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Semester 3 PM Exam 4 > Thoracic Spine Clinical Presentation > Flashcards

Thoracic Spine Clinical Presentation Flashcards

1
Q

Subjective Exam

A 
Nature
Area
Behavior
Present Hx
Past Hx
Special Questions
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2
Q

Special questions to ask

A 
Imaging that has been done?
Difficulty/Sx with breathing or coughing
Sx parallel rib position
Surgeries
Autonomic sx
Relevant medical hx
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3
Q

mm strain/imbalance/weakness - Onset

A

Traumatic or insidious

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4
Q

mm strain/imbalance/weakness - Screening

A

Screening above and below will depend on their presenting behavior
Would be neck/cervical and lumbar

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5
Q

mm strain/imbalance/weakness - large mm of spine and shoulder girdle
Sup and Deep mm

A

Potential source of thoracic region sx
Superficial - Trap, rhomboids, lat
Deep - Erector spinae

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6
Q

mm strain/imbalance/weakness - small mm are associated with

A

Ribs, TP, Costo-vertebral region
Semispinalis, multifidus, rotatores
Serratus post, intercostals, diaphragm
Subcostals, levator costarum, intertransversarii

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7
Q

mm strain/imbalance/weakness - Erector spinae

A

Within TFL

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8
Q

mm strain/imbalance/weakness - Quadratus Lumborum

A

Lumbar spine, 12th rib, and pelvis attachments

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9
Q

mm strain/imbalance/weakness - Int/Ext obliques

A

Have costal attachments

Can impact posture

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10
Q

mm strain/imbalance/weakness - Rotatores Thoracis

A

Deep with rotational component

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11
Q

mm strain/imbalance/weakness - levator costarum and Intertransversarri

A

Small mm - patient might pinpoint location of pain

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12
Q

mm strain/imbalance/weakness - primary mm of ventilation

A

Diaphragm
Intercostals
Abdominal mm (IO, EO, TA, RA)

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13
Q

mm strain/imbalance/weakness - secondary mm of ventilation

A

Scalene
SCM
Pec Major and Minor
Quadratus Lumborum

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14
Q

mm strain/imbalance/weakness - scalene

A

life rib cage up to help with inspiration (upper ribs)

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15
Q

mm strain/imbalance/weakness - SCM

A

Move rib cage sup in pump handle when neck is fixed

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16
Q

mm strain/imbalance/weakness - Pec Minor

A

Can help raise rib 3, 4, 5

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17
Q

mm strain/imbalance/weakness - Quadratus Lumborum

A

Expiratory mm, stabilizes diaphragm with attachment onto 12th rib

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18
Q

mm strain/imbalance/weakness - Examination

A
  1. Posture/Observation
  2. Breathing assessment
  3. Mm length and strength
  4. Palpation
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19
Q

mm strain/imbalance/weakness - Intervention

A

Posture education, tx mm imbalance, trigger point, SCS, modalities for mm injury

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20
Q

Facet Dysfunction - onset

A

Trauma, degenerative, insidious

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21
Q

Facet Dysfunction - location/quality

A

Local sharp pain
referred pain
Costotransverse or Costovertebral joints

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22
Q

Facets are

A

Thin and flat with not a lot of tilt - as get to thorcolumbar junction are more vertical though

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23
Q

Facets - transverse and frontal plane

A

60 degrees to trans plane

20 degrees to frontal plane

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24
Q

SP slope

A

inf from T5-T8 and overlap SP of the adjacent inferior vertebrae

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25
Q

Rule of 3’s - T1 to T3

A

SP are level with the vertebral body of the same level

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26
Q

Rule of 3’s - T4 to T6

A

SP are level with the disc of the inferior level

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27
Q

Rule of 3’s - T7 to T9

A

SP level with the body of the vertebrae below

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28
Q

Rule of 3’s T10

A

Level with the body of the vertebrae below

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29
Q

Rule of 3’s T11

A

Level with the disc of the vertebrae below

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30
Q

Rule of 3’s T12

A

Level with its own vertebral body

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31
Q

At the top of the rib cage the ribs are

A

relatively horizontal - run more obliquely downward as the rib cage descends, by the 12th rib it is more vertical though

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32
Q

Anteriorly the ribs are

Posteriorly

A 
Ant = subcutaneous
Post = covered with mm
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33
Q

Rib articulations (7)

A 
Manubriosternal 
Xiphisternal
Costovertebral 
Costotransverse
Costochondral
Chondrosternal
Interchondral
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34
Q

Manubriosternal and Xiphisternal joints are what type

A

Synchondrosis

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35
Q

Manubriosternal ossifies

A

in 10% of older adults

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36
Q

Xiphisternal ossifies

A

by age 40-50

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37
Q

Costovertebral Joint is what type of joint

A

Synovial

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38
Q

Costovertebral joint is formed by what

A

Rib, two vertebral bodies, and the IVD

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39
Q

Costovertebral joints - which ribs attach with only 1 vertebrae

A

Rib 1, 10-12

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40
Q

Costovertebral joints - other characteristics

A

Fibrous capsule surrounds the entire articulation

Radiate ligament and capsular ligament for AP support

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41
Q

Costotransverse joints is what type

A

Synovial

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42
Q

Costotransverse joints is formed by

A

costal tubercle of rib with costal facet on TP of corresponding vertebrae
Ligamentous support

43
Q

Costotransverse joints present at

A

T1-T10

ribs 1-10

44
Q

Costochondral and Chondrosternal Joints are what type

A

Synchondroses surrounded by periosteum with no ligament support

45
Q

Costochondral joint is formed by what

A

Ribs articulate with costal cartilage

46
Q

Chondrosternal joints are formed by

A

Costal cartilage of rib attaching to sternum

47
Q

Interchondral joints are what type

A

Synovial

48
Q

Interchondral joints attach what

A

Cartilage of rib to cartilage of rib above them

49
Q

Interchondral joints - for ribs 8 to 10

A

this is their only attachment to sternum

50
Q

Interchondral joints - in old age

A

Become fibrous and fuse

51
Q

Coupled Movements - Upper thoracic

A

Rot and LF in same direction

52
Q

Coupled Movements - Middle/Lower thoracic

A

More variable among individuals - some say based on hand dominance or depending on which motion was introduced first

53
Q

Coupled movements - Lower thoracic

A

In neutral = Rot and LF in opp
In flex/ext = Rot and LF in same
T11 = tends to have more pure rot
T12 = just like lumbar

54
Q

Rib kinematics - flexion

A

Inf facets glide sup and fwrd on the sup facets of the vert below
Ant rib rotation

55
Q

Rib kinematics - extension

A

Inf facets of sup vert glide backward and downward on sup facets of vert below
Post rib rotation

56
Q

Rib kinematics - facets close with

A

Shoulder flexion

- thoracic ext with ipsilateral LF/ROT

57
Q

Rib kinematics - Manubrium rotates toward

A

shoulder flexed

58
Q

Rib kinematics - lateral flexion

A

Not a lot due to rib approximation

59
Q

Rib kinematics - Rotation - if rot L

A

the left rib will post rot (externally)

the right rib will ant rot (internally)

60
Q

Rib Actions - pump handle action

A

During inspiration - ribs 1-6 pulled upward and forward
Accompanied by elevation of manubrium
?? add more

61
Q

Rib Actions - bucket handle action

A

Ribs 7-10 movement in lateral dimension

Upward and back to inc infrasternal angle OR downward and forward to dec infrasternal angle

62
Q

Rib Actions - Caliper action

A

Ribs 8-12 move laterally to inc lateral diameter
Move with respiration
Thumbs come together post and fingers apart ant

63
Q

Structural Rib Dysfunction

A

More bony in nature - we cant really change this

64
Q

Torsional Rib Dysfunction

A

Twisting of the rib
Will feel like it sticks out a little in front and back
More of a soft tissue torsion but can have bony torsion too

65
Q

Respiratory Rib Dysfunction

A

Issue with breathing

66
Q

Bucket Bail Lesion

A

Stuck in bucket handle position

Bucket handle position is displaced more than pump handle position because of its more lateral position

67
Q

Ant/Post Ribs

A

Ant = deeper post, more prominent ant
Post = deeper ant, more prominent post
Compare to other side
Fixed rib has diminished respiratory movement

68
Q

Examination - Rib Dysfunction

A 
Seatbelt injury, cough, sneeze
Posture eval
Breathing assessment
Rib palpation
ROM
Joint mobility
Muscle testing
69
Q

Intervention - Rib Dysfunction

A

Tx thoracic first, could do manipulation to ribs, breathing exercises, stretching and strengthening

70
Q

Stenosis

A

Narrowing laterally or centrally in spinal cord
Usually degenerative
Symptoms of cord compression may result

71
Q

Disc Pathology

A

Relatively uncommon - more common at TL junction or lower thoracic spine
Limited thoracic spine so difficult to reproduce sx with ROM

72
Q

Age changes in disc

A 
Degeneration - 50-60% age 40
Disc narrowing
Loss of translation
Vertebral body wedging
Loss of thoracic extension
73
Q

Scheuermann’s Disease

A

Most common in M 12-18 yo
Mild to moderate pain
Excessive kyphosis, loss of flex/ext ROM
Schmorles nodes

74
Q

Scheuermann’s Disease - PT intervention

A

Rest/postural education

75
Q

Chest deformities -

A

Structural kyphosis

76
Q

Signs of structural kyphosis

A

Excessive thoracic kyphosis
Wedging
Loss of flex/ext ROM

77
Q

Interventions - structural kyphosis

A

Bracing
Surgical correction
PT - rest, postural ed, breathing ex, gradual mob of other areas post op

78
Q

Osteoporosis - what is it

A

Loss of bone density
Inc concavity
Loss of vert height

79
Q

Osteoporosis - interventions

A

Weight bearing activities but no spinal flexion, nutrition ed, fall prevention

80
Q

Osteoporosis vs. Osteopenia

A

Penia - low bone density but not the disease process where bones are deteriorating

81
Q

Peak bone mass

A

around age 30

82
Q

Spinal tumors

A

May cause neuro dysfunction from cord compression

83
Q

Spinal tumors - sx

A

Back pain is primary sx - worse at night

Sx may or may not be activity related

84
Q

Spinal tumors - Dx

A

Radiographs, CTs, MRI, Biopsy

85
Q

Ankylosing Spondylitis

A

Chronic inflammatory arthropathy
Stiffening or fusion of spine or SIJ
More common and sever in M

86
Q

Ankylosing Spondylitis - Sx

A

Low back ache
Maybe radicular sx
Low back stiffness especially in am

87
Q

Ankylosing Spondylitis - Intervention

A

Meds, surgery

PT - Ext flexibility, postural strengthening, chest expansion, breathing ex

88
Q

T4 syndrome

A

Usually T3-T5, Can be T2-T7
Autonomic NS involvement
Facet involvement

89
Q

T4 Syndrome presentation

A

Generalized HA
U or B pain/paresthesia
Associated neck, upper thoracic, scap pain

90
Q

T4 Syndrome - exam

A 
Local tenderdness
Joint hypomobility
Soft tissue texture changes
Prominent/depressed SP
Pos neurodyn testing
Non derm or multi derm (glove) pattern
91
Q

T4 Syndrome - Intervention

A

Mob/manipulation if not contraindicated
Postural ed/ex
Tx neural tissue

92
Q

Scoliosis

A

Deformity with one or more lateral curves of the Lx or T spine

93
Q

Two types of scoliosis - Non Structural

A

Non structural - Poor posture, nerve root irritation, leg length discrepancy

94
Q

Two types of scoliosis - Structural

A

Genetic, idiopathic, wedge/hemi-vertebra

95
Q

Scoliosis - curve pattern named according

A

to the apex of the curve

in the direction of the convexity

96
Q

Scoliosis - Vertebral rotation

A

Bodies rotate toward the rib hump
Causes rib movement post - rib hump
Narrowing of thoracic cage on one side

97
Q

Intervention - structural scoliosis

A

Sometimes need surgical

98
Q

Intervention - nonstructural scoliosis

A

Look at if there is mm imbalance, posture

99
Q

Chest deformities - Pectus Carinatum

A

Pigeon chest
Sternum projects forward, inc the AP dimension of chest
Restrict ventilation volume

100
Q

Chest deformities - Pectus Excavatum

A

Funnel chest
Sternum pushed post by an overgrowth of the ribs
AP chest dimension dec affects respiration
May result in kyphosis

101
Q

Chest deformities - Barrel Chest

A

Sternum projects forward
AP diameter inc
Seen with emphysema

102
Q

Thoracic Referred pain

A

If sx in the thoracic region are not reproduced through mechanical tests, serious pathology may be present
Refer to physician

103
Q

Referred pain from cervical spine

A

Cervical discs
Cervical facets
Medial scapular border
Cloward areas

Semester 3 PM Exam 4 (1 decks)

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