Thoracic Functional/Special Tests Flashcards
Exam Components
- Pt Hx
- Systems Review (referred pain is common)
- Observation
- Scanning Exam
- ROM/Flexibility
- Muscle
- Palpation
- Joint Play
- Special Tests
Differential Diagnosis for Thoracic
-Visceral
-Serious Origin
-T-spine dysfunction
-Rib dysfunction
Pt Hx
-trauma
-breathing/smoking
-eating
-central vs lateral pain
-posture
-Heart issues
Systems Review
-visceral pain
-Take vitals
-UMN Signs
Observations
-Respiration
-Posture
-Spinal Curves
-Position of scapula
-Chest shapes
Spinal Observations
Dowager’s Hump
-anterior wedge vertebrae
Hump Back:
-1-2 anteriorly wedged vertebrae
Flat Back:
-dec lordosis and kyphosis
Pelvic Heights:
-obliquities
Scoliosis
Chest Observations
Barrel Chest:
-wise ant/post
Funnel Chest:
-dip in sternum
Pigeon Chest:
-protrusion in sternum
UQ and Thoracic Scan
- Vitals (HR and BP)
- Observation: posture, plumb line, head, face, neck, mouth
- CNs (optional)
- Respiratory Excursion
- Gait: look for gross abnormalities
- Clear the spine (Cervical and Thoracic)
- UE ROM: All 6 w/ overpressure
- Dermatomes (C4-L1)
- Myotomes (C5-T1)
- DTR: bicep, brachioradialis, tricep, Abdominal
- UMN Testing: Hoffman’s, Babinski, Lhermitte
- Upper Limb Tension Testing (Median)
- Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
- Thyroid (optional)
- Chest Auscultation (optional)
LQ and Thoracic Scan
- Vitals***
- Observation: posture, plumb line
- Gait: look for gross abnormalities
- Functional MMts: squats***
- Balance Testing***
- Clear the spine**
- SI Joint Provocation**
- Myotomes: include functional testing (heel and toe walking)
- Dermatomes (T2-S1)
- DTR: patellar, med hamstring, Achilles
- UMN Testing: Babinski, clonus***
- Neurodynamic Testing: SLR, slump test**
- LE ROM: FABER, flx, DF/PF, toe flx/ext
- Pulses (optional)
- Lymph Nodes (optional)
- Chest Auscultationon
Respiratory Assessment: Superior Ribs
- Pt supine, PT behind head
- PT hands inferior to clavicle
- Instruct them to breathe in, hold it, then breathe in again
(+): expansion is asymmetrical, 1 rib rises when another doesn’t
Respiratory Assessment: Inferior Ribs
- Pt supine, PT on side
- PT hands in intercostal spaces of ribs of lateral rib cage
- Instruct them to breathe in, hold it, then breathe in again
(+): expansion is asymmetrical, 1 rib rises when another doesn’t
Thoracic AROM
- Pt is seated and arms crossed
- Flx/ext, SB, ROT, Qudrant (if needed)
- Resist in lengthened position if not painful, if painful, assess in neutral
Thoracic Spine ROM Norms
Total:
-Flx: 20-45
-Ext: 15-20
-Rot: 35-50
-SB: 25-45
T Spine Flexion/extension: Inclinometer
-flex 20-45 and ext 15-20
-c7
T Spine Lateral Flexion: Inclinometer
-25-45
-c7
UE ROM
-Cervical
-Shoulder, elbow, wrist, and fingers
-Thoracic
Flx/ext/abd/IR/ER
- AROM –> reproduction of local s/s
- AROM –> reproduction of remote s/s
- AROM –> no impact on s/s
LE ROM
-Flx/ext
-IR/ER
-ABD/ADD
Muscle Flexibility
-Pecs
-Lats
-Levator
-Cervical Extensors
Muscle Strength
-Serratus ant
-Rotator cuff
-Traps
Thoracic PA Springing
-C7-L1
1. Pt prone
2. Use hypothenar eminence on SP
3. Assess TP and press on Lamina
Thoracic PA Rib Springing
-T1-T12
- Pt Prone
- Use hypothenar eminence on Rib
Thoracic AP Rib Springing
-T1-T7
-Only performed when Pt has anterior chest pain
- Pt supine
- Assess sternum (upper, mid, lower) or Costocartilage
1st Rib Dysfunction Dx
- Height: 1/2 inch elevation
- (+) Spring test
- (+) Inc scalene tone ipsi
- (+) Cervical Rotation lateral flx test
1st Rib Elevation Assessment
-palpate 1st rib posteriorly
(+): elevated if 1 side is 1/2 inch higher
1st Rib Spring Test
-Place webspace on 1st rib and SB ipsi
Cervical Rotation/Lateral Flexion Test
-for 1st rib
- Pt in sitting
- Head rot contra
- Flex head
(+): flx blocked when rotation is contra
2nd Rib Elevation Assessment
-palpate 1st rib
-move thumbs done 1 thumb length and 45 deg laterally
-NOT on scap
(+): elevated if 1 side is 1/2 inch higher or more posterior
2nd Rib Spring Test
- Pt in sitting
- PT facing away from Pt
- Use pisiform on superior surface of 2nd rib
- Provide inferior force
Palpation: Anterior Structures
-Sternum
-Infrasternal angle
-Ribs
-Costal cartilage junction
-Intercostal muscles
-Abs
-Aortic pulse
Palpation: Posterior Structures
-SPs
-TPs
-Costo-transverse joints
-Ribs
-Multifidi
-Erectors
Palpation: Abdomen
-superficial to deep
RUQ: Liver, gallbladder, pancreas, R kidney
LUQ: stomach, spleen, L kidney, pancreas
RLQ: appendix, R ovary
LLQ: Sigmoid colon, L ovary
Palpation: Aortic Pulse
0= Absent
1= Faint
2+= Normal
4+= Bounding
> 3cm= wide
Compression Tests
- Pt in sitting
- PT behind with pressure through shoulders
(+): provocation of s/s
Distraction Test
- Pt in sitting w/ arms crossed
- PT behind with arms wrapped around
- Lift trunk
(+): relief of s/s
Thoracic Outlet Syndrome Tests
(+): disappearance of pulse
(+): Reproduction of neuro s/s
Treatment Prioritization
- Manual Therapy
- Mobility Exercises
- Stabilization Exercises
- Traction
Seated Cervico-Thoracic Juntion Manipulation
- Pt in sitting at edge of mat toward PT
- PT behind Pt w/ arms around PT w/ hands on forearm
- Pt relaxes
- PT leans back to take up slack and HVLAT
Prone Cervico-Thoracic Juntion Manipulation
-gapping of C7-T1
- Pt in in prone w/ chin resting on table
- PT in on contra side of treatment
- PT has pisiform on TP of C7/T1
- Pt head SB to contra, rotated to ipsi
Supine Thoracic Spine Gapping HVLAT
- Pt supine close to PT
- Pt interlaces fingers behind head (UPPER); Pt hugs shoulders (LOWER)
- SB away from PT
- Rotate towards PT
- PT uses pistol grip on level of spine
- PT rolls Pt back onto hand
- Take up slack by telling them to take a deep breath and push down
- Quick thrust
Prone Upper Thoracic Spine Gapping HVLAT
- Pt in prone w/ arms by head
- PT places both pisiforms on TPs of segment (check level)
- Pt breathes in while PT pushes down to take up slack
- Quick thrust
Prone Thoracic Spine Gapping HVLAT
- Pt in prone w/ arms by head
- PT places hands on SPs of segment (check level)
- Arms locked out, take up slack in skin
- Pt breathes in while PT pushes down to take up slack
- Quick thrust
Supine Rib Gapping HVLAT
- Pt supine close to PT
- Pt interlaces fingers behind head (UPPER); Pt hugs shoulders (LOWER)
- SB away from PT
- Rotate towards PT
- PT uses pistol grip on level of RIB
- PT rolls Pt back onto hand
- Take up slack by telling them to take a deep breath and push down
- Quick thrust
Prone Rib Gapping HVLAT
- Pt in prone w/ arms by head
- PT places hands on RIB of segment (check level)
- Arms locked out, take up slack in skin
- Pt breathes in while PT pushes down to take up slack
- Quick thrust
Prone Segmental PA Mobilization
- Pt in prone
- Hypothenars on SP of segment
Prone Rib PA Mobilization
- Pt in prone
- Hypothenars on costo-transverse joint of segment
- PT provides ant/lat force
Seated 1st Rib Mobilization
- Pt seated with arm on PT leg
- PT behind Pt with contra leg up
- PT stabilizes head ipsi
- PT mobilizes 1st Rib with MCP toward contra hip
Seated 2nd Rib Mobilization
- Pt in sitting
- PT facing away from Pt
- Use pisiform on superior surface of 2nd rib
- Provide inferior force
Thoracic Outlet Syndrome
-aim of test to dec pulse or reproduce neurologic s/s
-4 tests
Adson’s Vascular Test
-TOS
- Pt seated
- Pt hold arm into 15deg of abduction
- Pt asked to inhale and hold breath
- Then extend head and rotate away
- Check for dimished pulse or increased s/s
Costo-Clavicular Test
-TOS
- Pt seated w/ arms at side
- Pt retracts arms/shoulders and protrudes chest and hold for 60s
- Check for dimished pulse or increased s/s
Hyperabuction Test
-TOS
- Pt seated
- Pt asked to turn away from tesing side
- Pt asked to raise arm into hyperabd/ext for 1-2min
- Check for dimished pulse or increased s/s
Roo’s Test
-TOS
- Pt seated w/ both arms in 90/90
- Asked to open and close fingers for 3 min
- Check for diminished pulse or inc s/s
stop test if s/s present
