Thoracic Spine - Exam Flashcards
What are 2 characteristics of somatic T-spine pain?
- Deep, dull ache
- Changes with movement and posture
From what structure in the T-spine will a boring pain originate from?
Bone.
What structures may cause electric or shooting pain?
Spinal root impingement
What is the source of burning pain?
Neuropathic
What is the source of dull, heavy, or tight pain?
Visceral
What 2 types of pain may occur in a dermatomal pattern?
- Radicular
- Neuropathic
What is Scheuermann’s Disease?
- A form of osteochondrosis that occurs in adolescents in which the vertebrae take on a wedge shaped pattern
What 4 postural deviations should be assessed in the T-spine of individuals?
- Forward head posture
- Pes cavus
- Pigeon chest (Pectus carinatum)
- Scapular position deviations
What is the most common cause of kyphosis with increasing age?
- Progressive compression fractures of the vertebrae
What is the term for extreme kyphosis typically seen in the elderly?
- Dowager’s Hump
What is Gibbus?
A wedging of the lower T-spine vertebrae or upper L-spine vertebrae that cause a “beak” like protrusion from the back.
What is scoliosis? What are the 2 types?
A curvature of the spine in the frontal plane
- Functional (correctable)
- Structural
What 4 movements should be assessed during a movement screen?
- Flexion, extension, rotation, sidebending
- Deep inhalation and exhalation
- Bilateral arm reach overhead (watch T-spine examination)
- Ask Pt to do key movement reproducing symptoms
What is the rule of threes of the spinous processes?
- T1/2/3: SP @ the same level
- T4/5/6: SP @ 1/2 vertebra below
- T7/8/9: SP @ one level below
- T 10/11/12: SP @ same level
What 8 structures are palpated during examination of the T-spine?
- Spinous Processes
- Transverse Processes
- Facet Joints
- Costo Transverse Joints
- Rib angles
- Erector spinae muscles
- Costocartilage junctions
- Costosternal junctions
Since the costotransverse cannot be palpated, what is felt instead?
- The rib angle
How each rib oriented to the rib above and below it when palpating the rib angles?
- Anterior to rib below
- Posterior to rib above
What erector spinae muscle is typically tender on palpation of the rib angle?
- Iliocostalis
How is the costochondral junction assessed?
- Press A –> P through strernum
- Push medially from the lateral rib and assess pain at the sternal junction
How are the transverse processes assessed during palpation?
- Assess the presence of a prominence (for facet “locking”)
- Assess pain
- Assess symmetry
What type of rotation occurs in the thoracic spine?
In neutral: Type 1 (side bending and rotation in opposite directions)
In flexion/extension: Type 2 (Side bending and rotation in the same direction)
How are the rib angles assessed in sitting?
- Pt grips the contralateral shoulder to protract the scapula, and the rib angles are palpated along the lateral aspect of the rib cage 2 finger breadths from the transverse processes
Why is the articular pillar of the T-spine difficult to palpate?
- It is covered with multifidi`
How is T-spine rotation assessed?
- Provide medially, inferiorly, and anteriorly directed force on vertebra inferior to the targeted vertebra, assess segmental movement
How is respiratory rib dysfunction assessed?
- Palpate directly over the upper, middle, and lower ribs to determine which group of ribs stops moving first with either inhalation or exhalation
- May feel prominence on one side with a corresponding recess on the other side
Where will the rib be tender in precordial catch syndrome?
- At the junction of the sternum and the rib during either exhalation or inhalation
How is an inhalation restriction treated?
- Pt supine for the upper ribs, and sidelying for the lower ribs
- One hand rests the 2nd digit, and webspace against the superior rib, and guides the rib into elevation during inhalation
- Same hand resists the rib during inhalation (apply superiorly directed pressure)
How can the patient be positioned when treating an inhalation restriction of the upper ribs to assist with elevation?
- Sidebend to contralateral side
Describe the treatment for an exhalation restriction.
- Pt supine for upper ribs, sidelying for lower ribs
- Ulnar side of hand is placed on the inferior rib; The other hand grasps the humerus
- Guide the Pt’s rib inferiorly during a deep exhalation, and resist superior movement of the rib during inhalation
How is flexion motion of the T-spine assessed?
- Inferiorly and anteriorly directed pressure with the thenar or hypothenar eminence stabilize the inferior vertebra
- Segmentally flex the T-spine
How is extension motion of the T-spine assessed?
- Use a trigger grip with anteroinferiorly directed pressure on either side of the spinous process to stabilize the inferior vertebra
OR
- Use the thenar/ hypothenar eminence on the spinous process to stabilize the inferior vertebra
- Segmentally extend the T-spine
How is sidebending of the T-spine assessed?
- Sidebend segmentally from superior to inferior with medially directed pressure on the ribs to localize the movement
How is rotation of the T-spine assessed?
- Push towards the rotated side from the contralateral side of the vertebra using the thenar/ hypothenar eminence to stabilize the inferior vertebra
- Raise the Pt’s shoulder and sidebend away from the tested side with rotation
How is a CPA of the T-spine performed?
- Pisiform grip placed on the spinous process of the vertebra with the other hand stabilizing over the top
- Direct pressure in a PA direction
How is a transverse pressure of the T-spine performed?
- Thumb placed on the side of the vertebra, and reinforced with pressure from the other hand
- Apply pressure medially
How is a UPA performed on a vertebra of the T-spine?
- Pt prone
- Place thumb into the groove on the side of the spinous process on top of the articular pillar
- Place the other hand over the thumb, and provide a PA directed force
How is a rib spring performed?
- Pt prone
- Find rib angle
- Align contour of hand with rib
- Place pisiform onto rib angle
- Use other hand to apply pressure over the top of the palpating hand
- Apply a PA directed force
When the Cervical Rotation Lateral Flexion Test appropriate to perform?
- When thoracic/ girdle pain or TOS is suspected
What does the Cerivcal Rotation Lateral Flexion Test assess?
An elevated 1st rib.
How is the Cervical Rotation Lateral Flexion Test performed?
- Pt in correct sitting posture
- Pt’s head passively rotated away from symptomatic side to end range
- Pt’s head passively laterally flexed downwards
- Assess side-to-side, and the presence of a “bony block”
How is a 1st rib spring performed?
- Pt sitting with good posture
- Pt places contralateral fist under the middle clavicle, and reinforces the grip with their ipsilateral arm
- Grip the patients’ hands from behind in a hugging type grip
- Apply A-P force over Pt’s arm and fist
- Assess pain, or reproduction of symptoms
