Thoracic Eval and Treat

Question 1

what are the 3 major areas of MSK dysfunction in the spine?

Answer 1

1) costo-vertebral joints
2) thoracolumbar junction
3) cervicothoracic junction

Question 2

which spinal levels are involved in pain from Pancoast tumor?

Answer 2

C8-T1

Question 3

which dermatome is affected with cholecystitis?

Answer 3

C4

Question 4

what are the 3 primary areas of neoplasm metastasis to the thoracic region?

Answer 4

breast
lung
colon

Question 5

what is the critical zone for spinal stenosis in thoracic region?

Answer 5

T4-T9

Question 6

what is Tietze’s syndrome?

Answer 6

inflammation of cartilage between ribs and sternum (costo- or sterno-chondral) following RTI

Question 7

where is disc pathology more common in t spine?

Answer 7

lower t spine

Question 8

suggested rx for thoracic disc pathology

Answer 8

axial distraction
mechanical traction

Question 9

T____ disc herniation radiate pain to lateral or anterior trunk

Answer 9

3-8

Question 10

T____ disc herniation radiate pain to buttocks and lumbosacral region

Answer 10

9-11

Question 11

rib dysfunction will have localized pain ____ cm from midline

Answer 11

3-4 cm

Question 12

rib dysfunction will have pain with …

Answer 12

coughing, sneezing, rotation, deep breathing

Question 13

MOI for thoracic vertebral fx

Answer 13

hyperflexion
axial loading

Question 14

S&S of thoracic vertebral fx

Answer 14

high and immediate pain
articular signs + ALL directions
+ compression test

Question 15

if you observe a pt with a flail chest and/or paradoxical breathing, what do you do?

Answer 15

call 911 - EMERGENT

Question 16

posterior dislocation of the ___ joint can be life-threating

Answer 16

sternoclavicular

Question 17

what is Scheuermann Disease?

Answer 17

juvenile kyphosis
defect in apophyseal ring of vertebral body causing anterior wedging

Question 18

what is a Schmorl node?

Answer 18

thoracic end plate cracked causing disc herniation

Question 19

what levels are involved with T4 syndrome?

Answer 19

T2-7
always T4

Question 20

S&S of T4 syndrome

Answer 20

• STOCKING GLOVE
• hypomobile 1 segment (rest normal)
• pain down posterior arm and anterior forearm/hand
• HA, neck pain, UE pain
• night pain in sidelying or supine
• TTP on bony landmarks
• (+) slump
• (+) ULTTs
• depress or prominent 1 segment

Question 21

thoracic outlet borders

Answer 21

1st thoracic rib
clavicle
superior border of scapula

Question 22

borders of the interscalene interval/triangle

Answer 22

anterior scalene (anterior)
middle scalene (posterior)
1st rib (inferior)

Question 23

neurogenic TOS is compression of ____ at ____

Answer 23

brachial plexus
interscalene triangle

Question 24

venous TOS is compression of ____ at ____

Answer 24

subclavian vein
costoclavicular junction structures

Question 25

how do you diff dx b/w 1st rib dysfunction and cervical radiculopathy?

Answer 25

1st rib dysfunction - NON-dermatomal pattern of pain

Question 26

what levels do 1st rib dysfunction symptoms come from?

Answer 26

medial plexus = C8-T1

Question 27

where is pain in 1st vs 2nd rib dysfunction?

Answer 27

1st - neck 2nd - shoulder

Question 28

S&S of 2nd rib dysfunction

Answer 28

posterior shoulder pain w/o shld hx (-) contractile testing (-) palpation of tendon insertions loss of full shoulder girdle elevation

Question 29

important part of acute phase specifically for thoracic region?

Answer 29

correct breathing

Question 30

what exercises done in acute phase can reinforce spinal stability?

Answer 30

scap squeezes

Question 31

in sub-acute phase, restore normal ____ and ____ posture and movement patterns

Answer 31

lumbo-pelvic and cervical

Question 32

which thoracic spinal motions are especially important to t spine ther ex?

Answer 32

extension and rotation

Question 33

t spine stability exercises should include what other joint?

Answer 33

shoulder

Question 34

what surgical approach is more commonly used in t spine?

Answer 34

POSTERIOR