Thoracic Spine Flashcards
Thoracic spine problems are less common. T/F?
True
TS can be equally painful & disabling as cervical/lumbar disorders. T/F?
True
Treating TS can help resolve TS & Rib Dysfunction. T/F?
True
Treating TS can help resolve pain and movement disorders in other spine regions and peripheral joints. T/F?
True
Regional Interdependence?
Theory that dysfunction of one body part imparts dysfunction upon another
Sources of symptoms for TS?
Vertebral body Intervertebral disc Facet joints Costovertebral joints Costotransverse joints Tips Nerve Root Muscles/Myofascial tissue Intersegmental ligaments Dura
Muscles that effect near TS?
Traps
Rhomboids
Paraspinals
Identifying the exact source of your patient’s TS symptoms is difficult and often unknown. T/F?
True
Identifying the source is based on our understanding of anatomy, accurate manual assessment and recognition of clinical patterns. T/F?
True
Bilateral, intermittent tingling and weakness in both legs is a clinical pattern for…
T/S Central Cord Lesion
T/S Central Cord Lesion?
Central space occupying lesion compressing on spinal cord, producing serious neuro problems
i.e. tumor, vertebral body fx, central HNP, osteomyelitis
**Uncommon!
Evidence of what sources of pain in the TS?
Cervical/Thoracic facets
Costovertebral joints
Costotransverse joints
Determining pain from the cervical vs thoracic?
Differentiate the neck…
1) does moving your neck cause thoracic pain
2) AROM of CS
3) CS segmental mobility
4) reproduction of pain?
Determining which TS segments are painful/dysfunction?
Postural observation
AROM
Segmental mobility
Palpate myofascia
Forward neck can cause difficulty of what other movement/joint?
GHJ, flexing
…due to T1-T4 positioned in flexion
CS rotation
…due to upper/mid CS positioned in extension
Common TS posture?
Forward neck posture
Excessive upper TS flexion (kyphosis(
Excessive upper CS extension
For each AROM determine…
1) Amount of movement available
2) Location and type of symptom felt
3) Movement - symptom relationship
Facet orientation of TS
More vertical from proximal to distal
More flexion from proximal to distal
Less rotation from proximal to distal
What changes the mobility of the spine?
Facet orientation
CTJ
TLJ
Segmental Mobility Exam Assess?
1) Amount of motion
2) Amount of stiffness
3) Symptom response at each spinal segment
Reliability of segmental mobility exam is poor. T/F?
True. Pain provocation better than motion assessment.
Palpate Myofascia
Adjacent to the segment, feel for tenderness/increased resistance
Theories on vertebral motion dysfunction? Hypomobility.
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
Theories on vertebral motion dysfunction? Hypermobility.
1) Disease states (Marfan)
2) Physiologic. “Born loose”
3) compensatory due to area of hypo
Treatments for TS Mobility
1) PA/Rotation Mobs
2) MWM
3) HVLA
Duration of treatment?
As long as there’s an improvement, patient is making gains, and I can tolerate…
30s bouts, 3x5reps
CT Rotation Mobs
C7-T3
Improves…
CTJ rotation
- Transverse
- Unilateral PA w/ rotation
MWM goal:
Restore segmental motion w/ movement in a pain free manner
MWM vs PA
1) Patient is active vs passive
2) WB vs NWB
3) More dynamic: engages muscles/joints
4) Potential to incorporate other body regions
When is HVLA performed?
When patient is right for it…
Rib dysfunction
Onset of pain and dysfunction is related to blunt trauma to chest wall/upper body injury
Thoracic vs Rib?
Is breathing an issue?
Rib treatments:
Rib mobilization
- Angles become more oblique
- Coordinate w/ breathing
TOS
Neuro structures compressed at 1st rib
Classification:
Neurogenic (brachial plexus)
Vasogenic (subclavian artery/vein)
Non-specific (subclinical neurogenic)
TOS entrapment sites
1) CS intervertebral foramina
2) Inter-scalene triangle
3) Elevated 1st rib
4) Tight Pec Minor
5) Tight Pronator Teres
6) Carpal Tunnel
What test is used for 1st rib position?
CRLF
- rotate away from rib tested
- flex to chest
(+) = limited lateral flexion
1st rib caudal glide (supine)
A&T
Sideband towards rib being tested
Contact 1st rib w/ index MCP
Inferior direction
1st rib caudal glide (sitting)
A&T
PT 1/2 kneeling Sideband towards rib being tested Contact 1st rib w/ index MCP Inferior direction *Coordinate breathing
When to STM Pec Minor?
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
MOI muscles in TS?
Blunt trauma Strain/tear Unaccustomed overuse Activities w/ non-optimal mechanics Postural adaptations
Muscle tx goals?
Strengthen weak muscles Stretch tight muscles Correct faulty movement patterns Promote healing environment Provide hope/encouragement
Exercises should…
Complement your manual interventions!
JoNeCaLiMuBuDiMe
Joint Nerve Capsule Ligament Muscle Bursa Disc Meniscus
Pulmonary system: ASK…
New onset of coughing Increased sputum Hemoptysis SOB Orthopnea Auscultation (+)
GI system: ASK…
Abdominal pain
Pain before/after eating
Change in bowel habits
Change of weight since onset
TIM VaDeTuCoNe - differential dx
Trauma Inflammation/Infection Metabolic Vascular Degenerative Tumor Congenital Neuro/Psycho
HVLA - Grade 5 Reasoning
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…
Contraindications for HVLA
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
