Thoracic Spine Exam Flashcards
Area and Behavior of Pain
- Dysfunction of thoracic spine is commonly associated with poor posture and heavy lifting.
- Pain in most commonly seen in pts with abnormal postures, increased thoracic kyphosis
- -stiffness and tenderness of the muscles of the shoulder girdle and thorax
- -often women - Pt with thoracic dysfunction may also describe cervical and lumbar spine pain associated with prolonged sitting or typing
- -worse as the day goes on - Writers, muscians, dentist, secretaries, and computer programmers are common victims
Costovetebral joints are unique to T-spine
- -can present with well-localized pain close to midline or with referred pain quite distal down the spine
- -derangements of these joints typically due to trauma or an unguarded movement in rotation such as turning too rapidly
Costovertebral Joints
- Symptoms include pain on forced and deep breathing that radiates along the rib and sudden lightning-like pain that makes breathing difficult and may give the feeling of constriction
- 3-4 cm from midline, midline, posterior to the lateral chest wall and even the anterior chest wall
- Diagnosis may be confirmed when movement of the rib provokes pain at the costovertebral joint
Intercostal Muscles
- Most chest lesions are due to intercostal muscle spasm with coughing or sneezing
- The muscles may also restriction excursion of the rib in inhalation or exhalation and are associated with hypertonus intercostals above and below the involved rib
- Nerve irritation may also be the cause of the pain
Area and Behavior of Pain
- Lower cervical dysfunction often refers pain to the thoracic region
- According to Maigne, 70% of the common thoracic pain is of lower cervical origin
- Pain from the lower cervical spine can also be referred to the anterior chest and mimic coronary ischemic pain
Area and Behavior of Pain
- Disc Lesion less common than in cervical or lumbar
- Disc protrusion at T1,2 symptoms may be felt in the arm
- At lower levels, symptoms experienced at the side or front of the trunk
- Most common level of disc issue is T11-12
Area and Behavior of Pain
T1-4 is the stiffest part of the spine
T4 syndrome is associated with stiffness of these segments
–vague discomfort or pain in the arm
–parethesia that does not follow a determatomal pattern and always effects the hand
-Unaccustomed activity and poor posture can predispose a pt to this syndrome
Area and Behavior of pain
- Thoracic muscular injury occurs more frequently than in cervical or lumbar
- Most often strains of intercostals, pecs, lats and origins of the abdominals
- Strains of these muscles can be caused by overexertion and violent coughing and sneezing
Active Movements
Active Movements for the lower half of the T-spine are the same as the lumbar spine
Active movements for the upper half of the T-spine are the same as the cervical spine
Neurological Testing
No clear dermatomes or myotomes are present for the thoracic spine
Pathological Reflexes
1.Babinski
2.Oppenheim
3.Lhermitte’s sigh
—eletrical shock running down the back and into the limbs with cervical flexion
PPIVM’s FLexion
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PPIVM’s Extension
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PPIVM’s Sidebending
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PPIVM’s Rotation
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Palpation
Seeking out tenderness, swelling, muscle spasm, temperature alteration
