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PT 621 Clinical Ortho > Thoracic Spine > Flashcards

Thoracic Spine Flashcards

1
Q

Thoracic spine problems are less common. T/F?

A

True

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2
Q

TS can be equally painful & disabling as cervical/lumbar disorders. T/F?

A

True

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3
Q

Treating TS can help resolve TS & Rib Dysfunction. T/F?

A

True

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4
Q

Treating TS can help resolve pain and movement disorders in other spine regions and peripheral joints. T/F?

A

True

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5
Q

Regional Interdependence?

A

Theory that dysfunction of one body part imparts dysfunction upon another

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6
Q

Sources of symptoms for TS?

A 
Vertebral body
Intervertebral disc
Facet joints
Costovertebral  joints
Costotransverse joints
Tips
Nerve Root
Muscles/Myofascial tissue
Intersegmental ligaments
Dura
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7
Q

Muscles that effect near TS?

A

Traps
Rhomboids
Paraspinals

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8
Q

Identifying the exact source of your patient’s TS symptoms is difficult and often unknown. T/F?

A

True

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9
Q

Identifying the source is based on our understanding of anatomy, accurate manual assessment and recognition of clinical patterns. T/F?

A

True

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10
Q

Bilateral, intermittent tingling and weakness in both legs is a clinical pattern for…

A

T/S Central Cord Lesion

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11
Q

T/S Central Cord Lesion?

A

Central space occupying lesion compressing on spinal cord, producing serious neuro problems

i.e. tumor, vertebral body fx, central HNP, osteomyelitis

**Uncommon!

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12
Q

Evidence of what sources of pain in the TS?

A

Cervical/Thoracic facets
Costovertebral joints
Costotransverse joints

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13
Q

Determining pain from the cervical vs thoracic?

A

Differentiate the neck…

1) does moving your neck cause thoracic pain
2) AROM of CS
3) CS segmental mobility
4) reproduction of pain?

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14
Q

Determining which TS segments are painful/dysfunction?

A

Postural observation
AROM
Segmental mobility
Palpate myofascia

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15
Q

Forward neck can cause difficulty of what other movement/joint?

A

GHJ, flexing
…due to T1-T4 positioned in flexion

CS rotation
…due to upper/mid CS positioned in extension

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16
Q

Common TS posture?

A

Forward neck posture
Excessive upper TS flexion (kyphosis(
Excessive upper CS extension

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17
Q

For each AROM determine…

A

1) Amount of movement available
2) Location and type of symptom felt
3) Movement - symptom relationship

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18
Q

Facet orientation of TS

A

More vertical from proximal to distal
More flexion from proximal to distal
Less rotation from proximal to distal

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19
Q

What changes the mobility of the spine?

A

Facet orientation
CTJ
TLJ

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20
Q

Segmental Mobility Exam Assess?

A

1) Amount of motion
2) Amount of stiffness
3) Symptom response at each spinal segment

21
Q

Reliability of segmental mobility exam is poor. T/F?

A

True. Pain provocation better than motion assessment.

22
Q

Palpate Myofascia

A

Adjacent to the segment, feel for tenderness/increased resistance

23
Q

Theories on vertebral motion dysfunction? Hypomobility.

A

1) Alteration in arthro, lack of congruency.
2) Altered length/tone of muscles controlling joint motion. Adaptive shortening can affect joint mechanics.
3) Entrapment of synovial material between 2 joint surfaces (meniscoid tissue)
4) altered biomechanics/biochemical properties of myofascial elements

24
Q

Theories on vertebral motion dysfunction? Hypermobility.

A

1) Disease states (Marfan)
2) Physiologic. “Born loose”
3) compensatory due to area of hypo

25
Q

Treatments for TS Mobility

A

1) PA/Rotation Mobs
2) MWM
3) HVLA

26
Q

Duration of treatment?

A

As long as there’s an improvement, patient is making gains, and I can tolerate…
30s bouts, 3x5reps

27
Q

CT Rotation Mobs
C7-T3

Improves…

A

CTJ rotation

  • Transverse
  • Unilateral PA w/ rotation
28
Q

MWM goal:

A

Restore segmental motion w/ movement in a pain free manner

29
Q

MWM vs PA

A

1) Patient is active vs passive
2) WB vs NWB
3) More dynamic: engages muscles/joints
4) Potential to incorporate other body regions

30
Q

When is HVLA performed?

A

When patient is right for it…

31
Q

Rib dysfunction

A

Onset of pain and dysfunction is related to blunt trauma to chest wall/upper body injury

32
Q

Thoracic vs Rib?

A

Is breathing an issue?

33
Q

Rib treatments:

A

Rib mobilization

  • Angles become more oblique
  • Coordinate w/ breathing
34
Q

TOS

A

Neuro structures compressed at 1st rib

Classification:
Neurogenic (brachial plexus)
Vasogenic (subclavian artery/vein)
Non-specific (subclinical neurogenic)

35
Q

TOS entrapment sites

A

1) CS intervertebral foramina
2) Inter-scalene triangle
3) Elevated 1st rib
4) Tight Pec Minor
5) Tight Pronator Teres
6) Carpal Tunnel

36
Q

What test is used for 1st rib position?

A

CRLF

  • rotate away from rib tested
  • flex to chest

(+) = limited lateral flexion

37
Q

1st rib caudal glide (supine)

A&T

A

Sideband towards rib being tested
Contact 1st rib w/ index MCP
Inferior direction

38
Q

1st rib caudal glide (sitting)

A&T

A 
PT 1/2 kneeling
Sideband towards rib being tested
Contact 1st rib w/ index MCP
Inferior direction
*Coordinate breathing
39
Q

When to STM Pec Minor?

A

Hx: repetitive arm use, prolonged sitting
O: forward shoulder girdle
A: muscle length test, provocation w/ palpation
T: restore muscle length/nerve mobility
R: UE movement

40
Q

MOI muscles in TS?

A 
Blunt trauma
Strain/tear
Unaccustomed overuse
Activities w/ non-optimal mechanics
Postural adaptations
41
Q

Muscle tx goals?

A 
Strengthen weak muscles
Stretch tight muscles
Correct faulty movement patterns
Promote healing environment
Provide hope/encouragement
42
Q

Exercises should…

A

Complement your manual interventions!

43
Q

JoNeCaLiMuBuDiMe

A 
Joint
Nerve
Capsule
Ligament
Muscle
Bursa
Disc
Meniscus
44
Q

Pulmonary system: ASK…

A 
New onset of coughing
Increased sputum
Hemoptysis
SOB
Orthopnea
Auscultation (+)
45
Q

GI system: ASK…

A

Abdominal pain
Pain before/after eating
Change in bowel habits
Change of weight since onset

46
Q

TIM VaDeTuCoNe - differential dx

A 
Trauma
Inflammation/Infection
Metabolic
Vascular
Degenerative
Tumor
Congenital
Neuro/Psycho
47
Q

HVLA - Grade 5 Reasoning

A

1) Subjective, appropriate for PT
2) AROM TS, movement painful/limited
3) Segmental mobility (Central/Unilateral PA)
4) Identified specific TS segments (hypo/pain)
5) No Contraindications
6) Skill to implement
7) Reassess AROM & TS segment mobility
8) If + change, provide HEP to maintain AROM & prevent, correct faulty movement patterns w/ re-education
9) If no change, self reflect…

48
Q

Contraindications for HVLA

A

Lack pt consent
Lack dx
Patient positioning cannot be achieved
Bone pathology
Neuro - myelopathy, cord compression, cauda equina, nerve root compression w/ increasing neuro deficit
Vascular - VBO/Aortic aneurysm/Hemophilia
Pregnancy

PT 621 Clinical Ortho (2 decks)

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