Thoracic Spine and Rib Cage Flashcards
Describe the Cervical Rotation Lateral Flexion Test
- 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.
Describe a typical clinical presentation of a patient with Ankylosing Spondylitis affecting the Thoracic Region
- Thoracic Spine Stiffness
- Reduced Chest Expansion (difficulty breathing)
What thoracic segments are implicated and can possibly mimic Angina?
T4-T7
Describe T4 Syndrome
- 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
Can Hip pain be caused by thoracic dysfunction?
- 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.
Describe Postherpetic Neuralgia
- 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
What is Costochondrtitis, what is the preferred treatment?
- Inflammation or irritation at the CostoChondral Junction.
- Preferred treatment is Segmental Mobilization or Manipulation
If patient having difficulty activating the lower trapezius, what portion of the Thoracic Spine should you consider evaluating?
- T8-T12
- Manipulation or mobilization in this area to correct extension restriction has been shown to increase firing of the lower trap
If pnt has difficulty firing the Serratus Anterior, what portion of the Thoracic spine should you consider evaluating?
- T3-T7
- Manipulation or mobilization in this area to correct Flexion restriction has been shown to increase firing of the Serratus Anterior
What are the Rule of 3’s in relation to Thoracic Vertebral Anatomy?
- 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
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?
- Cervical- 2:5
- Thoracic- 1:5
- Lumbar- 1:3
- Due to the small disk ratio, the T Spine is less mobile
Describe True Ribs vs False Ribs
- Ribs 1-7 are True because they attach directly to Sternum
- Ribs 8-12 are False Ribs because they attach distally to Costochondral Cartilage
What effect can shortening of the Pec Minor have on Scapular Motion?
- Can cause protraction and anterior tipping and potentially affect the normal scapular motion during elevation of the arm
What area is known as the Critical Zone in the T Spine and why?
- 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
What is T4 Syndrome?
- 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
Describe a Flexion Impairment of the T Spine
- 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
Describe an Extension Impairment of the T Spine
- 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
How would a Peptic Ulcer produce Musculoskeletal pain?
- Boring pain from the epigastric area to the Middle Thoracic Spine
- Typically Relief after eating, Occasionally worsens after eating
How would a Inflamed Gall Bladder (Cholecystitis) produce Musculoskeletal pain?
- 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
How would Pancreatitis produce Musculoskeletal pain?
- Pain around Thoracolumbar Junction
How would a Pyelonephritis (Kidney Infection) produce Musculoskeletal pain?
- Pain referred to Costovertebral or flank area
- Often accompanied by fever, nausea, vomiting and renal colic
What is Renal Colic?
- Flank Pain accompanied by lower abdominal pain that spreads to the labia in women and testicles in men
What are the Clinical Prediction Rule factors for diagnosing Anylosing Spondylitis?
- 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
What is the Key Physical Examination finding of Ankylosing Spondylitis?
- Limited Chest Expansion
What is the Cervical Rotation Lateral Flexion Test?
- Test used to assess the presence of an elevated First Rib in patients with brachialgia
What T Spine Manipulation would you use to increase Flexion vs Extension (theoretically)?
- To Increase Extension- Prone
- To Increase Flexion- Supine
