t-spine exam

Question 1

history

Answer 1

Rule out serious pathology, screen appropriateness for PT

Site and distribution: to identify potential referrals to and from the TS

Quality and character

• somatic= deep, dull ache changes w/ movement/posture
• bone= boring
• radicular= electric, shooting (dermatome?)
• neuropathic=burning (dermatome?)
• visceral= dull, heavyness, tightness

Listen/ask for:

• chest pain, SOB
• fevers
• pain not related to movements or postures
• unexplained weight changes, fatigue
• abdominal pain coming and going

Question 2

observation

Answer 2

POSTURE: correct and note change in Sx

• although no clear associated exists btwn cervicothoracic posture and pain
• Scheuermann’s disease (juvenile kyphosis)
• poor habitual posture (FHP, pes cavus, pigeon chest, scap position)
• kyphosis increases w/ age from comp fx
• Dowager’s hump

INTEGUMENTARY

DEFORMITIES:

• gibbus(sharp angulation kyphosis)
• scoliosis: functional, structural

Question 3

movement screen

Answer 3

Slump, extend, rotate, SB

• watch for segmental hyper/hypo mobility
• watch for deviations (out of plane)
• watch for kinesiophobia (guarding)

Deep in/exhalation

bilateral arms overhead
-watch for normal TS extension

ask pt. to do key movements reproducing symptoms

Question 4

palpation

Answer 4

reliability for tenderness is good but validity is unknown

Spinous processes
Facet joints
TPs/costotransverse joints
Rib angles
Erector spinae muscles
costocartilage junctions
costosternal junctions

Question 5

spinous processes- rule of 3s

Answer 5

T1-3= TP at same level of SP

T4-6=TP 1/2 vert above SP

T7-9= TP 1 level above SP

T10-12= TP at same level of SP

Question 6

erector spinae muscles-superficial to deep

Answer 6

tenderness of iliocostalis insertion of rib angle

Question 7

diagnosing respiratory rib dysfunction

Answer 7

diagnosed by palpating directly over upper, middle and lower ribs to determine which group of ribs stops moving first (indicates hypomobility/dysfunction) either w/ inhalation or exhalation

*usually pain w/ on inhalation OR exhalation
pump vs bucket handle

Question 8

somatic rib dysfunction

Answer 8

not uncommon for somatic rib dysfunction to impact respiration

*usually pain on BOTH inhalation and exhalation

EX: 1 posterior prominent rib angle, anterior depression= posterior translation of the rib

Question 9

precordial catch syndrome

Answer 9

L hand side pain, shuts down respiration- feels like a heart attack

more common in females, around nipple line
chronic, intermittent–> t-spine stiffness

Question 10

key rib for inhalation restriction mobilization?

Answer 10

top rib

Question 11

key rib for exhalation restriction mobilization?

Answer 11

bottom rib

Question 12

movement testing

Answer 12

AROM–>PROM w/ OP

• flex/ext
• lat flex
• rotation

Isometric strength screen (NOT segmental- looking for symptoms provocation, substitutions)

Rib motion during max in/exhalation

• pump
• bucket
• caliper

PAIVM testing in neutral/endrange

• CPA (recognize vertebrae wil be tilting bc of rule of 3)
• UPA
• rib spring

Question 13

special tests

Answer 13

cervical rotation lateral flexion test

1st rib spring