TEST 3: Thoracic Spine Dx OSCE

Question 1

what is an important bony landmark of the thoracic spine?

Answer 1

C7 and T1:

-C7 is vertebra prominent and may be used to help locate T1

Question 2

what is located at T3?

Answer 2

spine of scapula

Question 3

where is the inferior angle of the scapula located?

Answer 3

-spinous process of T7 and transverse process of T8

Question 4

explain the Rule of 3s

Answer 4

• T1-3: SP in the same plane as the TP of the same numbered vertebra
• T4-6: SP halfway between the TP of the same numbered vertebra and the vertebra one inferior
• T7-9: SP at the level of the TP of one vertebra inferior
• T10: same as T7-9
• T11: same as T4-6
• T12: same as T1-3

Question 5

what is the rotation and side bending of the thoracic spine?

Answer 5

rotation is up to 90 deg

side bending is up to 40 deg

Question 6

Type I Spinal Mechanics

Answer 6

TONGO:

• type one neutral group opposite
• typically > or = 3 segments
• neither flexed or extended (in neutral)
• sidebending of spine in one direction results in rotation of the thoracic vertebrae in the direction opposite to sidebending

Question 7

Type II Spinal Mechanics

Answer 7

“Non-Neutral”

• typically involves a single vertebral unit
• flexion or extension of thoracic spine
• sidebending of spine in one direction results in rotation of thoracic vertebrae in the same direction

Question 8

how to assess R and L rotation in neutral?

Answer 8

• pt in prone with examiner at side of table
• palpate the TP with the pads of thumbs
• examiner alternately presses on R and L TP of T7 (load and spring) evaluating for ease of motion/hard end feels
  
  • if the R TP moves anteriorly easier, that segment is rotating L more freely

Question 9

how to assess R and L side bending in neutral?

Answer 9

-inferred by spinal mechanics after flexion and extension assessment as well as rotation assessment

Question 10

how to assess for flexion in prone?

Answer 10

• have pt in cat back position
• palpate the TP with the pads of thumbs
• examiner alternately presses on R and L TP of T7 (load and spring) evaluating for ease of motion/hard end feels

Question 11

how to assess for extension in prone?

Answer 11

• have pt in TV watching position
• palpate the TP with the pads of thumbs
• examiner alternately presses on R and L TP of T7 (load and spring) evaluating for ease of motion/hard end feels

Question 12

how to assess R and L rotation in a seated position?

Answer 12

• segmental motion testing can be assessed doing seated loading and springing (R and L rotation)
  
  • examiner should be behind pt and load and spring from T1-12
• assess in active flexion and extension

Question 13

how to assess for passive side bending and passive rotation?

Answer 13

• passive sidebending: in seated position, examiner pushes down on pt’s ipsilateral shoulder and monitor ipsilateral TP for hard end feel
• passive rotation: in seated position, examiner contacts front of pt’s ipsilateral shoulder and induces rotation while monitoring ipsilateral TP for hard end feel

Question 14

evaluation of findings

Answer 14

• always evaluate in flexion/extension: repeat loading and springing thru F, E, N
• if improves/becomes more symmetric in flexion, then we have a flexion dysfunction–restricted to/becomes asymmetric in extension
• if improves/becomes more symmetric in extension, then we have an extension dysfunction–restricted to/becomes asymmetric in flexion

Question 15

if F or E component exists, you can assume…

Answer 15

Type II Mechanics/Dysfunction

Question 16

if no change in F/E (doesn’t prefer F/E), you can assume…

Answer 16

Type I Mechanics/Dysfunction