Thoracic Pathologies Flashcards
Tiezete Syndrome
Inflammation of the costal cartilage
Anterior chest pain, usually over the 2nd and 3rd rib areas
What is painful with Tiezete Syndrome?
Pain with breathing, sleeping on the affected side
Pain may radiate into the shoulder
Pain with lifting heavy items
MOI for Tiezete Syndrome?
Physical strain
Repetitive coughing
What should be ruled out with Tiezete Syndrome?
Myocardial infarction
Fractured ribs
Pleurisy
Pneumothorax
Treatment of Tiezete Syndrome?
Treat the physical impairments that you find:
Rest
Mobilization
Costochondritis
Local palpable pain at costal cartilage between sternum and ribs (without inflammation and swelling)
Causes of Costochondritis:
upper respiratory infection, minor traumas, repetitive movements
Clinical Signs and Symptoms of Costochondritis:
Pain with lying on ribs
Pain with deep breath
Pain with carrying heavy objects
Interventions for Costochondritis:
Modalities for pain relief
Joint mobilization (rib mobilization, Thoracic spine mobilization)
Myofascial release
Postural education
Thoracic Outlet Syndrome
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
Sites of compression for Thoracic Outlet Syndrome:
Interscalene triangle
Costoclavicular Space
Thoraco-coraco-pectoral space
Interscalene triangle
Compression between middle and anterior scalenes
Costoclavicular Space
Area between the clavicle and first rib
Could be reduced with arm elevation – the clavicle needs to elevate and retract
Could produce increased compression
Who is thoracic outlet seen in?
Seen in females more than males
20-50 year age range
Signs and Symptoms of thoracic outlet:
Mild pain to sensory changes
Quality, location and timing of symptoms can vary
Doesn’t follow a dermatomal pattern
Thoracic Outlet Intervention
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
Thoraco-coraco-pectoral space
Coracoid process (superiorly) Pectoralis Minor (anteriorly) Ribs 2-4 posteriorly
Onset of thoracic outlet?
Typically repetitive trauma
Could be insidious onset
Could be unilateral or bilateral
If bilateral anatomical abnormality
2nd Rib Syndrome
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
Diagnosis of 2nd rib syndrome:
2nd rib or 3rd rib is painful on palpation
Limited mobility in the upper thoracic spine C7-T1 and ribs
2nd Rib Intervention
2nd rib HLVA
Mobilization to the Upper Thoracic Spine
HLVA at T2-3 spine
T4 Syndrome
Bilateral and unilateral upper extremity pain referral with paresthesia, mid thoracic hypomobility
Not very common condition
Diagnosis T4 syndrome:
PA spring testing to T4 region
Scapular Pain
The grey area between a shoulder problem and a thoracic problem
Pain between or around the scapulae
Type I or Inferior Angle Dysfunction scapula :
Associated with anterior tipping of the scapula
Type II: Medial Border Classification
Internal rotation of the scapula
Type III: Superior Scapular Dysfunction:
Excessive and early elevation of the scapula.
Typically seen with insufficient rotator cuff
Increased/over active deltoid muscle
Rib Strain
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
Snapping Scapula
Feeling of crepitus when moving the scapula
Retraction
Protraction
What is snappy scapula associate with?
Associated with winging scapula
Associated with shoulder pain/impingement
Associated with overhead throwing activities
