Thoracic Eval & Treatment Flashcards
History: what type of pain may be provoked or alleviated by movement or posture?
Musculoskeletal pain
History: what type of pain may be provoked by respiration?
Rib or pleuritic pain
History: what type of pain may be provoked by eating or drinking?
Gastric pain
History: what type(s) of screen(s) should be conducted for patients with both T spine and chest wall complaints?
Neurological
Systemic disease
Referral patterns for visceral organs: Thorocolumbar
Male genitalia
Referral patterns for visceral organs: Thorocolumbar T10-L2
Bladder/ureter
Referral patterns for organs: Right T7-9
Liver, gall bladder
Referral patterns for organs: T2-4
Lung
Referral patterns for organs: Right mid/lower T spine
Appendix
Referral patterns for organs: T6-T10
Stomach
Referral patterns for organs: T10-L1
Kidney
Referral patterns for organs: T1-5
Heart
Non-musculoskeletal T spine pain sources
Malignancy, viscera, shingles, cardiac or pulmonary issues
Cancers that commonly metastasize to spine
Prostate Thyroid Breast Lungs Kidneys
Remember “PT Barney Loves Kids”
Also GI tract
Outcome measures for T spine
NDI above T4
ODI below T4
Upper rib motion
Anterior-posterior, “pump handle”
Ribs 1-4 or 5
Lower rib motion
Medial-lateral, “bucket handle”
Muscles contributing to respiratory dysfunction
Scalenes, intercostals, pec minor, serratus anterior, diaphragm, quadratus lumborum
Muscle attachments to ribs: scalenes
Ribs 1-2
Muscle attachments to ribs: pec minor
Ribs 3-5
Muscle attachments to ribs: serratus anterior
Ribs 3-9
Muscle attachments to ribs: diaphragm
Ribs 6-12
Muscle attachments to ribs: quadratus lumborum
Rib 12
What is an inhalation restriction?
Occurs when a rib or ribs do not rise with inhalation, but move freely with exhalation
Key rib is the uppermost affected rib
AKA exhalation dysfunction
What is an exhalation restriction?
Occurs when a rib or ribs do not lower with exhalation, but move freely with inhalation
Key rib is the lowermost affected rib
AKA inhalation dysfunction
Med conditions resulting in T spine pain: Cardiac pain
Pain from myocardium as a result of decreased bloodflow
Squeezing, sub-sternal sensation; tightness or pressure
Med conditions/diff dx: acute MI
Intolerable gripping or crushing sensation substernally; sweating, shortness of breath
Also sx in jaw, neck, left chest and arm
Send to ED ASAP
Med conditions/diff dx: Angina pectoris
Increased cardiac pn with exertion, relieved by rest
Physician referral
Med conditions/diff dx: Aortic dissection
Sudden, severe, unrelenting pain substernally or btwn scapulae; pt may be pale or cyanotic
BP usually normal, distal pulses diminished or absent
Send to ED ASAP
Med conditions/diff dx: pericarditis
Mild to severe chest pain aggravated by respiration, cough, motion, relieved by sitting and forward bending
Possible fever, chills, weakness, tachycardia, cough
Pn substernal, infrasternal, L upper trap
Med conditions/diff dx: Mitral valve prolapse
Sharp, stabbing pn; also can be dull pn
Chest pn, angina-like pn; non-exertional pn
Stethoscope: systolic non-ejection click, late holosystolic murmur
Physician referral
Med conditions/diff dx: Esophageal disorer
Mild to severe burning in epigastric or retro-sternal area
Pn often worse at night
C/o brackish taset, frequent belching
Pn diagram: horizontal band across chest or back, similar to radicular pn
Med conditions/diff dx: Tracheobronchial Pn
Pn referred to upper and lateral sternum
Med conditions/diff dx: Pleurisy
Sharp or stabbing pn at end of inspiration or exhalation
Pn felt over site of pleurisy or chest wall
Med conditions/diff dx: Pulmonary embolism
Use Wells criteria to dx, dyspnea and tachypnea also very common
High risk: unilateral extremity swelling and chest pn
Send to ED ASAP
Med conditions/diff dx: Cholecystitis
Pn typically occurs 1-2 hours after a meal
Pn peaks after 2-3 hours and resolves in 10 hours
Pn in upper right abdominal quadrant and/or right subscapular area
Fever, chills
Med conditions/diff dx: Peptic ulcer disease
Burning pn below xiphoid process or left upper abdominal quadrant
Frequent, consistent NSAID use
Possibly relief via antacid use
Med conditions/diff dx: Renal disease
Pn at costovertebral angle
Signs of UTI
Fever, chills, sweats
Physician referral
