Thoracic Spine

Question 1

motions of rib cage

Answer 1

pump handle, bucket handle, caliper, torsion

Question 2

why is there less extension motion in the thoracic spine?

Answer 2

imbricated spinous processes

Question 3

Scheuermann’s disease

Answer 3

increased thoracic kyphosis; MC in young males that present with mid/low back pain

Question 4

characteristics of scheuermann’s disease

Answer 4

schmorl’s nodes, anterior wedging in 3 consecutive segments,

Question 5

when is scheuermann’s disease surgical?

Answer 5

if kyphosis is >70 degrees with intractable pain and neurologic deficit

Question 6

management of scheuermann’s disease

Answer 6

soft tissue work, gentle adjusting, posture education

Question 7

when is bracing recommended for scheuermann’s disease?

Answer 7

> 60 degree curve

Question 8

costochondritis

Answer 8

insidious onset from overuse (cough, sneeze), infection of costal cartilage, trauma

Question 9

presentation of costochondritis

Answer 9

sharp, often B/L pain, pain with breaths, usually ribs 2-5

Question 10

costochondritis examination findings

Answer 10

shallow breathing, bucket handle restriction, positive schepelmann’s test

Question 11

intercostal neuritis presentation

Answer 11

unilateral pain in torso that extends as a band around the chest (dermatomal); sharp burning, spasmodic pain parallel with rib

Question 12

MC cause of intercostal neuritis

Answer 12

herpes zoster virus–shingles

Question 13

additional causes of intercostal neuritis

Answer 13

tumors, ruptured disc, bone spurs, diabetes, rib motion dysfunction

Question 14

intercostal neuritis examination findings

Answer 14

herpes zoster lesions, schepelmann’s produces pain on concave side

Question 15

home care for intercostal neuritis

Answer 15

avoid stressors, ice, B vitamins, zinc

Question 16

comanagement for intercostal neuritis

Answer 16

injecting a local anasthetic, NSAIDs, acupuncture/acupressure

Question 17

idiopathic scoliosis

Answer 17

abnormal lateral curvature of the vertebral column that is not due to pain, degeneration, neuromuscular disease or congenital malformations

Question 18

MC type of scoliosis

Answer 18

idiopathic

Question 19

idiopathic scoliosis examination findings

Answer 19

lateral flexion to side of concavity, decrease ROM, adams test

Question 20

congenital scoliosis observations

Answer 20

club foot, foot deformities

Question 21

spina bifida observations

Answer 21

patches of hair along spine

Question 22

neurofibromatosis observations

Answer 22

cafe au lait spots or patches

Question 23

adams test interpretation for scoliosis

Answer 23

if curve straightens with forward flexion, may be a functional scoliosis, not structural

Question 24

when may bracing be needed for scoliosis?

Answer 24

curve >40 degrees

Question 25

what contraindication is there to adjustment with scoliosis?

Answer 25

do not adjust into concavity

Question 26

thoracic outlet syndrome

Answer 26

group of disorders involving the neurovasculature of the upper extremity

Question 27

TOS cause/risk

Answer 27

insidious onset, most arise from nervous system from repetitive activity, poor posture, scalene/1st rib/pec involvement

Question 28

TOS presentation

Answer 28

diffuse arm pain/numbness/tingling into the 4th and 5th digit that is made worse with overhead activity, neck/shoulder pain, thenar atrophy, diminished grip strength, hand/arm swelling, palor of hand

Question 29

when may TOS be surgical?

Answer 29

cervical rib present