Thoracic region Flashcards
Upper limb tension test A
(Median nerve bias)
Patient supin.
Practitioner passively depresses patients shoulder and abducts arm to 110 degrees. Externally rotate arm at shoulder joint.
Extend arm at humero-ulnar joint, supinate forearm, extend wrist and fingers.
Contralateral then ipsilateral cervical sidebending can also be introduced to further tension the nerve Positive test: reproduction of radicular/neurological symptoms in the median nerve distribution. Contralateral c-sp lateral flexion or rotation may increase symptoms, ipsilateral may decrease
Upper limb tension test B
(Radial nerve bias)
Patient supine.
Practitioner passively depresses patients shoulder complex, and abducts arm to 10 degrees.
Pronate forearm, internally rotate shoulder, extend arm at humero-ulnar joint. Flex wrist with ulnar deviation, flex fingers.
Contralateral then ipsilateral cervical sidebending may also be added to further tension the nerve. Positive test: reproduction of radicular/neurological symptoms in radial distribution.
Contralateral csp lateral flexion or rotation may increase symptoms, ipsilateral may decrease symptoms. Deep held inhalation may also further increase nerve compression.
Upper limb tension test C
(Ulnar nerve bias)
Patient supin.
Practitioner passively depresses patients shoulder and abducts arm to 90 degrees Internally rotate shoulder, fully flex elbow joint.
Extend radially deviated wrist to approximate hypothenar eminence to approximate ipsilateral external occipital protuberance with digiti minimi pointing inferiorly.
(ie patient to place palm of hand over same side ear with fingers facing their feet)
Contralateral c-sp lateral flexion or rotation may increase symptoms, ipsilateral may decrease symptoms. Deep held inhalation may also further sensitize test.
Adson’s Test
Thoracic outlet syndrome tests (TOS)
Test to indicate compression of the neurovascular bundle at the thoracic outlet. Compression can occur between the scalenes, under the clavicle, under a cervical rib or subclavius muscle. Has high sensitivity but low specificity. (Malanga et al 2003)
Patient seated.
Practitioner locates radial pulse at the wrist and continues to monitor pulse throughout test.
Practitioner externally rotates and extends patients 90 degree abducted arm. Patient actively ipsilaterally rotates and head with c-sp flexion whilst deeply inhaling.
Diminished pulse and/or reproduction of neurological symptoms is a positive test.
Brachial plexus compression test
Thoracic outlet syndrome tests (TOS)
Test to assist diagnosis of neuropathy from brachial plexus compression.
Practitioner stands behind seated patient, and applies compression through the trapezius and mid clavicle to compress the brachial plexus towards the 1st rib
Pain in the shoulder or UEX is a positive test.
Need to know articulation technques to improve segmental ROM for the following (4)
Flexion
Extension
Sidebending - usually seated position
Rotation - usually seated position
What is Scheuermann’s disease?
A deformity in the thoracic or thoracolumbar spine in children resulting in wedged vertebral bodies and multiple herniations of nucleus pulposus (Smorl’s Nodes)
Technique to improve segmental extension
Spinal springing articulation
- use reinforced hyperthenar eminence over SP
Articulation to improve thoracic flexion
Patients arms are crossed and resting on shoulders.
Use patients elbows as levels to encourage flexion.
Articulation to improve thoracic extension
Use some anterior thumb pressure on SP to enhance extension.
Technique to improve segmental sidebending articulation for the thoracic spine
Different arm positions possible.
Use thumb on SP as patient side-bends.
which ribs are atypical and what does this mean?
they only have one costa-vertebral articulation though a uni-facet. Other ribs have two attachments, one on the vertebral body, and one on the TP.
what are the muscles of inspiration?
external intercostalis, serratus anterior/ posterior superior, scalenes, levator costarium, SCM, pectoralis, Q.L. by fixing the 12th rib (provides a stable border for the descending diaphragm)
what are the muscles of expiration?
recoil of the diaphragm, internal intercostalis, transversus thoracics, serratus posterior inferior, lat. dorsalis, Iliocostalis lumborum, longissimus thoracics, subcostalis, Q.L., plus abodominal muscles in forced exhalation.
what is the direction of the ribs (11, 12) that do calliper movements?
inspiration ; posterior and lateralexhalation ; anterior and medial
