Thoracic Spine Flashcards
cervical spine
lordotic curve
thoracic spine
kyphotic curve
lumbar spine
lordotic curve
intervertebral disks:
-annulus fibrous: multilayered fibers, thiner poseriotly
-nucleus pulpous: 60-70% water, compression and dehydration, high elastic and semigelatinous substance
-23 IV disks: no disk between C0-C1 and C1-C2
clinical anatomy: articulations and ligamentous anatomy
-anterior and posterior longitudinal ligaments
-supraspinatus ligament
-interspinous ligaments
-ligamentum flavum
extrinsic muscles
respiration and movement with the UE and scapula
intrinsic muscles
close to the spinal cord and directly influence its motion
past medical history
hisory of spinal cord, general health, changes in activity, mental health status
history of the present conditions
location of the pain and referred or radicular symptoms, onset of the pain, severity of the pain, MOI, consistency fo the pain: constant of intermittent, bowel or bladder control, disability associated with low back pain-sleeping pattern
functional assesment
-gait
general movement and posture (scoliosis?)
general inspection
frontal curvature, sagittal curvature, skin markings
scoliosis:
lateral bending of the spinal column in the frontal plane
inspection of the thoracic spine
bretahing patterns, bilateral comparison of skin folds, shape of chest
inspetion of the lumbar spine
lordotic curve, standing posture, erector muscle tone.
-compensatory posture for nerve root impingement.
active range of motion
flexion and extension, lateral bending, rotation
passive range of motion
flexion, extension, rotation
joint play tests
assessing for hypomobility, hypermobility, pain.
caused by: facet joint pathology, degenerative changes, spondylitic defects
tests for lower motor neuron lesions:
-hyporeflexia: flacidity of the muscles
-upper and lower quarter screen: muslce testing (myotomes), sensory testing (dermatomes), deep tendon reflexes
spinal stenosis:
-narrowing of the spinal canal or intervertebral foramen
-compresses the contents within the canal
-50-60 year olds
-pain during walking, numbness/tinglgling, weakness, radiating pain
intervertebral disk lesions
loss of water, decreasede protein, altering of chemical structure
disk herniation
extrusion of the nucleus pulpous through the annulus fibrosus
errector spinae muscle strain
self-limiting conditions, MOI usually from heavy or repetitive lifting, aching increases with flexion, pain increases with flexion and resisted extension
facet joint dysfunction
-dislocation, subluxation, or degeneration of the facet
-localized pain over the facet
-decrease in symptoms with an increase in activity
-facetectomy: surgical restriction of a vertebral facet
spondylosis:
defect in the pars interarticularis. collared scooty dog. localazied low back paun restricts extension
sopndylolisthesis:
can be a progression of spondylolysis. seperation of vertebrae. decapitated scotty dog.
thoracic spine
-cann affect respiration
-cancer, gall bladder, gastroesophageal conditions
scheumanns disease
juvenille kyphosis.
13-16 year olds, more boys than girls
-schmorls node is often associated,. herniation of the nucleus pulpous throught the vertebral endplate.
on field history
location of pain, peripheral symtoms: pain, numbness, weakness. MOI: rotation of eccentric contratcions
on field inspection:
position of te athlete- prone or supine.
posture-flexion or extensino, flaccidity of the muscles
willingness to move-motionlless assume unconcious
on field neurologic tests:
-sensory: bilateral extremity checks: anterior, posterioir, medial, lateral
-motor tests: wiggle the feet and hands and bend knees and elbows
on field palpation:
bony palpation: spinous and transverse processes
paraspinal muscles: spasm? MOI trauma.
management of suspected fracture
spine boarded, transported to hospital, radiographs
lumbar spine:
-bilateral symptoms: spinal cord injury
-pain spinous processes: compression or burst fracture
-management of suspected fracture or spinal cord: spine board and transport to hospital
posterior anterior vertebral joint play
prone
push spinous processes anteriorly and feel for springing vertebrae.
positive test is if vertebrae moves excessively and pain is elicted
scoliosis test
stand wwith hand held in front with arms straight. have patient bend forward sliding hands down to toes. posiitve test when an asymmetrical hump is observed along lateral aspect fo the thoracolumbar spine and ribcage.
hoovers test
supine. cup the heels of the patient. patient attempts to raise one leg on involved side. posiitve test: the patient does not attempt to lift leg and no pressure on examiners hand.
valsalva test:
sitting. pateint holds a deep breath while bearing down similar to performing a bowel movement. posiitve is increase spinal or radicular pain.
milgram test:
supine. pateint performs a bilateral straight leg to raist to the height of 2-6 inces and hold for 30 seconds. posiitve test: patient is unable to hold positiion, cannot lift leg, has pain.
kernig’stest/ brudzinski test
supine. pateint performs a unilateral straight leg raise with the knee extended until pain occurs. when pain occurs flex the knee. posiitve: pain experienced in the spine and possibly radiating into the lower extremity. pain releived when knee is flexed.
straight leg raise
supine. hold under heel and anterior knee to keep leg in full extension. examiner raises the leg by flexing hte hip until discomfort in experuenced or full ROM obtained. positve: patient compains of pain before end of normal ROM. pain may raidate distally along tested leg, usually in psterior thight radiatin ginto the claf and maybe the foot.
well (cross) straight leg test
supine. onehand under heel other paced anterior thigh superior to the knee. raise the leg by flexing th rhi[ until discomfort reported. posiitve if pain experienced on side opposit being raised.
slump test
sitting over the edge of the table. stand at the side of the patient.
slump forward rounding shoulders and keep cervical spine neutral, flex cervical spine by bringing chin to the chest examiner holds patient in thisd position. then extend one knee and dorsiflex the ankle. repeat on other side.
follow all steps until symptoms are provoked.
positive if sciatic pain or other neurologic symptoms arise.
quadrant test
stand with feet shoudler width apart. examiner stands behind patient holding their shoulders. patient extend spine then side bends and rotates to affected side.
positive if reproduction of symptoms
single led stance test
pateint stands evenly distributing body weight across two feet. examiner stands behind. patient lifts one leg, places the trunk in hyperextension. examiner may need to assist . repeat other side.
positive: pain noted in lumbar spine of SI area.
