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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
Q

What elimination test is done for fracture?

A

Percussion Test

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26
Q

Percussion Test:

  • Health Condition?
  • Patient Position?
  • Procedure?
  • Positive Test?
  • Research Properties?
  • Clinical Implications?
A 
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.
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27
Q

What elimination test is done for Thoracic Outlet Syndrome?

A

Wright Test

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28
Q

Wright Test

  • Health Condition?
  • Patient Position?
  • Examinere Position?
  • Procedure?
  • Positive Test?
  • Research Properties?
  • Clinical Implications?
A

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

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29
Q

What elimination test is done for Scoliosis?

A

Adam’s Forward Flexion Test

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30
Q

Adam’s Forward Flexion Test:

  • Health Condition?
  • Patient Position?
  • Examinere Position?
  • Procedure?
  • Positive Test?
  • Research Properties?
  • Clinical Implications?
A 
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
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31
Q

STRUCTURAL STRESS TESTING T-SPINE AND RIBS

A

STRUCTURAL STRESS TESTING T-SPINE AND RIBS

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32
Q

What are the 3 parts of structural stress testing?

A
  • AROM
  • PROM
  • Resistive Testing
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33
Q

What 4 things are we looking at when performing structural stress tests?

A
  • Quality
  • Quantity
  • Symptom Provocation
  • Willingness to move
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34
Q

What is the pt position when performing AROM?

A
  • Pt seated at corner of table

- Feet flat on floor

35
Q

What should we note when performing AROM?

A
  • combined vs. isolated movements

- coordination, symmetry

36
Q

What is done at the end of AROM?

A

overpressure

37
Q

What T-Spine movements are assessed during AROM?

A
  • Flexion
  • Extension
  • Rotation
  • Lateral Flexion
38
Q

Describe flexion patient position and procedure for AROM.

A

Patient Position
-Sitting, fingers interlocked behind neck, elbows close to approximation
Procedure
-The patient is instructed to bring the elbows toward the umbilicus

39
Q

Describe extension patient position and procedure for AROM.

A

Patient Position
-Sitting, fingers interlocked behind neck, elbows close to approximation
Procedure
-The patient is instructed to bring the elbows toward the ceiling

40
Q

Describe rotation patient position and procedure for AROM.

A

Patient Position
-Sitting, arms crossing the chest
Procedure
-The patient is instructed to rotate the trunk

41
Q

Describe lateral flexion patient position and procedure for AROM.

A

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
Q

What is the pt position when performing PROM?

A
  • seated at edge of table

- feet flat on floor

43
Q

With PROM we want to assess to ____-______.

44
Q

What T-Spine movements are assessed during PROM?

A
  • Flexion
  • Extension
  • Rotation
  • Lateral Flexion
45
Q

Describe flexion patient position, examiner position, and procedure for PROM.

A

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
Q

Describe extension patient position, examiner position, and procedure for PROM.

A

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
Q

Describe rotation patient position, examiner position, and procedure for PROM.

A

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
Q

Describe lateral flexion patient position, examiner position, and procedure for PROM.

A

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
Q

With resistive testing we want to support the trunk until _________ force is applied and gradually ramp intensity, hold for 3-5s.

50
Q

Describe flexion patient position, examiner position, and procedure for resistive testing.

A

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
Q

Describe extension patient position, examiner position, and procedure for resistive testing.

A

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
Q

Describe rotation patient position, examiner position, and procedure for resistive testing.

A

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
Q

Describe lateral flexion patient position, examiner position, and procedure for resistive testing.

A

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
Q

What are some other potential strength testing (MMT) that can be done?

A
  • Trunk flexion
  • Trunk extension
  • Trunk rotation
  • Scapulothoracic Musculature (MT,LT,Serratus Anterior)
55
Q

PALPATION AND JOINT MOBILITY

A

PALPATION AND JOINT MOBILITY

56
Q

Palpations to know at the sternum, ribs, and thoracic vertebrae?

A 
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
Q

Structural Relationships:

  • Superior Angle = ___ rib
  • Spine of Scapula = __ SP
  • Inferior Angle = ___ rib
A
  • 2nd
  • 3rd SP
  • 7th
58
Q

Soft Tissue Structures to Palpate?

A
  • Paraspinals
  • Trapezius
  • Pec Major (sternal and clavicular head)
  • Pec Minor
59
Q

PPIVM (Passive Physiological Intervertebral Mobility Testing) of the thoracic spine involves what motions?

A

flexion and extension

60
Q
  • PAIVM (Passive Accessory Intervertebral Mobility Testing) of the thoracic spine involves ___s and ___s.
  • PAIVMs of the ribs involve ___.
A
  • UPAs and CPAs

- PA

68
Q

CONFIRMATION TESTS

A

CONFIRMATION TESTS

69
Q

What diagnosis do we have confirmation tests for?

A
  • TOS
  • Restricted 1st Rib
  • Disc/Sympathetic Nervous System
70
Q

What tests do we have to rule-in TOS?

A
  • Roo’s Test
  • Hyperabduction Test
  • Adson’s Test
71
Q

Roo’s Test:

  • Patient position?
  • Examiner position?
  • Procedure?
  • Positive test?
A
  • 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
Q

What are the clinical implications of the Roo’s test?

A
  • Generally limited research
  • High false positive rate
  • Poor +/- LR reported in higher quality studies
  • Feasibility with required time?
73
Q

Hyperabduction Test:

  • Patient position?
  • Examiner position?
  • Procedure?
  • Positive test?
A

-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
Q

What are the clinical implications of the Hyperabduction test?

A
  • Limited research

- Lesser quality studies report higher specificity

75
Q

Adson’s Test:

  • Patient position?
  • Examiner position?
  • Procedure?
  • Positive test?
A

-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
Q

What are the clinical implications of the Adson’s Test?

A
  • Limited research
  • Lesser quality studies report higher specificity
  • Use with caution
77
Q

What tests do we have to rule-in Restricted 1st Rib?

A
  • Cervical Rotation Lateral Flexion Test

- First Rib Spring Test

78
Q

Cervical Rotation Lateral Flexion Test:

  • Patient position?
  • Examiner position?
  • Procedure?
  • Positive test?
A
  • 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
Q

___ research properties are reported for the Cervical Rotation Lateral Flexion Test?

80
Q

First Rib Spring Test:

  • Patient position?
  • Examiner position?
  • Procedure?
  • Positive test?
A

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
Q

___ research properties are reported for the First Rib Spring Test?

82
Q

What tests do we have to rule-in Disc/Sympathetic Nervous System?

A

Thoracic Slump Test

83
Q

Thoracic Slump Test:

  • Patient position?
  • Examiner position?
  • Procedure?
  • Positive test?
A
  • 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
Q

___ research properties are reported for the Thoracic Slump Test?

S3- Musculoskeletal (27 decks)

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