Thoracic Spine and Rib Cage

Question 1

Describe the Cervical Rotation Lateral Flexion Test

Answer 1

• Used to detect First Rib Hypomobility in patients with Brachialgia
• Cervical Rotation and Lateral flexion (Ear Towards Chest). When lateral flexion motion is limited, test is positive.

Question 2

Describe a typical clinical presentation of a patient with Ankylosing Spondylitis affecting the Thoracic Region

Answer 2

• Thoracic Spine Stiffness

- Reduced Chest Expansion (difficulty breathing)

Question 3

What thoracic segments are implicated and can possibly mimic Angina?

Answer 3

T4-T7

Question 4

Describe T4 Syndrome

Answer 4

• A Group of Symptoms including dysfunction within the T2-7 Segments.
• Pain in Upper Limbs, neck , upper thoracic, and scapular region and headaches.
• May have Glovelike Parasthesias in one or both hands

Question 5

Can Hip pain be caused by thoracic dysfunction?

Answer 5

• Yes
• Dorsal Rami that innervate the lower thoracic segments become cutaneous over the buttock and pnt can report Greater Trochanter type pain because of this.

Question 6

Describe Postherpetic Neuralgia

Answer 6

• Pain that persists for > 1 months after acute rash of Herpes has resolved
• Can manifest itself along dermatomal patterns in thoracic spine and mimic thoracic pain or radiculopathy

Question 7

What is Costochondrtitis, what is the preferred treatment?

Answer 7

• Inflammation or irritation at the CostoChondral Junction.

- Preferred treatment is Segmental Mobilization or Manipulation

Question 8

If patient having difficulty activating the lower trapezius, what portion of the Thoracic Spine should you consider evaluating?

Answer 8

• T8-T12
• Manipulation or mobilization in this area to correct extension restriction has been shown to increase firing of the lower trap

Question 9

If pnt has difficulty firing the Serratus Anterior, what portion of the Thoracic spine should you consider evaluating?

Answer 9

• T3-T7
• Manipulation or mobilization in this area to correct Flexion restriction has been shown to increase firing of the Serratus Anterior

Question 10

What are the Rule of 3’s in relation to Thoracic Vertebral Anatomy?

Answer 10

• Spinous Processes of T1-3 are at the same level of the transverse processes
• Spinous Processes of T4-6 are one half vertebral level below Transverse Processes
• Spinous Processes of T7-9 are one full vertebral level below the Transverse Processes

Question 11

What is the Disk Height to Vertebral Body Ratio of different portions of the spine, and how does it affect movement of the T Spine?

Answer 11

• Cervical- 2:5
• Thoracic- 1:5
• Lumbar- 1:3
• Due to the small disk ratio, the T Spine is less mobile

Question 12

Describe True Ribs vs False Ribs

Answer 12

• Ribs 1-7 are True because they attach directly to Sternum

- Ribs 8-12 are False Ribs because they attach distally to Costochondral Cartilage

Question 13

What effect can shortening of the Pec Minor have on Scapular Motion?

Answer 13

• Can cause protraction and anterior tipping and potentially affect the normal scapular motion during elevation of the arm

Question 14

What area is known as the Critical Zone in the T Spine and why?

Answer 14

• T4-T9
• Because of the small diameter of the spinal canal and reduced blood supply compared to other parts of the spine
• Significant Pathology such as a large herniated disk, may lead to central spinal cord compression

Question 15

What is T4 Syndrome?

Answer 15

• Constellation of signs and symptoms associated with stiffness of upper back and T Spine
• Symptoms include headaches, neck pain, upper extremity pain, and bilateral “stocking glove” parasthesias

Question 16

Describe a Flexion Impairment of the T Spine

Answer 16

• Commonly in upper to middle T Spine (T3-7)
• Relative Straightening or loss of kyphosis
• Occurs often after whiplash
• Decreased Flexion, Decreased Contralateral SB and ROT

Question 17

Describe an Extension Impairment of the T Spine

Answer 17

• Commonly in upper T Spine and Cervicothoracic Junction (C7-T2)
• Increase in Kyphosis
• Occurs d/t poor postural habits, degenerative changes, disk height loss etc
• Loss of Extension, Ipsilateral Side Bending and Ipsilateral Rotation

Question 18

How would a Peptic Ulcer produce Musculoskeletal pain?

Answer 18

• Boring pain from the epigastric area to the Middle Thoracic Spine
• Typically Relief after eating, Occasionally worsens after eating

Question 19

How would a Inflamed Gall Bladder (Cholecystitis) produce Musculoskeletal pain?

Answer 19

• Pain in Right Upper Quadrant and Right Infrascapular region
• Sx often occur 1-2 hours after ingestion of heavy meal
• Pain often accompanied with moderate fever, nausea, vomiting
• (+) Murphy Sign

Question 20

How would Pancreatitis produce Musculoskeletal pain?

Answer 20

• Pain around Thoracolumbar Junction

Question 21

How would a Pyelonephritis (Kidney Infection) produce Musculoskeletal pain?

Answer 21

• Pain referred to Costovertebral or flank area

- Often accompanied by fever, nausea, vomiting and renal colic

Question 22

What is Renal Colic?

Answer 22

• Flank Pain accompanied by lower abdominal pain that spreads to the labia in women and testicles in men

Question 23

What are the Clinical Prediction Rule factors for diagnosing Anylosing Spondylitis?

Answer 23

• Stiffness > 30 minutes duration
• Improvement of back pain with exercise and not rest
• Awakening because of back pain during the SECOND half of the night
• Alternating Buttock Pain

Question 24

What is the Key Physical Examination finding of Ankylosing Spondylitis?

Answer 24

• Limited Chest Expansion

Question 25

What is the Cervical Rotation Lateral Flexion Test?

Answer 25

• Test used to assess the presence of an elevated First Rib in patients with brachialgia

Question 26

What T Spine Manipulation would you use to increase Flexion vs Extension (theoretically)?

Answer 26

• To Increase Extension- Prone

- To Increase Flexion- Supine