Thoracic/Ribs

Question 1

Rule of 3s: thoracic landmarks

Answer 1

T1-3: SP same level as TP
T4-6: SP 1/2 level below TP
T7-9: SP 1 level below TP
T10-12: same level

Question 2

Disc height to vertebral body size

Answer 2

Smaller discs in thoracic region than lumbar or cervical,

This contributes to decreased motion in thoracic region

Question 3

True ribs vs false vs floating

Answer 3

Ribs 1-7 are true ribs with sternal attachments
Ribs 8-12 are “false”
Ribs 11, 12 are floating, with no anterior attachment

Question 4

Rib movement during breathing

Answer 4

upper rib cage rises in sagittal plane

lower ribs widen in frontal plane

Question 5

Thoracic level of “critical zone”

Answer 5

T4-9

Decreased blood flow, narrower spinal canal

stiffness here can have widespread effect

Question 6

Zygoaphophaseal joint pain referral

Answer 6

Most likely distal than proximal.

most intense symptoms one segment below and slightly lateral

Question 7

What motions tension the sympathetic chain

Answer 7

flexion, contralateral SB/rot

Question 8

Due to location of sympathetic chain, manipulation of what region may improve s/s of altered neurodynamics

Answer 8

Middle thoracic

Question 9

s/s of T4 syndrome

Answer 9

HA, neck pain UE pain, BUE “stocking glove” parasthesia—

Manipulation of T4 region may improve conductivity of hands

Question 10

What may be reason for T4 syndrome

Answer 10

influence of middle thoracic region on sympathetic nervous system

Question 11

What region of Tspine are flexion impairments more common

Answer 11

upper/middle.

T3-6

Question 12

postural sign of Tspine flexion impairment

Answer 12

reduction of kyphosis, often following whiplash injury

Question 13

What type of injury may lead to flexion impairment of upper tspine

Answer 13

whiplash

Question 14

Where are Tspine extension impairments most common

Answer 14

CTJ

Question 15

postural sign of Tspine extension impairment

Answer 15

Increased kyphosis

Question 16

s/s of dissecting thoracic aneurysm

Answer 16

chest pain, may radiate to back.
Sudden onset
unrelenting
not relieved with position change

Question 17

CPR to rule in/out CAD

Answer 17

• Age >65 (55 for men)
• Known CVD
• Pain worse with exercise
• not reproduceable with palpation
• Patient believes cardiac origin

2 predictor variables met, Sn of .98

3 predictor variables met, Sn .87, Sp .8, +LR 4.52

Question 18

Thoracic pain triggered or relieved by eating may be sign of?

Answer 18

peptic ulcer

Question 19

Where would inflammed gall bladder pain refer?

Answer 19

right upper quadrant and infrascapular region

Question 20

Ankylosing spondylitis CPR

Answer 20

• stiffness of greater than 30 min
• improvement with exercise, not rest
• awakening due to pain in 2nd half of night only
• alternating buttock pain

2 met= Sn.7, Sp.81
3 met=Sn.33, Sp.94

Question 21

Chest expansion values

Answer 21

Normal: 5cm at nipple

Less than 2.5cm considered pathological

Question 22

Key physical characteristic of ankylosing spondylitis

Answer 22

decreased chest expansion

Question 23

Risk of vertebral fx with osteopenia?

Answer 23

relatively low, but should be considered

Question 24

What motion occurs with serratus anterior activation with UE fixed?

Answer 24

posterior translation of rib

Question 25

What treatment should be considered for acute/irritable cervical condition

Answer 25

T/s manipuation

Question 26

Potential predictors for shoulder pain improving with t/s manip? (4 items)

Answer 26

• pain free flexion of 127 or less
• GH IR of less than 53
• not on pain meds for shoulder
• negative neer