The Thoracic Spine Flashcards
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 _____.
Herniation
Degeneration
True or False: In the thoracic spine, a symptomatic disc herniation is extremely rare .
TRUE
True or False: Paresthesia is a much stronger indication of nerve compression.
FALSE
NUMBNESS is a much more stronger indication of nerve compression than paresthesia.
Why may a patient experience radiating pain when coughing, sneezing or with bowel movements?
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.
What may pain with deep breathing be indicative of?
- Thoracic or rib problem
2. Lung problem (referred pain)
List two areas of the body that can refer pain to the thoracic spine.
- Lungs
2. Digestive tract
An increase in the kyphotic curve at one level may be an indication of a ______ which is common with ______.
Vertebral fracture
Osteoporosis
What is the most common idiopathic scoliotic curve?
Right thoracic, left lumbar
What is the preferred breathing pattern?
Diaphragmatic breathing
What are 2 plausible reasons as to why many patients choose to breathe with their upper chest muscles?
- Can maintain the appearance of a flatter stomach with this breathing pattern than with diaphragmatic breathing
- Use of their diaphragm is compromised
List 3 types of chest deformities.
- Barrel chest: the anterior to posterior distance is greater than ½ the distance between the two sides of the chest wall
- Funnel chest: indented sternum
- Pigeon chest: protruding sternum
What should be examined, in terms of palpation, in addition to the usual items when assessing the thoracic spine?
Skin temperature: Some clinicians consider skin temperature changes to be a good indication of the location of the lesion
What is the scratch test? What should occur to the skin?
- 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.
- The scratched skin should blanch and then turn red
What scratch test results defines an acute vs chronic or non-injured area of the spine?
Compare the progression of the reaction on the side of the pain to the unaffected side.
- Acute: reaction on the side of the pain is faster than the reaction at the unaffected side
- Chronic: reaction on the side of the pain is slower than the reaction at the unaffected side
- Noninjured: symmetrical reaction
Explain the skin roll test
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
Overpressure should be performed only if ______.
AROM is pain free at the end of range
True or False: PROM is usually tested in the thoracic spine.
FALSE
Usually not tested
List 3 ways to examine PROM at the thoracic spine.
- Forward bending by asking the patient to bring the knees to the chest in supine
- Backward bending by instructing the patient to perform a prone press up
- 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
What is considered to be a normal finding regarding the difference between neutral and end range forward bending?
2-3cm
How can ROM be measured for inspiration and expiration? What is a normal finding?
- Calculate the difference in tape measure length wrapped around the trunk at T4 in full inspiration and in full expiration.
- The difference should be between 3 to 7 centimeters.
Accessory motion at the spine is called _____.
Passive intervertebral motion (PIVMs)
_________ occurs when accessory motion is being tested without stabilizing an adjacent vertebrae.
Spring testing
Why is resistive isometric testing considered invalid in the spine?
It is impossible to eliminate intervertebral movement while isometrically contracting the paraspinals
List 5 things significantly associated with pain at the thoracic spine.
- Concurrent musculoskeletal pain
- Growth and physical, lifestyle and social;
- Back pack;
- Postural
- Psychological and environmental factors
List 3 muscles that may have possible strength impairments in patients with forward head posture and ROM impairments in those with military posture.
- Middle trapezius
- Lower trapezius
- Lower cervical paraspinal and/or anterior upper cervical musculature (longus colli and longus capitus)
List 9 muscles that may have ROM impairments in patients with forward head posture and STRENGTH impairments in those with military posture.
- Suboccipitals
- Scalenes
- Sternocleidomastiods
- Upper trapezius
- Levator scapulae
- Pectoralis major
- Pectoralis minor
- Serratus anterior
- Upper cervical paraspinal and/or anterior lower cervical musculature (longus colli)
What population of patients experiences better chest expansion, posture and spinal mobility after manual mobilization of the thoracic spine?
Ankylosing spondylitis
What treatment has been found to be effective in attenuating thoracic kyphosis in elderly patients with osteoporosis?
Three months of rehabilitation with manual mobilization
List 1 treatments that may provide short term improvement in patients with acute/subacute mechanical neck pain.
Thoracic spine thrust manipulations
________ alone or in combination with other interventions is a suitable intervention to use in the treatment of non-specific neck pain
Thoracic spine manipulation
Thoracic spine thrust manipulation can reduce symptoms in patients with what 3 pathologies?
- Shoulder impingement syndrome
- Shoulder rotator cuff tendinopathy
- Medial/Lateral epicondylitis
What is regional interdependence?
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)
