Thoracic Pathologies

Question 1

Tiezete Syndrome

Answer 1

Inflammation of the costal cartilage

Anterior chest pain, usually over the 2nd and 3rd rib areas

Question 2

What is painful with Tiezete Syndrome?

Answer 2

Pain with breathing, sleeping on the affected side
Pain may radiate into the shoulder
Pain with lifting heavy items

Question 3

MOI for Tiezete Syndrome?

Answer 3

Physical strain

Repetitive coughing

Question 4

What should be ruled out with Tiezete Syndrome?

Answer 4

Myocardial infarction
Fractured ribs
Pleurisy
Pneumothorax

Question 5

Treatment of Tiezete Syndrome?

Answer 5

Treat the physical impairments that you find:
Rest
Mobilization

Question 6

Costochondritis

Answer 6

Local palpable pain at costal cartilage between sternum and ribs (without inflammation and swelling)

Question 7

Causes of Costochondritis:

Answer 7

upper respiratory infection, minor traumas, repetitive movements

Question 8

Clinical Signs and Symptoms of Costochondritis:

Answer 8

Pain with lying on ribs
Pain with deep breath
Pain with carrying heavy objects

Question 9

Interventions for Costochondritis:

Answer 9

Modalities for pain relief
Joint mobilization (rib mobilization, Thoracic spine mobilization)
Myofascial release
Postural education

Question 10

Thoracic Outlet Syndrome

Answer 10

A nerve compression “syndrome” of the upper quarter
Multiple sites of “entrapment” or “compression”
Not exactly sure what is happening
Controversial
Neurogenic vs Vascular condition
Most cases are neurogenic

Question 11

Sites of compression for Thoracic Outlet Syndrome:

Answer 11

Interscalene triangle
Costoclavicular Space
Thoraco-coraco-pectoral space

Question 12

Interscalene triangle

Answer 12

Compression between middle and anterior scalenes

Question 13

Costoclavicular Space

Answer 13

Area between the clavicle and first rib
Could be reduced with arm elevation – the clavicle needs to elevate and retract
Could produce increased compression

Question 14

Who is thoracic outlet seen in?

Answer 14

Seen in females more than males

20-50 year age range

Question 15

Signs and Symptoms of thoracic outlet:

Answer 15

Mild pain to sensory changes
Quality, location and timing of symptoms can vary
Doesn’t follow a dermatomal pattern

Question 16

Thoracic Outlet Intervention

Answer 16

Cyriax release manuever
Education: heavy/overhead lifting/postural
1st rib mobs
Mobility work stretching the scalene/1st rib
Diaphragmatic Breath
Mobilization to the ACJ and Glen humeral
Pectoralis stretching (pectoralis space)
Scapular muscle strengthening

Question 17

Thoraco-coraco-pectoral space

Answer 17

Coracoid process (superiorly)
Pectoralis Minor (anteriorly)
Ribs 2-4 posteriorly

Question 18

Onset of thoracic outlet?

Answer 18

Typically repetitive trauma
Could be insidious onset
Could be unilateral or bilateral
If bilateral anatomical abnormality

Question 19

2nd Rib Syndrome

Answer 19

Often misdiagnosed as a “shoulder impingement”
2nd Rib dysfunction may present with pain in the posterior shoulder region with arm movement or at rest; Pain with arm elevation

Question 20

Diagnosis of 2nd rib syndrome:

Answer 20

2nd rib or 3rd rib is painful on palpation

Limited mobility in the upper thoracic spine C7-T1 and ribs

Question 21

2nd Rib Intervention

Answer 21

2nd rib HLVA
Mobilization to the Upper Thoracic Spine
HLVA at T2-3 spine

Question 22

T4 Syndrome

Answer 22

Bilateral and unilateral upper extremity pain referral with paresthesia, mid thoracic hypomobility
Not very common condition

Question 23

Diagnosis T4 syndrome:

Answer 23

PA spring testing to T4 region

Question 24

Scapular Pain

Answer 24

The grey area between a shoulder problem and a thoracic problem
Pain between or around the scapulae

Question 25

Type I or Inferior Angle Dysfunction scapula :

Answer 25

Associated with anterior tipping of the scapula

Question 26

Type II: Medial Border Classification

Answer 26

Internal rotation of the scapula

Question 27

Type III: Superior Scapular Dysfunction:

Answer 27

Excessive and early elevation of the scapula.
Typically seen with insufficient rotator cuff
Increased/over active deltoid muscle

Question 28

Rib Strain

Answer 28

trauma that occurs to the ribcage
subluxation of a rib either posteriorly or anteriorly
Pain with a coughing or sneezing
Pain with palpation of the costotransverse joints

Question 29

Snapping Scapula

Answer 29

Feeling of crepitus when moving the scapula
Retraction
Protraction

Question 30

What is snappy scapula associate with?

Answer 30

Associated with winging scapula
Associated with shoulder pain/impingement
Associated with overhead throwing activities