thoracic

Question 1

Rules of 3s

Answer 1

• T1-3 SP at same level
• T4-6 SP 1/2 level below
• T7-9 SP 1 full level below
• T10 1 full level below
• T11 1/2 level below
• T12 at same level

Question 2

Ligamenta Flava

Answer 2

• Assists in resuming posture after flexion

- Can cause stenosis

Question 3

Radiate Ligament

Answer 3

• Connect anterior head of each rib with bodies of 2 vert and intervertebral fibrocartilage
• Triradiate (above, at level, below) except 1, 10, 11, 12 (biradiate - above and at level)

Question 4

Multifidi: Jull, Hodges, Hides

Answer 4

• Between TP and SP, sacrum to C2
• stabilize vertebral column
• pain inhibits

Question 5

Critical Zone: artery of adamkiewicz

Answer 5

-T4-9 has 3mm of redundancy, watershead vascularization

Question 6

Typical Ribs

Answer 6

• Ribs 3-10

- Attached above and below and to intervertebral disc

Question 7

Atypical ribs

Answer 7

• Ribs 1, 2, 11, 12
• Ribs 1, 11, 12 to T1, 11, 12 with unifacet
• Rib 2 to T1 with 2 demifacets

Question 8

Respiratory motion with thoracic flexion

Answer 8

Rib internal torsion

Question 9

Respiratory motion with thoracic extension

Answer 9

Rib external torsion

Question 10

Physiological motion of costal cage

Answer 10

• Pump handle: upper/mid
• Bucket handle: mid to inf ribs
• Calipers: ribs 11-12
• Torsional motion: internal/external, mid to lower ribs

Question 11

Structural dysfunction: superior subluxation

Answer 11

First rib: exhalation dysfunction

Question 12

Structural dysfunction: anterior/posterior subluxation

Answer 12

circumferential pain = sympathetic facilitation, traumatic force.
asymmetry of boney landmarks of UE

Question 13

Structural dysfunction: internal or external torsion

Answer 13

rib stuck with dysfunctional vertebrae or chronic myofascial restrictions.

• circumferential tenderness, hypertonicity of ipsilat intercostals
• Inf edge post: internal torsion
• Sup edge post: external torsion

Question 14

Structural dysfunction: inhalation and exhalation

Answer 14

Often asymptomatic, no asymmetries.

Less problematic

Question 15

Thoracic Scan: Compression

Answer 15

seated, arms crossed. push down through shoulders

ID: fracture

Question 16

Thoracic Scan: Traction

Answer 16

seated, arms crossed, lift up

ID: disc/ligament

Question 17

Thoracic Scan: Breathing pattern

Answer 17

look at breathing, can put hands on ribs

Question 18

Thoracic Scan: Manubrial compression

Answer 18

pain provication

Question 19

Thoracic Scan: Upper sternal compression

Answer 19

pain provication

Question 20

Thoracic Scan: Lower sternal compression

Answer 20

pain provication

Question 21

Thoracic Scan: abdominal cutaneous relfex

Answer 21

pt in hooklying, drag sharp end of reflex hammer into belly button.
Look for asymmetry of inconsistency.
Upper: T6-10
Lower: T10-12

Question 22

Thoracic Scan: Beevor’s Sign

Answer 22

hooklying, pt lift head off pillow, look for deviation (will deviate away from dysfunction)

Question 23

Thoracic Scan: Aortic pulse

Answer 23

larger than 3 finger width, lack of normal lub-dub

Question 24

Thoracic Scan: Abdominal quadrant palpation

Answer 24

looking for rebound or pain

Question 25

Thoracic Scan: Sprin test

Answer 25

- PA of SP pt in prone | - Rib spring PA, pt in prone

Question 26

Thoracic Scan: Soft tissue spring

Answer 26

due to segmental innervation soft tissue changes will be along same level of dysfunction. "idiot light"

Question 27

Thoracic Tests: AROM

Answer 27

- Flexion, ext, rotation, SB | - in sitting, prone, prone pressup, arch/sag

Question 28

Thoracic Tests: Positional/motion testing

Answer 28

-Hands on TPs, pt flex/ext

Question 29

Thoracic tests: PIVM

Answer 29

-Flexion, extension, rot, SB

Question 30

Thoracic Test: PAIVM

Answer 30

combined motions: quadrants

Question 31

Thoracic Tests: Anterior translation

Answer 31

- Pt prone - Stabilize inferior vert - Cranial hand on TP give P>A force to superior vert. - Positive = excessive translation, clunk, crepitus

Question 32

Thoracic Tests: Rotational stability

Answer 32

- Pt prone - Stabilize inf vert at TP - Sprint opposite side of TP of superior vert to rotate the superior vert on inferior.

Question 33

Thoracic Tests: Posterior translation

Answer 33

- Pt sitting - P>A vert inferior to one being tested, block ribcage - essentially an A>P of sup vert

Question 34

Thoracic Tests: Lateral stress test

Answer 34

- pt sitting | - Palpate SP of inf vert, shear trunk toward PT

Question 35

Costal Cage Assessment: Key Rib

Answer 35

- Rib within a group of ribs that is limiting respiration of others - Will have both structural and respiratory rib dysfunction - Inhalation: key rib above - Exhalation: key rib below

Question 36

Costal Cage Assessment: Bony landmarks

Answer 36

Look for asymmetries

Question 37

Costal Cage Assessment: Passive overpressure

Answer 37

- Spring into internal torsion (flexion) | - Spring into external torsion (extension)