Thoracic Eval and Treat Flashcards
what are the 3 major areas of MSK dysfunction in the spine?
1) costo-vertebral joints
2) thoracolumbar junction
3) cervicothoracic junction
which spinal levels are involved in pain from Pancoast tumor?
C8-T1
which dermatome is affected with cholecystitis?
C4
what are the 3 primary areas of neoplasm metastasis to the thoracic region?
breast
lung
colon
what is the critical zone for spinal stenosis in thoracic region?
T4-T9
what is Tietze’s syndrome?
inflammation of cartilage between ribs and sternum (costo- or sterno-chondral) following RTI
where is disc pathology more common in t spine?
lower t spine
suggested rx for thoracic disc pathology
axial distraction
mechanical traction
T____ disc herniation radiate pain to lateral or anterior trunk
3-8
T____ disc herniation radiate pain to buttocks and lumbosacral region
9-11
rib dysfunction will have localized pain ____ cm from midline
3-4 cm
rib dysfunction will have pain with …
coughing, sneezing, rotation, deep breathing
MOI for thoracic vertebral fx
hyperflexion
axial loading
S&S of thoracic vertebral fx
high and immediate pain
articular signs + ALL directions
+ compression test
if you observe a pt with a flail chest and/or paradoxical breathing, what do you do?
call 911 - EMERGENT
posterior dislocation of the ___ joint can be life-threating
sternoclavicular
what is Scheuermann Disease?
juvenile kyphosis
defect in apophyseal ring of vertebral body causing anterior wedging
what is a Schmorl node?
thoracic end plate cracked causing disc herniation
what levels are involved with T4 syndrome?
T2-7
always T4
S&S of T4 syndrome
- 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
thoracic outlet borders
1st thoracic rib
clavicle
superior border of scapula
borders of the interscalene interval/triangle
anterior scalene (anterior)
middle scalene (posterior)
1st rib (inferior)
neurogenic TOS is compression of ____ at ____
brachial plexus
interscalene triangle
venous TOS is compression of ____ at ____
subclavian vein
costoclavicular junction structures
how do you diff dx b/w 1st rib dysfunction and cervical radiculopathy?
1st rib dysfunction - NON-dermatomal pattern of pain
what levels do 1st rib dysfunction symptoms come from?
medial plexus = C8-T1
where is pain in 1st vs 2nd rib dysfunction?
1st - neck
2nd - shoulder
S&S of 2nd rib dysfunction
posterior shoulder pain w/o shld hx
(-) contractile testing
(-) palpation of tendon insertions
loss of full shoulder girdle elevation
important part of acute phase specifically for thoracic region?
correct breathing
what exercises done in acute phase can reinforce spinal stability?
scap squeezes
in sub-acute phase, restore normal ____ and ____ posture and movement patterns
lumbo-pelvic and cervical
which thoracic spinal motions are especially important to t spine ther ex?
extension and rotation
t spine stability exercises should include what other joint?
shoulder
what surgical approach is more commonly used in t spine?
POSTERIOR
