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MSK II FINAL > Thoracic Spine and RibsClinical Exam > Flashcards

Thoracic Spine and RibsClinical Exam Flashcards

1
Q

Sitting/Standing:

A

Posture
Quality of Movement
UQ screen

Add LQ reflexes (Patellar, Achilles, Babinski)

Reflex Δ’s suggestive of spinal cord lesion or serious pathology

Thoracic ROM

Resisted isometrics

First rib: cervical flexion lateral rotation (CRLF), rib spring

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2
Q

Supine:

A

Trunk MMT/Muscle Length

UE neural provocation tests/ULTT

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3
Q

Prone:

A

Trunk MMT

Spring testing, PA’s

Rib spring testing

Extra tests: mobility in sitting, regionalization

TOS tests

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4
Q

Inspection

A

Kyphosis: < 30° is normal

Upper trap contour, 1st rib position

Supraclavicular fullness

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5
Q

Palpation:

A

Tender ant ribs 2 & 3: Tietze syndrome (chondrosternal inflammation)

Manubriosternal junction: Ankylosing spondylitis

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6
Q

Tietze syndrome –

A

more often female, linked to excessive UE mvmnt pulling on rigid upper ribs, treated with injection or ionto, transverse friction to the costochondral junction, JST to rib jts and upper Tsp

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7
Q

Motion Tests in sitting

A

Flexion
> With Neck flexion, (+) disc

Extension
> Side bending (L) and (R)
> Rotation (L) and (R)
> With neck flexion, (+) disc

Active and passive (overpressure) 1D motion
Observe the quantity and quality of movement
Assess for pain provocation

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8
Q

Thoracic flexion

A

Patient seated on the corner of the table

Verbal cues:
“Flex through the trunk”
“Bring your shoulders to your waist”

Add OP
Add neck flexion – (+) disc

Add breathing:
Increased pain with expiration = disc

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9
Q

Thoracic flexion + neck flexion

A

If neck flexion increases pain, increased suspicion of disc pathology

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10
Q

Thoracic extension

A

Verbal cues
“Bring your sternum to the ceiling”

Therapist can stroke the back into extension

Passive extension
> PT supports the patient under the arms
> Can add overpressure for pain provocation

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11
Q

Thoracic side bending

A

Pure SB, no rotation
PT stands opposite to SB
Front arm around shoulder
Back hand stabilizes the iliac crest

Most provocative of rib dysfunction
> Add overpressure for pain provocation
> Add expiration = provokes lower ribs (5-10)

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12
Q

Thoracic rotation

A

Wedge or sandbag under IT you are rotating toward

PT stands in front and blocks the knees

Rotation = most ROM in Tsp

Rotation is most provocative of a disc lesion d/t axis of rotation

Add neck flexion
(+) disc

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13
Q

Resisted motions in sitting

A

Sitting side bending

Sitting rotation

Do not allow any motion

If painful = Fracture ? Serious pathology

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14
Q

Cervical rotation lateral flexion (CRLF) test

A

Purpose: To assess for 1st rib elevation

Procedure: Gently rotate the head as far as possible, stabilize the shoulders with your elbows. Without losing the rotation, add side bend. Need 50-70 dg rotation for valid test.

Positive test: limited side bending ROM, palpable block or stiffness

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15
Q

1st Rib Spring Test

A

Motion is caudal, slightly ventral, slightly medial

Assessing end feel

Can place the other hand near the sternum and feel the gap

Helpful if the patient has insufficient cervical rotation for a valid CRLF test

TP of T1 is as wide at the TP of C1
Drop down from the mastoid process
Move laterally onto the first rib

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16
Q

Supine tests

A

Resisted abdominals or MMT
> Rectus
> Obliques

Muscle length
> Pecs, lats

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17
Q

Prone tests

A

MMT
> Active extension
> parascapular
Spring tests

> Spinous processes – creates an extension moment

> Transverse processes – creates a flexion moment

18
Q

C6 =

A

is the most caudal SP to move ventrally during cervical extension

19
Q

T1 =

A

is the most cranial SP to move dorsally with dorsal pressure on the manubrium of the sternum

20
Q

T2 =

A

is at the level of the suprasternal notch

21
Q

T3 =

A

is at the level of the spine of the scapula

22
Q

T8 =

A

is at the level of the inferior angle of the scapula (in ideal alignment, scapulae move, so are not exact)

23
Q

Central PA/Spring testing

A

Across the spinous processes
> To assess motion
> To provoke or clear the joint

24
Q

Cranially & Caudally directed PA

A

In the thoracic spine a PA may be cranially or caudally directed to assess more precisely the flexion or extension (distraction or compression) accessory motions.

25
Q

Unilateral PA (rotation)

Set up:

A

AIM: Assess intersegmental motion, test for pain provocation/alleviation.

PATIENT POSITION: Prone, closer to therapist’s side of plinth

THERAPIST POSITION: Hypothenar eminence over transverse process to be tested (test the side opposite where you are standing), elbow straight, shoulder and elbow aligned directly over the transverse process to be tested.

26
Q

Unilateral PA (rotation)

technqiue:

A

Apply a posterior to anterior force through the arm onto the transverse process.

Feel for quality and quantity of movement and assess for pain provocation.

To confirm spinal level, palpate the spinous process while performing the unilateral PA, if the spinous process moves you have identified the associated transverse process

27
Q

T1-12 spacing:

A

T1-4 tr pr is lateral to the sp pr of the level above (T4 tr pr is lateral to T3 sp pr)

T5-8 tr pr is lateral to the sp pr of 1.5-2 levels above (T7 tr pr is lateral to interspinous space between T5-6)

T9-12 tr pr is lateral to the sp pr of the level above (T10 tr pr is lateral to T9 sp pr)

28
Q

Mid & Lower Ribs(posterior aspect)

set up:

A

AIM: Assess motion, test for pain provocation/alleviation.

PATIENT POSITION: Prone, positioned closer to therapist’s side of plinth

THERAPIST POSITION: Hypothenar eminence over angle of rib to be tested (test the side opposite where you are standing), elbow straight, shoulder and elbow aligned directly over the transverse process to be tested. Opposite hand must stabilize the vertebra at the transverse process.

29
Q

Mid & Lower Ribs(posterior aspect)

technqiue:

A

Apply a posterior to anterior force through the arm onto the angle of the rib.

Feel for quality and quantity of movement and assess for pain provocation.

To confirm spinal level, palpate the spinous process while performing the unilateral PA on the rib, if the spinous process moves you have identified the associated rib

To isolate the rib motion, stabilize the transverse process of the associated rib

30
Q

Additional Tests

A

Upper thoracic mobility tests using cervical rotation or arm elevation

Determining if the problem is in the cervical spine or the thoracic spine
> Which region is involved? – regionalization

31
Q

Mobility tests in sitting

A

Axial rotation

Move the patient into cervical rotation

Assess the motion between SP’s

Should feel rotation to T4

If the patient is unable to rotate through the cervical spine, use arm elevation
> Motion possible to T6

32
Q

Regionalization using provoking/alleviating tests (is it C or T Spine?)

A

Axial compression is painful (distraction may relieve)

Rotation CSp is painful

CSp extension is painful

33
Q

Axial compression is painful (distraction may relieve)

A

Could be CSp or TSp

Differentiate by comparing with TSp compression through the shoulders (still painful? TSp)

34
Q

Rotation CSp is painful

A

Could be CSp or upper TSp

Differentiate by rotating trunk & neck together to the opposite side to end range, fix TSp at this end range, then rotate CSp away (still painful? CSp)

35
Q

CSp extension is painful

A

Could be CSp or upper TSp

Differentiate with full C & T spine flexion (slump), fix both 1st ribs (preventing TSp extension), now slowly extend CSp (still painful? CSp)

36
Q

Capsular pattern (CP) or Non-capsular pattern (NCP)?

A

CP = Extension-> equal limitations of SB and rot (painful)-> small flexion limit

37
Q

Special tests for Thoracic Outlet Syndrome (TOS)

A

Vascular testing
> Adson’s test
> Costoclavicular Test
> Roo’s test

38
Q

Adson’s Test

A

Extend cervical spine
Rotate toward
Deep breathe
Monitor radial pulse

+ test – diminished pulse, sx reproduction

39
Q

Roos Test (EAST)

A

Open and close hands for 3 minutes

Results if normal:
Only forearm muscle fatigue and minimal distress

40
Q

Roos Test (EAST)

Possible symptoms if TOS is present:

A

Gradual increase in pain at neck and shoulder, progressing down the arm

Paraesthesia in forearm and fingers

In case of arterial compression: arm pallor with arm elevated, reactive hyperemia when limb is lowered

In case of venous compression: Cyanosis and swelling

Inability to complete test, and patient drops arms in lap in marked distress, recognized as reproduction of usual symptoms

Reproduction of the usual symptoms that involve the entire extremity!

41
Q

Costoclavicular Syndrome Test

A

Therapist will depress and retract the scapula

Monitor radial pulse

+ test – diminished pulse, sx reproduction

MSK II FINAL (13 decks)

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