Thoracic Spine

Question 1

Which are true ribs?

Answer 1

Ribs 1-7

Question 2

Which are false ribs?

Answer 2

Ribs 8-12

Question 3

Where do false ribs attach?

Answer 3

costochondral cartilage of the superior rib
-ribs 11 and 12 have no attachment at all

Question 4

Which ribs are atypical?

Answer 4

1, 10, 11, 12
-they attach to only 1 facet on corresponding vertebral body

2
-attaches to T1 and T2 but is atypical because of attachment to sternum and manubrium

Question 5

Which ribs are typical?

Answer 5

3-9
-attach to demi facets of corresponding vertebral body

Question 6

Key exam finding for ankylosing spondylitis?

Answer 6

Limited chest expansion
-measured at the nipple
5cm is normal
2.5cm is pathologic

Question 7

Preferred imaging for suspected cancer of infection

Answer 7

MRI or bone san due to high sensitivity

Question 8

Preferred imaging for trauma

Answer 8

X-ray
-especially w/ symptoms of spinal tenderness, neruo signs, or altered consciousness

Not indicated if pt is awake, alert, and none of the above findings

Question 9

Red flags for cancer

Answer 9

-personal or family history of cancer
-unexplained weight loss
-unrelenting night pain
-history or current smoking
-age >50

Question 10

Red flags for infection

Answer 10

-fever
-chills
-night sweats
-known recent infection(PNA)
-current IV or drug use
-recent surgery

Question 11

Red flags for visceral/GI disorders

Answer 11

-bowel/bladder dysfunction
-abdominal pain
-reflux
-excussive use of NSAIDs
-alcohol abuse

Question 12

Red flags for cardiopulmonary

Answer 12

-chest pain or SOB w/ exertion
-personal or family history of cardiovascular disease
-thoracic or chest wall pain throbbing or pulsatile sensations

Question 13

Red flags for fracture

Answer 13

-history of osteoporosis or osteoporotic fractures
-history of significant trauma
-prolonged corticosteroid use

Question 14

Red flags for cord compromise(disease or lesion)

Answer 14

-BUE or BLE paresthesias, weakness, sensory loss

Question 15

T spine landmarks

Answer 15

T1 found by finding C7(most prominent vertebrae)
T1 below that

T12 found via L4(at level of iliac crest)
-count up

Question 16

Wainner et al test-item cluster for cervical radiculopathy

Answer 16

-Cervical rotation <60* on painful side
-positive Spurling test
-positive ULNDT-A median nerve
-positive cervical distraction test

3 of 4 LR=6.1
4 of 4 LR=30.1

ULNDT-A is most sensitive .97
-negative LR .12 meaning negative ULNDt effectively rules of cervical radiculopathy

Question 17

Signs of central sensitization

Answer 17

-non discrete, widespread pain
-non mechanically patterned pain
-sensitivity to temperature, light, smells
-comorbid GI distress

Question 18

Beyond rehab, what additional workup/recs for those w/ thoracic vertebral compression fractures?

Answer 18

-diagnostic BMD
-vitamin D levels

in order to address any pharmacotherapy or supplementation needs

Question 19

McBurney’s Test

Answer 19

RLQ tenderness that occurs w/ acute appendicitis

2/3 distance from navel to R ASIS

Question 20

Murphy’s PERCUSSION test or murphy’s punch sign

Answer 20

-percussion test over 12th costovertebral angle
-indicative of kidney injury/stones/infection

Question 21

Scheurmann’s disease or scheurmann’s kyphosis

Answer 21

typically develops in adolescence
-rounded or “hunchback posture”

Question 22

Imaging signs of ankylosing spondylitis

Answer 22

bamboo sign
-ossification of annulus fibrosis

dagger sign
-ossification of interspinous ligament
-all SP appear as solid line

tram/trolley sign
-SOMETIMES used to describe presence of BOTH bamboo and dagger sign