Thoracic Lab Flashcards
Most rib injuries are related to what
Trauma
What is dowager’s hump
Many anteriorly wedged vertebrae
What is hump back
1-2 anteriorly wedged vertebrae
What is the Upper thoracic and lower thoracic
T1-T7
T8-T12
What respiratory assessment can u do for the ribs
Superior rib (pump handle movement)
Inferior ribs (bucket handle movement)
When doing thoracic ROM what test is helping u look for closing and opening restriction
Quadrant testing (just do over pressure dont resist)
If you are doing thoraciac AROM testing and there is pain with over pressure how do u test resisted testing
In neutral position
What do u test the flexibility - hypertoniciity of the levator scap and upper trap
flex , sb away and rotate away
Flex and sb away
How do u test the strength - inhibition/hypotonciity of
• Serratus Anterior
• Lower Trapezius
• Rotator Cuff Muscles
• Middle Trapezius
• Upper Trapezius
• Serratus Anterior- punch out
• Lower Trapezius- 135° abduction
• Rotator Cuff Muscles - IR/ ER
• Middle Trapezius- arms at 90° of abduction “T” position
• Upper Trapezius- shrug
If you are on the SP of T6 how would u find the TP
Go up Half a level
When do u perform the AP rib sprining joint mobility test (T1-T7)
Only performed when pt presents (+) for anterior chest pain
For rib dysfunctions, you will more often see what subluxation
Superior subluxation of 1st and 2nd ribs
How do you dx 1st rib dysfucntion (4)
- Height: 1⁄2 inch elevation superior is (+) sign
- (+) Spring Test
- (+) ipsilateral ↑ scalene tone
- (+) Cervical rotation lateral flexion test
How do u know if a rib is elevated
By palpating the 1st rib on each side and if one is 1/2 inch higher than the other
What do u do once u palpate 1st rib and u find that it is elevated (what test and how is the force)
Do spring test
Place webspace on 1st rib and SB patient head towards rib that is elevated
Forced applied shoudl be ant/med/inf
What are the 2 1st rib assessment test
1st rib spring test
Cervical rotation/lateral flexion test
How do u perform the cervical rotation/lateral flexion test for 1st rib assessment
Rotate head away from side being tested and flex eat to chest (assess bilaterally)
(+) if flexion blocked w head rotated contralterally ( so if u turn head to R and it is limited then it is the left rib)
How do u palpate second rib
Find 1st rib and then move 1 thumb width inferiorly and 45° lataterally
How do u do the 2nd rib spring test
Use pisform of 1 hand on superior surface of second rib and provide an inferior force
When palpating the abdomen how should ur hands be to be deeper
Vertical
What is included in the R UQ of the abdomen
liver, gallbladder, duodenum, pancreas and R kidney
V What is included in the R LQ of the abdomen
appendix, R ovary and tube
V What is included in the L LQ of the abdomen
sigmoid colon, L ovary and tube
V What is included in the L UQ of the abdomen
stomach, spleen, L kidney, pancreas
What is the normal and wide width of the aortic pulse
- Normal = 2-3 cm
- Wide = >3 cm
When would u palpate the aortic pulse
For older popele , pulmonary problems , or cardiac problem
If pain is provoked w aortic pulse what do u do
Contact phsician for possible AAA
What is a positive test for compression testing
Provocation/reporudction of pt SYMTOMS
What is a positive test for distraction testing
Relief/reduction of pt symptoms
What is a (+) test when performing TOS test
Either disappearance or diminish of pulse or reproduction of neurologic S/S
But mainly trying to reproduce s/s
What are the 3 test u could perform for TOS
- adsons vascular test
- Costco clavicular test
-Roo’s test
How do u perform the Adsons vascular test and what is a postivie test
- have pt arm in 15° of abduction and palpate radial pulse athen have patient hold breath and tilt head backwards and turn chin to affected side
(+)= decreased radial pulse and/or reproduction of UE neuro symptoms
How to perfomr the costo clavicular test and what is positive test
TOS
- pt sit w straight posture and palpate radial pulse then ask pt to retract and depress both shoulder while protruding chest t, hold x 60 secs
(+)= decreased radial pulse and/or reproduction of UE neuro symptoms
How to do Roo’s test and what is a positive sign
- pt seated w B arms in 90° shoulder abduction and 90° elbow flexion and then ask pt to open and blanch fingers into/out a fist. X 3 mins
(+)= decreased radial poulse and/or reproduction of UE neuro symptoms at ANY point during the test
If symptoms present , test stops immediately
What is the treatment prioritization for t spine
Manual therapy —> mobility exercises —> stbailility —> traction (if needed for pain control)
When do u use traction
If pain is still present and nothing else is working
What are indication for manual therapy (6)
• Mild MSK pain
• Joint hypomobility
• MSK condition w/ low irritability (Pain provoked w/ motion and Pain relieved w/ rest)
• Intermittent MSK pain
• Pain that is relieved or provoked w/ specific motions or positions
• Pain related to Δ’s in sitting or standing postures
What are the 3 goals of manual therapy techniques
- reduce pian
- alter stiffness
- pt education
What are the grades of oscillatory joint mobs
Grade 1- small amp (25%) , beg of avaiable joint play
Grade 2: large amp (mid 50%)
Grade 3: large amp (last 50) at end of joint play
Grade 4: small amp (last 25%) at end of joint pay
Grade 5: quick movmeemtn that exceeds resistance barrier
During the cervico thoracic junction manip there is a gappy where
C7-T1
How would u do a cervico thoracic junction manip to the R side
Place R hand on R TP of T1 and then SB pt head to the L and rotate slightly to the R and then take up slack by leaning onto R UE (on T1) and apply a quick downward (infeiror) thrust
For the supine thoracic spine gapping HVLAT if u are hitting upper t spine how should the pateitns hands be and what about lower t spine
Upper= interlaces fingers behind head
Lower= folds arms to hug shoulders
How do u lock out pt when doing supine thoracic spine gapping HVLAT
Side bend pt away from PT and then rotate pt toward PT
What direction is the thrust for the supine thoracic spine gappy HVLAT
Quick posterior thrust
What kind of force is being applied during a prone upper thoracic spine gapping HVLAT
Quick anterior thrust
How do u do the prone thoracic spine gapping HVLAT
Find SP that is hypomobility and then stand hands w elbows locked around the affected SP and then take up slack by provideing a constant anterior force and use the screw mechanisms and then apply a quick anterior thrust
Where is the PT pistol grip when doing a supine rib gappying HVLAT
On Costo transverse joint (slightly lateral to SP)
When would u use a grade 1 and 2 mob rather then a grade 3 or 4 mob
Grade 1 and 2= if patient has pain
Grade 3 adn 4= if patient is mainly stiff
Whar are the contras for manual therapy ( 16)
- systemic or localized infection
- Febrile state
- Acute circulatory condition
- Malignancy
- Open wound or sutures over/near tx site
- Recent fracture
- Osteoporosis
- Hematoma
- Hypersensitivity of skin
- Inappropriate end-feel
- RA (during exacerbation)
- Cellulitis
- Constant, severe pain
- Extensive radiation of pain
- Pt is afraid of/declines manual therapy treatment** main
- Advanced DM
