Thoracic 4B Flashcards
The thoracic is the most ________ region of the spine
Stiff
What are the 3 major areas of dysfunction in the thoracic spine
- Costo-vertebral Jt
- TLJ
- CTJ
Trauma/specific event injuries are more common with ______ in the thoracic region
ribs
Insidious onset injuries (postural) in the thoracic region are most common w/
Thoracic spine
What do we need to rule out when examining thoracic complaints
Visceral symptoms
Patient history red flags for thoracic
Heart problems
smoking
DM
HTN medication
Smoking
non-positional pain
surgery
bedridden
breathing difficulty
infection/illness
Patient history red flags
Fall/MVA
Coughing up sputum
Relieved w/ eating
Fatty foods increase symptoms
UTI
KIdney stone
Flank pain that comes on suddenly
Where does angina usually refer
Jaw, neck, scapular pain, medial UE, mid thoracic
Chest pain, pallor, sweating, dyspnea, nausea, palpitations,
symptoms over 30 mins
Myocardial infarction
Tumor compressing C8-T1
Apical pancoasts tumor
Chest, shoulder , upper abdominal pain w/ significant difficulty breathing
EMERGENT!
pulmonary embolism
Chest pain that increases or decreases with breathing,
pt w/ decreased breath sounds
Pneumothorax
EMERGENT!
Mimics joint lesion, pain w/ breathing and thoracic movement
“knife like pain”
Pleural pain
C4 dermatome d/t irritation of diaphram w/ digestion and eating
Cholecystitis/gall bladder
Crippling chest pain that can radiate to back, not positional
emergent!!!
Dissecting aortic aneurysm
Relevant question to ask if you suspect a person may have an infection in the thoracic region
have you had any injections recently
What is the most narrow portion of the spine and affected by spinal stenosis in the thoracic
T4 - T 9
Disc protrusions are more common in the _______ thoracic spine
lower
Increased pain w/ stress fatigue
difficult to reproduce in exam
negative neuro exam
Postural dysfunction
Forward head posture, abnormal pelvic tilt
Thoracic disc pathology 3 positive signs
Pain w/ active and passive motion
positive dural signs with or without radiculopathy
positive symptoms w/ coughing
recommendations for postural dysfunction
ergonomic advice, t-spine mobility ex, strengthening ex, pt education
thoracic disc pathology recommendations
Axial distraction ,mechanical traction
Surgery rarely recommended
What are the most common levels to have a thoracic disc pathology
T3-T8 most common
followed by T9-T11
Where will t1-t2 disc pathology refer?
Medial arm, forearm
where will T2-T3 (rarest type) disc pathology refer
Toward clavicle, scapular spine, medial arm
Where will T3-T8 disc pathology refer?
pain or neuro symptoms at lateral or anterior portion of truck
Where will T9-T11 disc pathology refer?
Pain can radiate into buttocks and mimic lumbosacral radiculopathy
bilateral symptoms weakness suggesting myelopathy
What is the key for determining thoracic facet joint dysfunction
palpation
Pt recently increased training load or ergonomic set up
possible thoracic facet joint dysfunction
pain w/ deep breathing, trunk rotation, coughing, sneezing
localized pain 3-4cm from midline
Possible rib dysfunction near costo-vertebral joint
Localized pain and tenderness
pain worse with movement, deep inspiration,coughing
pain w/ isometric contractions and/or passive stretching
Typically caused by MVA, physical altercation
Abdominal muscle strains and contusion
Whats a common cause of thoracic vertebral fractures
osteoporosis
Osteoporosis typically causes ___________ fx in the thoracic or a burst fx
anterior wedge fracture
Pt w/ positive compression test
articular signs are positive in all directions
immediate onset of pain
thoracic vertebral fracture
Pt has flail segment (unstable rib fx) what do you do?
call ambulance immediately
Precautions for scapular fx
NWB on that arm
Posterior dislocation of SC joint can be _________
life threatening
call ambulance now
What is Scheurmann disease
Found in 10% of the population
excessive juvenile kyphosis
deficit in apophysial ring of vertebral body causing anterior wedging
What is T4 syndrome
Can be anywhere between T2-T7
no known etiology
Dr Arnold says there will be hypomobile segment
Positive slump test
positive ULTT
MD refers for cervical disc herniation
Paresthesia that are NOT dermatomal
Symptoms in C8-T1
Hypertonic scalene muscles
1st rib dysfunction
Loss of full Shoulder elevation
negative contractile testing
posterior shoulder pain w/o a “shoulder” history
2nd rib dysfunction
Whats the most common way to differentiate a 2nd rib dysfunction
shoulder pain with negative contractile testing
Whats the most common way to differentiate a 1st rib dysfunction
paresthesias in a non-dermatomal pattern
