Thoracic Evaluation Flashcards
General principles for thoracic evaluation
rule out cardiopulmonary or other gen med conditions
small number of special tests, so palpation most important
identification of involved structures
Compromised bone density
predisposition to fracture
lifestyle and occupation
if prolonged sitting, what is posture like? length of time?
occupational habits and posture
prolonged driving/electronic use
Questions relating to non-mechanical pathology
night pain
unexplained weight loss
hx of cancer
psychosocial factor
Lateral view
seated and standing
ear in relation to shoulder
curvature of cervical spine
amount of kyphosis
position of shoulders
Lateral view
seated and standing
ear in relation to shoulder
curvature of cervical spine
amount of kyphosis
position of shoulders
Lateral view
seated and standing
ear in relation to shoulder
curvature of cervical spine
amount of kyphosis
position of shoulders
posterior view
shoulder height scapula position presence of lateral curvature arm to trunk distance iliac crest height
posterior view
shoulder height scapula position presence of lateral curvature arm to trunk distance iliac crest height
posterior view
shoulder height scapula position presence of lateral curvature arm to trunk distance iliac crest height
Measurement of kyphosis
kyphometer-captures Cobb’s angle
Occiput to wall distance
normal to have occiput touch
distance of > 2-4 cm is significant
no extension of the head (ear and nose stay in line)
Prone palpations
spinous process alignment
transverse process
costotransverse mobilization
pa mobilization of spinous process
prone palpation of musculature
erector spinae multifidi lats rhomboids trapezius levator scapulae suboccipitals
costotransverse
the joint formed between the facet of the tubercle of the rib and the adjacent transverse process of a thoracic vertebra.
hypothenar eminence
Opponens Digiti Minimi
Origin - the hook of hamate and associated transverse carpal ligament
Insertion - Ulnar border of 5th metacarpal
Nerve - Deep branch of ulnar nerve (C8, T1)
Artery - Ulnar artery
Function - flex and laterally rotate the 5th metacarpal about the 5th carpometacarpal joint
Abductor digiti minimi
Origin - pisiform bone and the tendon of flexor carpi ulnaris
Insertion - the ulnar base of the proximal phalanx of the small finger
Nerve - Deep branch of ulnar nerve (C8, T1)
Artery - Ulnar artery
Function - abduction of the 5th finger, as well as flexion of its proximal phalanx
Flexor digiti minimi brevis
Origin - the hook of hamate and associated transverse carpal ligament
Insertion - the base of the proximal phalanx of the small finger
Nerve - Deep branch of ulnar nerve (C8, T1)
Artery - Ulnar artery
Function - flexes the little finger at the metacarpophalangeal joint
Palmaris brevis
Origin - the transverse carpal ligament
Insertion - on the skin of the medial palm
Nerve - Deep branch of ulnar nerve (C8, T1)
Artery - Ulnar artery
Function - tenses the skin of the palm on the ulnar side during a grip action and deepens the hollow of the palm
thenar eminence
Opponens Pollicis the largest of the 3 muscles
Origin - at the tubercle of the trapezium
Insertion - lateral margin of the metacarpal of the thumb
Nerve - recurrent branch of the median nerve
Artery - Superficial palmar arch from the radial artery
Function - performs opposition by flexing and medially rotating the metacarpal on the axis of the trapezium.
Abductor Pollicis Brevis positioned anteriorly to the opponens pollicis
Origin - tubercles of the scaphoid and trapezium
Insertion - lateral aspect of the proximal phalanx of the thumb
Nerve - recurrent branch of the median nerve
Artery - Superficial palmar arch from the radial artery
Function - primary muscle providing opposition. Also leads to abduction of the thumb which is drawing the thumb away from the midline
Flexor Pollicis Brevis
Origin - tubercle of the trapezium via the deep head, and the associated flexor retinaculum via the superficial head
Insertion - lateral aspect of the proximal phalanx of the thumb
Nerve - dual innervation with fibers from both the median ( superficial head) and ulnar ( deep head) nerves
Artery - branches of the radial artery; superficial palmar artery, branches of the princeps pollicis artery and radialis indicis artery
Function - flexion at the metacarpophalangeal and carpometacarpal joints leading to opposition of the thumb and, if continued, produces the medial rotation of thumb
supine palpation
costosternal junctions
costochondral junction
anterior ribs
anterior palpation of musculature
pec major pec minor subclavius SCM scalenes
AROM
Seated flexion
Seated extension: hands behind head
Seated rotation: arms across chest or behind head
rotation in lumbar locked position (quadruped)
seated lateral flexion (hands across chest)
MMT trunk flexion
hooklying position
perform abdominal curl with hands behind head- grade 5
hands across chest - grade 4
hands at side- grade 3
MMT trunk rotation
hooklying position
perform abdominal curl and bring shoulder towards opposite side
grading as same as trunk flexion
MMT trunk lateral flexion
sidelying
lift shoulders and trunk off table with hands behind head- grade 5
hands across chest -grade 4
hands at side- grade 3
MMT trunk extension
prone
lift head and shoulder off table with hands behind head- grade 5
hands behind back- grade 4
hands at side- grade 3
T1 dermatome
anteriormedial lateral forearm and arm to axilla
T2 dermatome
medial arm to the axilla
T4 dermatome
nipple line
T6 dermatome
xiphoid process
T 10 dermatome
umbilicus
Superficial abdominal reflex
stroke from lateral to medial in each of the four quadrants following dermatomal pathways and using the hand end of a reflex hammer
may be absent in 15% of the population
difficult to elicit in patients that are anxious, elderly, or obese
reflexes will fatigue/diminish on repeated testing
Adam’s forward bending test
scoliosis Pt stands with feet togerher, put hand together, bends straight forward (+) rib hump and or visible curvature indicates scoliosis rib hump on the convex side
Thoracic compression test
patient seated
apply axial load by pressing down on shoulders
(+) if reproduces pain
indicates discogenic pain or decreased foraminal space
thoracic foraminal closure test
patient seated
passively flex to one side
apply axial load by pressing down on shoulders
(+) if reproduces pain
indicates decreased intervertebral foraminal space
Anterior to posterior rib compression test
place hands on anterior and posterior rib cage and squeeze together
(+) pain or crepitus
indicates rib fracture
Lateral rib compression test
place hands on the side of the rib cage and squeeze together
(+) pain or crepitus
indicates rib fracture or costochondrol seperation
Postural conditions
scoliosis
hyperkyphosis
forward head posture
upper crossed syndrome
rib pathologies
contusion
fracture
costrotransverse/costovertebral
costochondritis
spinal pathologies
fracture
discogenic pain, stenosis, spondy, facet
Muscular pathologies
strain
trigger point
