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Thoracic Functional/Special Tests Flashcards

1
Q

Exam Components

A
  1. Pt Hx
  2. Systems Review (referred pain is common)
  3. Observation
  4. Scanning Exam
  5. ROM/Flexibility
  6. Muscle
  7. Palpation
  8. Joint Play
  9. Special Tests
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2
Q

Differential Diagnosis for Thoracic

A

-Visceral
-Serious Origin
-T-spine dysfunction
-Rib dysfunction

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3
Q

Pt Hx

A

-trauma
-breathing/smoking
-eating
-central vs lateral pain
-posture
-Heart issues

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4
Q

Systems Review

A

-visceral pain
-Take vitals
-UMN Signs

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5
Q

Observations

A

-Respiration
-Posture
-Spinal Curves
-Position of scapula
-Chest shapes

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6
Q

Spinal Observations

A

Dowager’s Hump
-anterior wedge vertebrae

Hump Back:
-1-2 anteriorly wedged vertebrae

Flat Back:
-dec lordosis and kyphosis

Pelvic Heights:
-obliquities

Scoliosis

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7
Q

Chest Observations

A

Barrel Chest:
-wise ant/post

Funnel Chest:
-dip in sternum

Pigeon Chest:
-protrusion in sternum

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8
Q

UQ and Thoracic Scan

A
  1. Vitals (HR and BP)
  2. Observation: posture, plumb line, head, face, neck, mouth
  3. CNs (optional)
  4. Respiratory Excursion
  5. Gait: look for gross abnormalities
  6. Clear the spine (Cervical and Thoracic)
  7. UE ROM: All 6 w/ overpressure
  8. Dermatomes (C4-L1)
  9. Myotomes (C5-T1)
  10. DTR: bicep, brachioradialis, tricep, Abdominal
  11. UMN Testing: Hoffman’s, Babinski, Lhermitte
  12. Upper Limb Tension Testing (Median)
  13. Pulses (carotid, axillary, brachial, radial, ulnar) (optional)
  14. Thyroid (optional)
  15. Chest Auscultation (optional)
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9
Q

LQ and Thoracic Scan

A
  1. Vitals***
  2. Observation: posture, plumb line
  3. Gait: look for gross abnormalities
  4. Functional MMts: squats***
  5. Balance Testing***
  6. Clear the spine**
  7. SI Joint Provocation**
  8. Myotomes: include functional testing (heel and toe walking)
  9. Dermatomes (T2-S1)
  10. DTR: patellar, med hamstring, Achilles
  11. UMN Testing: Babinski, clonus***
  12. Neurodynamic Testing: SLR, slump test**
  13. LE ROM: FABER, flx, DF/PF, toe flx/ext
  14. Pulses (optional)
  15. Lymph Nodes (optional)
  16. Chest Auscultationon
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10
Q

Respiratory Assessment: Superior Ribs

A
  1. Pt supine, PT behind head
  2. PT hands inferior to clavicle
  3. Instruct them to breathe in, hold it, then breathe in again

(+): expansion is asymmetrical, 1 rib rises when another doesn’t

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11
Q

Respiratory Assessment: Inferior Ribs

A
  1. Pt supine, PT on side
  2. PT hands in intercostal spaces of ribs of lateral rib cage
  3. Instruct them to breathe in, hold it, then breathe in again

(+): expansion is asymmetrical, 1 rib rises when another doesn’t

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12
Q

Thoracic AROM

A
  1. Pt is seated and arms crossed
  2. Flx/ext, SB, ROT, Qudrant (if needed)
  3. Resist in lengthened position if not painful, if painful, assess in neutral
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13
Q

Thoracic Spine ROM Norms

A

Total:
-Flx: 20-45
-Ext: 15-20
-Rot: 35-50
-SB: 25-45

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14
Q

T Spine Flexion/extension: Inclinometer

A

-flex 20-45 and ext 15-20
-c7

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15
Q

T Spine Lateral Flexion: Inclinometer

A

-25-45
-c7

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16
Q

UE ROM

A

-Cervical
-Shoulder, elbow, wrist, and fingers
-Thoracic

Flx/ext/abd/IR/ER

  1. AROM –> reproduction of local s/s
  2. AROM –> reproduction of remote s/s
  3. AROM –> no impact on s/s
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17
Q

LE ROM

A

-Flx/ext
-IR/ER
-ABD/ADD

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18
Q

Muscle Flexibility

A

-Pecs
-Lats
-Levator
-Cervical Extensors

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19
Q

Muscle Strength

A

-Serratus ant
-Rotator cuff
-Traps

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20
Q

Thoracic PA Springing

A

-C7-L1
1. Pt prone
2. Use hypothenar eminence on SP
3. Assess TP and press on Lamina

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21
Q

Thoracic PA Rib Springing

A

-T1-T12

  1. Pt Prone
  2. Use hypothenar eminence on Rib
22
Q

Thoracic AP Rib Springing

A

-T1-T7
-Only performed when Pt has anterior chest pain

  1. Pt supine
  2. Assess sternum (upper, mid, lower) or Costocartilage
23
Q

1st Rib Dysfunction Dx

A
  1. Height: 1/2 inch elevation
  2. (+) Spring test
  3. (+) Inc scalene tone ipsi
  4. (+) Cervical Rotation lateral flx test
24
Q

1st Rib Elevation Assessment

A

-palpate 1st rib posteriorly

(+): elevated if 1 side is 1/2 inch higher

25
1st Rib Spring Test
-Place webspace on 1st rib and SB ipsi
26
Cervical Rotation/Lateral Flexion Test
-for 1st rib 1. Pt in sitting 2. Head rot contra 3. Flex head (+): flx blocked when rotation is contra
27
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
28
2nd Rib Spring Test
1. Pt in sitting 2. PT facing away from Pt 3. Use pisiform on superior surface of 2nd rib 4. Provide inferior force
29
Palpation: Anterior Structures
-Sternum -Infrasternal angle -Ribs -Costal cartilage junction -Intercostal muscles -Abs -Aortic pulse
30
Palpation: Posterior Structures
-SPs -TPs -Costo-transverse joints -Ribs -Multifidi -Erectors
31
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
32
Palpation: Aortic Pulse
0= Absent 1= Faint 2+= Normal 4+= Bounding >3cm= wide
33
Compression Tests
1. Pt in sitting 2. PT behind with pressure through shoulders (+): provocation of s/s
34
Distraction Test
1. Pt in sitting w/ arms crossed 2. PT behind with arms wrapped around 3. Lift trunk (+): relief of s/s
35
Thoracic Outlet Syndrome Tests
(+): disappearance of pulse (+): Reproduction of neuro s/s
36
Treatment Prioritization
1. Manual Therapy 2. Mobility Exercises 3. Stabilization Exercises 4. Traction
37
Seated Cervico-Thoracic Juntion Manipulation
1. Pt in sitting at edge of mat toward PT 2. PT behind Pt w/ arms around PT w/ hands on forearm 3. Pt relaxes 4. PT leans back to take up slack and HVLAT
38
Prone Cervico-Thoracic Juntion Manipulation
-gapping of C7-T1 1. Pt in in prone w/ chin resting on table 2. PT in on contra side of treatment 3. PT has pisiform on TP of C7/T1 4. Pt head SB to contra, rotated to ipsi
39
Supine Thoracic Spine Gapping HVLAT
1. Pt supine close to PT 2. Pt interlaces fingers behind head (UPPER); Pt hugs shoulders (LOWER) 3. SB away from PT 4. Rotate towards PT 5. PT uses pistol grip on level of spine 6. PT rolls Pt back onto hand 7. Take up slack by telling them to take a deep breath and push down 8. Quick thrust
40
Prone Upper Thoracic Spine Gapping HVLAT
1. Pt in prone w/ arms by head 2. PT places both pisiforms on TPs of segment (check level) 3. Pt breathes in while PT pushes down to take up slack 4. Quick thrust
41
Prone Thoracic Spine Gapping HVLAT
1. Pt in prone w/ arms by head 2. PT places hands on SPs of segment (check level) 3. Arms locked out, take up slack in skin 4. Pt breathes in while PT pushes down to take up slack 4. Quick thrust
42
Supine Rib Gapping HVLAT
1. Pt supine close to PT 2. Pt interlaces fingers behind head (UPPER); Pt hugs shoulders (LOWER) 3. SB away from PT 4. Rotate towards PT 5. PT uses pistol grip on level of RIB 6. PT rolls Pt back onto hand 7. Take up slack by telling them to take a deep breath and push down 8. Quick thrust
43
Prone Rib Gapping HVLAT
1. Pt in prone w/ arms by head 2. PT places hands on RIB of segment (check level) 3. Arms locked out, take up slack in skin 4. Pt breathes in while PT pushes down to take up slack 4. Quick thrust
44
Prone Segmental PA Mobilization
1. Pt in prone 2. Hypothenars on SP of segment
45
Prone Rib PA Mobilization
1. Pt in prone 2. Hypothenars on costo-transverse joint of segment 3. PT provides ant/lat force
46
Seated 1st Rib Mobilization
1. Pt seated with arm on PT leg 2. PT behind Pt with contra leg up 3. PT stabilizes head ipsi 4. PT mobilizes 1st Rib with MCP toward contra hip
47
Seated 2nd Rib Mobilization
1. Pt in sitting 2. PT facing away from Pt 3. Use pisiform on superior surface of 2nd rib 4. Provide inferior force
48
Thoracic Outlet Syndrome
-aim of test to dec pulse or reproduce neurologic s/s -4 tests
49
Adson's Vascular Test
-TOS 1. Pt seated 2. Pt hold arm into 15deg of abduction 3. Pt asked to inhale and hold breath 4. Then extend head and rotate away 5. Check for dimished pulse or increased s/s
50
Costo-Clavicular Test
-TOS 1. Pt seated w/ arms at side 2. Pt retracts arms/shoulders and protrudes chest and hold for 60s 3. Check for dimished pulse or increased s/s
51
Hyperabuction Test
-TOS 1. Pt seated 2. Pt asked to turn away from tesing side 3. Pt asked to raise arm into hyperabd/ext for 1-2min 4. Check for dimished pulse or increased s/s
52
Roo's Test
-TOS 1. Pt seated w/ both arms in 90/90 2. Asked to open and close fingers for 3 min 3. Check for diminished pulse or inc s/s *stop test if s/s present*

MSK (48 decks)

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