The Thoracic Spine

Question 1

People under 50 years of age are more likely to have a disc _____, and people over the age of 50 are more likely to have disc _____.

Answer 1

Herniation

Degeneration

Question 2

True or False: In the thoracic spine, a symptomatic disc herniation is extremely rare .

Answer 2

TRUE

Question 3

True or False: Paresthesia is a much stronger indication of nerve compression.

Answer 3

FALSE

NUMBNESS is a much more stronger indication of nerve compression than paresthesia.

Question 4

Why may a patient experience radiating pain when coughing, sneezing or with bowel movements?

Answer 4

The diaphragm attaches to the dura of the spinal cord. These movements can pull on the dura, and reproduce symptoms if there is a space-occupying lesion, such as a disc herniation, affecting the dura or nerve root.

Question 5

What may pain with deep breathing be indicative of?

Answer 5

1. Thoracic or rib problem

2. Lung problem (referred pain)

Question 6

List two areas of the body that can refer pain to the thoracic spine.

Answer 6

1. Lungs

2. Digestive tract

Question 7

An increase in the kyphotic curve at one level may be an indication of a ______ which is common with ______.

Answer 7

Vertebral fracture

Osteoporosis

Question 8

What is the most common idiopathic scoliotic curve?

Answer 8

Right thoracic, left lumbar

Question 9

What is the preferred breathing pattern?

Answer 9

Diaphragmatic breathing

Question 10

What are 2 plausible reasons as to why many patients choose to breathe with their upper chest muscles?

Answer 10

1. Can maintain the appearance of a flatter stomach with this breathing pattern than with diaphragmatic breathing
2. Use of their diaphragm is compromised

Question 11

List 3 types of chest deformities.

Answer 11

1. Barrel chest: the anterior to posterior distance is greater than ½ the distance between the two sides of the chest wall
2. Funnel chest: indented sternum
3. Pigeon chest: protruding sternum

Question 12

What should be examined, in terms of palpation, in addition to the usual items when assessing the thoracic spine?

Answer 12

Skin temperature: Some clinicians consider skin temperature changes to be a good indication of the location of the lesion

Question 13

What is the scratch test? What should occur to the skin?

Answer 13

1. Scratch” the patient’s back by moving the back of both of your thumb nails simultaneously down the spine about 1 inch lateral to the spinous processes.
2. The scratched skin should blanch and then turn red

Question 14

What scratch test results defines an acute vs chronic or non-injured area of the spine?

Answer 14

Compare the progression of the reaction on the side of the pain to the unaffected side.

1. Acute: reaction on the side of the pain is faster than the reaction at the unaffected side
2. Chronic: reaction on the side of the pain is slower than the reaction at the unaffected side
3. Noninjured: symmetrical reaction

Question 15

Explain the skin roll test

Answer 15

Pick up the skin and roll it to determine whether the tissue density is the same as that of the other side, and similar to surrounding tissue

Question 16

Overpressure should be performed only if ______.

Answer 16

AROM is pain free at the end of range

Question 17

True or False: PROM is usually tested in the thoracic spine.

Answer 17

FALSE

Usually not tested

Question 18

List 3 ways to examine PROM at the thoracic spine.

Answer 18

1. Forward bending by asking the patient to bring the knees to the chest in supine
2. Backward bending by instructing the patient to perform a prone press up
3. Side bending by moving the patient’s legs to one side and then the other side while positioned supine with the hips and knees straight

Question 19

What is considered to be a normal finding regarding the difference between neutral and end range forward bending?

Answer 19

2-3cm

Question 20

How can ROM be measured for inspiration and expiration? What is a normal finding?

Answer 20

1. Calculate the difference in tape measure length wrapped around the trunk at T4 in full inspiration and in full expiration.
2. The difference should be between 3 to 7 centimeters.

Question 21

Accessory motion at the spine is called _____.

Answer 21

Passive intervertebral motion (PIVMs)

Question 22

_________ occurs when accessory motion is being tested without stabilizing an adjacent vertebrae.

Answer 22

Spring testing

Question 23

Why is resistive isometric testing considered invalid in the spine?

Answer 23

It is impossible to eliminate intervertebral movement while isometrically contracting the paraspinals

Question 24

List 5 things significantly associated with pain at the thoracic spine.

Answer 24

1. Concurrent musculoskeletal pain
2. Growth and physical, lifestyle and social;
3. Back pack;
4. Postural
5. Psychological and environmental factors

Question 25

List 3 muscles that may have possible strength impairments in patients with forward head posture and ROM impairments in those with military posture.

Answer 25

1. Middle trapezius
2. Lower trapezius
3. Lower cervical paraspinal and/or anterior upper cervical musculature (longus colli and longus capitus)

Question 26

List 9 muscles that may have ROM impairments in patients with forward head posture and STRENGTH impairments in those with military posture.

Answer 26

1. Suboccipitals
2. Scalenes
3. Sternocleidomastiods
4. Upper trapezius
5. Levator scapulae
6. Pectoralis major
7. Pectoralis minor
8. Serratus anterior
9. Upper cervical paraspinal and/or anterior lower cervical musculature (longus colli)

Question 27

What population of patients experiences better chest expansion, posture and spinal mobility after manual mobilization of the thoracic spine?

Answer 27

Ankylosing spondylitis

Question 28

What treatment has been found to be effective in attenuating thoracic kyphosis in elderly patients with osteoporosis?

Answer 28

Three months of rehabilitation with manual mobilization

Question 29

List 1 treatments that may provide short term improvement in patients with acute/subacute mechanical neck pain.

Answer 29

Thoracic spine thrust manipulations

Question 30

________ alone or in combination with other interventions is a suitable intervention to use in the treatment of non-specific neck pain

Answer 30

Thoracic spine manipulation

Question 31

Thoracic spine thrust manipulation can reduce symptoms in patients with what 3 pathologies?

Answer 31

1. Shoulder impingement syndrome
2. Shoulder rotator cuff tendinopathy
3. Medial/Lateral epicondylitis

Question 32

What is regional interdependence?

Answer 32

A patient’s primary musculoskeletal symptom(s) may be directly or indirectly related or influenced by impairments from various body regions and systems regardless of proximity to the primary symptom(s)