Thoracic and TOS Special Test Flashcards
What is the purpose of Upper Thoracic Forward Bending PIVM?
This test is used to evaluate the passive forward-bending segmental motion of the thoracic segments C7-T1 through T3-T4
What is the procedure for Upper Thoracic Forward Bending PIVM?
The pad of the long finger on the left hand is used to palpate the interspinous space of the C7-T1 segment. The right hand is used to passively forward bend the patients head and neck.
- The PT palpates for the C7-T1 interspinous space to expand with forward bending by palpating the relative amount of movement of the superior spinous process of the spinal segment in relation to the inferior spinous process.
- The amount of forward bending of the head and neck are moved with small oscillations to avoid excessive movement of the patients neck, which may be painful with large movements
What is the purpose for Upper Thoracic Region PIVM?
To evaluate the passive rotation of thoracic segments C7-T1 through T3-T4
What is the procedure of Upper Thoracic Region PIVM?
The pad of the thumb on the right hand is used to palpate the right lateral aspect of the interspinous space of the C7-T1. Left rotation is induced with the left hand passively rotating the patients head to the left
- The amount of rotation of the head and neck is increased as the assessment moves caudally. The PT should try to move the head and neck as little as possible during the performance of this technique because the patients often have neck pain.
- If the Cervical Spine is hypomobile, positioning the cervical spine in a particular forward bent position can take up the slack
What is the purpose of Central Posteroanterior PAIVM?
This is for passive accessory motion and pain provocation of the thoracic spinal segments.
- Assess joint mobility and reactivity
- For intervention, one should use the appropriate grade of movement (I - IV) for treatment of pain or hypomobility
What is the procedure for Central Posteroanterior PAIVM?
The PT applies a PA force on each spinous process being examined for a total of three slow repetitions. The first pressures should be applied gently; amplitude and depth of the movement are increased if no pain response occurs
- PT assess the quality of movement and the EF and compares with the levels above and below.
- A midrange of movement trust (Spring test) could also be used with this technique for assessment of tissue resistance and pain provocation.
- A (+) response is movement that reproduces the comparable sign (Pain or resistance or muscle guarding).
What is the purpose of Posteroanterior Forward-Bending (Transverse Process of same vertebra) PAIVM?
To assess passive forward bending motion and the level of reactivity (pain provocation) of thoracic segments T3-T4 through T11-T12
What is the procedure of Posteroanterior (Transverse Process of same vertebra) PAIVM {Forward bend}?
The index finger and thumb of the cranial hand gently pinch the lateral edges of spinous process of T2. The second and third digit of the caudal hand are placed lateral to the spinous process (dummy fingers) this position places them over the transverse process of T3.
- Th volar aspect is then put over the dummy fingers and gives an impulse.
- A (+) pain provocation test may indicate reactivity of the facet joint and surrounding soft tissue.
What is the purpose of Posteroanterior Rotation (Transverse processes of adjacent Vertebrae) PAIVM?
To assess the passive motion and level of reactivity of thoracic segments T3-T4 through T11-T12
- Mobility and pain provocation are tested
What is the procedure for Posteroanterior Rotation (Transverse processes of adjacent Vertebrae) PAIVM?
The PT stands on the patients right side and places the second digit of the caudal hand approximately a fingers width to the right of the spinous process of T4, which positions the finger over the right transverse process of T5, the third digit is place on the left transverse process of T6, and these will be the dummy fingers.
- The volar aspect of the other hand will go over the dummy fingers and give an impulse, inducing left rotation.
“The direction of the rotation of the spinal segments is the same as the side of the lower finger”
What is the procedure for First Rib Accessory Motion (Spring) Test?
The PT uses their radial aspect of the index finger and MCP joint to palpate 1st rib.
- The PT side bends the head and neck toward the side tested to place the scalene muscle on slack and then take up the tissue slack and gives a slight spring to assess the mobility.
- Any stiffness or tenderness is noted, and right and left side are compared. This evaluation can also be a pain provocation test.
- This assesses the mobility of the first costovertebral, costotransverse and sternocostal joints.
What is the purpose of Adson’s Maneuver?
To determine whether there is a vascular compromise or peripheral nerve irritation occurring at the Thoracic Outlet
What is the procedure for Adson’s Maneuver?
The patient is asked to take and hold a deep inhalation as he fully extends the neck and rotates the head toward the side being examined. The therapist palpates the radial pulse and ask the patient if the maneuver replicates the patients UE symptoms.
- A (+) test for vascular compromise is reduction or ablation of the radial pulse. Reproduction of symptoms is associated with a neurogenic sTOS.
- This test is designed to implicate the anterior scalene muscles role in obliterating the pulse when the muscle is full elongated
What is the purpose of Hyperabduction Maneuver?
To determine if there is vascular compromise or brachial plexus nerve irritation at the Thoracic Outlet
What is the procedure for Hyperabduction Maneuver?
The test arm is positioned in 30-40° of elbow flexion and is passively abducted to 30°, 60°, 90° and 180° with documentation of the angle at which the radial pulse is abolished and the angle at which the patients symptoms are reproduced.
- A (+) test for vascular compromise is reduction or ablation of the radial pulse. Reproduction of symptoms is associated with a neurogenic sTOS.
What is the procedure for Roos Stress Test?
The patients positions his arms at 90° of shoulder abduction and full shoulder ER with the elbows flexed at 90°. The patient is then requested to flex and extend the fingers for up to 3 minutes.
- The test is (+) if the patient is unable to maintain the test position for 3 minutes by demonstrating a dropping extremity that could indicate fatigue or arterial compromise.
- The PT should observe the color of the distal extremity comparing left to right and monitor the time of onset of symptoms
