Thoracic spine Flashcards
special questions
deep breath/ cough sneeze/ SOBOE (use of inspiratory muscles, raise intraabdominal pressure), eating/drinking- could be visceral pain, stress (more stress=more pain= more stimulate CNS), lying down, positional changes, night symptoms, bone density tests- osteoporosis, menstrual history
special questions- continued
loss of height- kyphosis, osteoporosis (often 50+), family history (cancer, rheumatoid), young adults/ teens post growth spurt- change in body mechanics, blood tests- calcium deficiency, drug history- immunosuppressants/ steroid, rash, severe stiffness, general feeling of malaise, recent fracture
objective assessment
obs- postural alignment, asymmetry- spine shape, functional demonstration, AROM/PROM (look for quality, range, end feel)- deep breathing, muscle length tests- scanes, SCM
PAIVIMS
PA, transverse, unilateral over ZA jts, unilateral over CT junctions, unilateral over rib angles
PPIVMs
patient place arms across chest, palpate Tx, place other arm across their arms, rotated towards, flex forward, or place arm under theirs to ext
Roos stress test
head in neutral, arms in GH abd and LR to 90°, elbow flexed to 90°, flex and ext fingers for 3x1 mins, monitor symptoms whilst observing for dropping of arms +/- cyanosis
adsons test
abd with supination, cx rotation same way, ext neck and hold breath, positive is obliteration of radial pulse (hold pulse throughout)
muscle strength test
scalenes, pec major/minor
MWM’s
same technique as PPIVMS, patient sit near end of bed and with legs off the bed, therapist behind patient
palpate SP with pisiform
what is thoracic outlet syndrome
a group of disorders that occur when blood vessels or nerves in the space between collarbone and first rib (thoracic outlet) are compressed. this can cause pain in Sh and neck and numbness in your fingers.
causes of TOS
physical trauma from a car accident, repetitive injuries from job or sports related activity, pregnancy
S and S TOS
muscle wasting in the fleshy base of your thumb, numbness or tingling in your arms or fingers, pain or aches in neck, Sh or hand, weakening grip
first narrowing area TOS
inter-scalene triangle- boarded by anterior scalene muscle anteriorly, the middle scalene muscle posteriorly and the medial surface of first rib inferiorly. the fact that both scalenes muscles insert onto the first rib (can cause overlapping)- leads to compression o brachial plexus and subclavian artery
second passageway- TOS
costoclavicular triangle bordered anteriorly by the middle third of the clavicle, posteromedially by the first rib, and posterolaterally by the upper boarder of the scapula. subclavian vein, artery and brachial plexus. compression of these structures can occur due to congenital abnormalities, trauamt. first rib or clavicle, structural changes in the subcalvian muscle or the costocoracoid lig
third passageway- TOS
sub-pectoralis minor space- beneath the coracoid process and just under pec minor tendon. shortening of pec major can lead to a narrowing of this space and therefore compression of the neurovascular structures during hyperabduction
