes
  • Long Track Tests
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23
Q

What are some landmarks for dermatomes?

A
  • T1= anteriomedial arm
  • T4= nipple level
  • T10= umbilicus
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24
Q

What are we trying to eliminate with our elimination tests?

A
  • Fracture
  • Thoracic Outlet Syndrome
  • Scoliosis
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25
What elimination test is done for fracture?
Percussion Test
26
Percussion Test: - Health Condition? - Patient Position? - Procedure? - Positive Test? - Research Properties? - Clinical Implications?
``` Health Condition -Compression Fracture Patient Position -Standing Procedure -Lightly percuss along the length of the spine with a closed fist. Positive Test -Pt reports sudden, sharp, severe pain Research Properties Moderate for -LR (.14) Clinical Implications -Use cautiously if fracture is suspected. ```
27
What elimination test is done for Thoracic Outlet Syndrome?
Wright Test
28
Wright Test - Health Condition? - Patient Position? - Examinere Position? - Procedure? - Positive Test? - Research Properties? - Clinical Implications?
Health Condition -Thoracic Outlet Syndrome Patient Position -Sitting Examiner Position -Standing behind or to the side on symptomatic side -Radial pulse on the symptomatic side is palpated throughout the procedure Procedure -Pt instructed to abduct the shoulder to 90 degrees and flex the elbows to 90 degrees, and horizontally abduct the shoulders -The pt rotates the neck to the contralateral direction -The position is held for 1-2 minutes Positive Test -Reproduction of paresthesia or a decrease in radial pulse Research Properties -Weak for -LR pulse (0.56), weak for symptom provocation (0.34) Clinical Implications -Generally limited research investigating diagnostic properties
29
What elimination test is done for Scoliosis?
Adam's Forward Flexion Test
30
Adam's Forward Flexion Test: - Health Condition? - Patient Position? - Examinere Position? - Procedure? - Positive Test? - Research Properties? - Clinical Implications?
``` Health Condition -Scoliosis Patient Position -Standing Examiner Position -Standing facing the pt Procedure -The pt is instructed to stand with the feet at shoulder-width, place the hands together, and slowly bend forward (reaching toward the floor) Positive Test -Presence of an observable rib hump Research Properties -Moderate for -LR (0.13) Clinical Implications -Generally limited research investigating diagnostic properties ```
31
STRUCTURAL STRESS TESTING T-SPINE AND RIBS
STRUCTURAL STRESS TESTING T-SPINE AND RIBS
32
What are the 3 parts of structural stress testing?
- AROM - PROM - Resistive Testing
33
What 4 things are we looking at when performing structural stress tests?
- Quality - Quantity - Symptom Provocation - Willingness to move
34
What is the pt position when performing AROM?
- Pt seated at corner of table | - Feet flat on floor
35
What should we note when performing AROM?
- combined vs. isolated movements | - coordination, symmetry
36
What is done at the end of AROM?
overpressure
37
What T-Spine movements are assessed during AROM?
- Flexion - Extension - Rotation - Lateral Flexion
38
Describe flexion patient position and procedure for AROM.
Patient Position -Sitting, fingers interlocked behind neck, elbows close to approximation Procedure -The patient is instructed to bring the elbows toward the umbilicus
39
Describe extension patient position and procedure for AROM.
Patient Position -Sitting, fingers interlocked behind neck, elbows close to approximation Procedure -The patient is instructed to bring the elbows toward the ceiling
40
Describe rotation patient position and procedure for AROM.
Patient Position -Sitting, arms crossing the chest Procedure -The patient is instructed to rotate the trunk
41
Describe lateral flexion patient position and procedure for AROM.
Patient Position -Sitting, arms at side & fingers interlocked behind the head Procedure -The patient is instructed to bring the elbow (on the tested side) toward the lateral pelvis
42
What is the pt position when performing PROM?
- seated at edge of table | - feet flat on floor
43
With PROM we want to assess to ____-______.
end-range
44
What T-Spine movements are assessed during PROM?
- Flexion - Extension - Rotation - Lateral Flexion
45
Describe flexion patient position, examiner position, and procedure for PROM.
Patient Position -Sitting, fingers interlocked behind neck, elbows close to approximation Examiner Position -Standing, facing patient’s side -Ventral arm placed over the patient’s UEs, hand grasping contralateral shoulder -Dorsal hand placed at the patient’s lower thoracic spine Procedure -The patient is passively flexed at the thoracic spine; the trunk is maintained over the center of mass
46
Describe extension patient position, examiner position, and procedure for PROM.
Patient Position -Sitting, fingers interlocked behind neck, elbows close to approximation Examiner Position -Standing, facing patient’s side -Ventral arm placed under the patient’s UEs, hand grasping mid/ proximal upper arm -Dorsal hand placed at the patient’s mid/lower thoracic spine Procedure -The patient is passively extended at the thoracic spine by bringing the patients arms upward and the trunk forward; the trunk is maintained over the center of mass
47
Describe rotation patient position, examiner position, and procedure for PROM.
Patient Position -Sitting, arms crossing the chest Examiner Position -Standing, facing patient’s side -Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder -Dorsal hand placed at the patient’s scapula (closest to the examiner) Procedure -The patient is passively rotated in the direction away from the examiner; the trunk is maintained over the center of mass
48
Describe lateral flexion patient position, examiner position, and procedure for PROM.
Patient Position -Sitting, arms crossing the chest Examiner Position -Standing, facing patient’s side -Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder -Dorsal hand placed at the patient’s trunk (opposite the examiner) Procedure -The patient is passively laterally flexed in the direction away from the examiner; the trunk is maintained
49
With resistive testing we want to support the trunk until _________ force is applied and gradually ramp intensity, hold for 3-5s.
isometric
50
Describe flexion patient position, examiner position, and procedure for resistive testing.
Patient Position -Sitting, arms crossing the chest (arm closest to patient under contralateral arm) Examiner Position -Standing, facing patient’s side -Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder -Dorsal hand placed at the patient’s mid-back Procedure -Isometric resistance applied to trunk with extension moment on trunk
51
Describe extension patient position, examiner position, and procedure for resistive testing.
Patient Position -Sitting, arms crossing the chest (arm closest to patient under contralateral arm) Examiner Position -Standing, facing patient’s side -Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder -Dorsal hand placed at the patient’s mid-back Procedure Isometric resistance applied to trunk with flexion moment on trunk
52
Describe rotation patient position, examiner position, and procedure for resistive testing.
Patient Position -Sitting, arms crossing the chest (arm closest to patient under contralateral arm) Examiner Position -Standing, facing patient’s side -Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder -Dorsal hand placed at the patient’s scapula (closest to the examiner) Procedure -Isometric resistance applied to trunk with rotation moment on trunk (directed away from examiner)
53
Describe lateral flexion patient position, examiner position, and procedure for resistive testing.
Patient Position -Sitting, arms crossing the chest (arm closest to patient under contralateral arm) Examiner Position -Standing, facing patient’s side -Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder; shoulder contacts patient’s shoulder -Dorsal hand placed at the patient’s trunk (opposite the examiner) Procedure -Isometric resistance applied to trunk with lateral flexion moment on trunk (directed away from examiner)
54
What are some other potential strength testing (MMT) that can be done?
- Trunk flexion - Trunk extension - Trunk rotation - Scapulothoracic Musculature (MT,LT,Serratus Anterior)
55
PALPATION AND JOINT MOBILITY
PALPATION AND JOINT MOBILITY
56
Palpations to know at the sternum, ribs, and thoracic vertebrae?
``` Sternum -suprasternal notch -manubrium -body of sternum -xiphoid process Ribs -sternocostal and costochondral "articulations" -posterior angle -intercostal spaces Costal Cartilage Thoracic Vertebrae -spinous processes ```
57
Structural Relationships: - Superior Angle = ___ rib - Spine of Scapula = __ SP - Inferior Angle = ___ rib
- 2nd - 3rd SP - 7th
58
Soft Tissue Structures to Palpate?
- Paraspinals - Trapezius - Pec Major (sternal and clavicular head) - Pec Minor
59
PPIVM (Passive Physiological Intervertebral Mobility Testing) of the thoracic spine involves what motions?
flexion and extension
60
- PAIVM (Passive Accessory Intervertebral Mobility Testing) of the thoracic spine involves ___s and ___s. - PAIVMs of the ribs involve ___.
- UPAs and CPAs | - PA
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CONFIRMATION TESTS
CONFIRMATION TESTS
69
What diagnosis do we have confirmation tests for?
- TOS - Restricted 1st Rib - Disc/Sympathetic Nervous System
70
What tests do we have to rule-in TOS?
- Roo's Test - Hyperabduction Test - Adson's Test
71
Roo's Test: - Patient position? - Examiner position? - Procedure? - Positive test?
- Pt Position: sitting - Examiner position: facing the patient to observe - Procedure: The patient is instructed abduct and externally rotate the shoulders 90 degrees (elbows flexed 90 degrees). Pt instructed to rapidly open/ close the hands; this is done for 1 minute - Positive Test: reproduction of concordant symptoms
72
What are the clinical implications of the Roo's test?
- Generally limited research - High false positive rate - Poor +/- LR reported in higher quality studies - Feasibility with required time?
73
Hyperabduction Test: - Patient position? - Examiner position? - Procedure? - Positive test?
-Pt Position: sitting -Examiner position: standing behind & to the side of the patient (on symptomatic side). The radial pulse on the symptomatic side is palpated. -Procedure: The patient is instructed to abduct the shoulders 90 degrees & fully externally rotate the shoulders (with elbows flexed 90 degrees). The position is held for 1 minute. The examiner palpates the radial pulse. Positive Test: change in radial pulse and patient report of paresthesia
74
What are the clinical implications of the Hyperabduction test?
- Limited research | - Lesser quality studies report higher specificity
75
Adson's Test: - Patient position? - Examiner position? - Procedure? - Positive test?
-Pt Position: Sitting with shoulders at ~15 degrees of abduction -Examiner position: Standing behind & to the side of the patient (on symptomatic side). The radial pulse on the symptomatic side is palpated throughout the procedure. Procedure: The patient is instructed to inhale deeply & hold the breath, tilt the head back & rotate the neck toward the examined side. Positive Test: A change in the radial pulse and report of paresthesia.
76
What are the clinical implications of the Adson's Test?
- Limited research - Lesser quality studies report higher specificity - Use with caution
77
What tests do we have to rule-in Restricted 1st Rib?
- Cervical Rotation Lateral Flexion Test | - First Rib Spring Test
78
Cervical Rotation Lateral Flexion Test: - Patient position? - Examiner position? - Procedure? - Positive test?
- Pt Position: sitting - Examiner position: standing behind the patient - Procedure: The neck is passively rotated away from the affected side. The neck is passively laterally flexed toward the chest. - Positive Test: A bony restriction that blocks lateral flexion.
79
___ research properties are reported for the Cervical Rotation Lateral Flexion Test?
No
80
First Rib Spring Test: - Patient position? - Examiner position? - Procedure? - Positive test?
Pt Position: supine Examiner position: Sitting at patient’s crown, facing patient Procedure: The patient’s head is passively rotated toward the assessed rib. Mobilizing hand placed posterior to the first rib (contacting with 2nd MCP joint). Caudal/ ventral force applied to the rib. The opposite side is assessed. Positive Test: The rib is “stiff” compared to the contralateral side.
81
___ research properties are reported for the First Rib Spring Test?
No
82
What tests do we have to rule-in Disc/Sympathetic Nervous System?
Thoracic Slump Test
83
Thoracic Slump Test: - Patient position? - Examiner position? - Procedure? - Positive test?
- Pt Position: Long sitting on treatment table, knees flexed to ~45 degreees, hands placed behind back. - Examiner position: Standing at the patient’s side. - Procedure: - Resting symptoms assessed - The examiner places a caudal load through the patient’s shoulders with his or her cranial UE; symptoms re-assessed - The patient assumes exaggerated forward head posture (flexed lower c-spine & extended upper c-spine) ; symptoms re-assessed - Thoracic spine is passively flexed and/or rotated (ipsilaterally) ; symptoms re-assessed - The LE on the symptomatic side is straightened to lie flat on the table & the ankle is dorsiflexed; symptoms re-assessed - Positive Test: Asymmetry, reproduction of concordant pain, and sensitization.
84
___ research properties are reported for the Thoracic Slump Test?
No

S3- Musculoskeletal (27 decks)

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