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MS II > Thoracic Spine - Exam > Flashcards

Thoracic Spine - Exam Flashcards

1
Q

What are 2 characteristics of somatic T-spine pain?

A
  • Deep, dull ache

- Changes with movement and posture

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2
Q

From what structure in the T-spine will a boring pain originate from?

A

Bone.

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3
Q

What structures may cause electric or shooting pain?

A

Spinal root impingement

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4
Q

What is the source of burning pain?

A

Neuropathic

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5
Q

What is the source of dull, heavy, or tight pain?

A

Visceral

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6
Q

What 2 types of pain may occur in a dermatomal pattern?

A
  • Radicular

- Neuropathic

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7
Q

What is Scheuermann’s Disease?

A
  • A form of osteochondrosis that occurs in adolescents in which the vertebrae take on a wedge shaped pattern
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8
Q

What 4 postural deviations should be assessed in the T-spine of individuals?

A
  • Forward head posture
  • Pes cavus
  • Pigeon chest (Pectus carinatum)
  • Scapular position deviations
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9
Q

What is the most common cause of kyphosis with increasing age?

A
  • Progressive compression fractures of the vertebrae
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10
Q

What is the term for extreme kyphosis typically seen in the elderly?

A
  • Dowager’s Hump
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11
Q

What is Gibbus?

A

A wedging of the lower T-spine vertebrae or upper L-spine vertebrae that cause a “beak” like protrusion from the back.

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12
Q

What is scoliosis? What are the 2 types?

A

A curvature of the spine in the frontal plane

  • Functional (correctable)
  • Structural
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13
Q

What 4 movements should be assessed during a movement screen?

A
  • Flexion, extension, rotation, sidebending
  • Deep inhalation and exhalation
  • Bilateral arm reach overhead (watch T-spine examination)
  • Ask Pt to do key movement reproducing symptoms
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14
Q

What is the rule of threes of the spinous processes?

A
  • 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
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15
Q

What 8 structures are palpated during examination of the T-spine?

A
  • Spinous Processes
  • Transverse Processes
  • Facet Joints
  • Costo Transverse Joints
  • Rib angles
  • Erector spinae muscles
  • Costocartilage junctions
  • Costosternal junctions
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16
Q

Since the costotransverse cannot be palpated, what is felt instead?

A
  • The rib angle
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17
Q

How each rib oriented to the rib above and below it when palpating the rib angles?

A
  • Anterior to rib below

- Posterior to rib above

18
Q

What erector spinae muscle is typically tender on palpation of the rib angle?

A
  • Iliocostalis
19
Q

How is the costochondral junction assessed?

A
  • Press A –> P through strernum

- Push medially from the lateral rib and assess pain at the sternal junction

20
Q

How are the transverse processes assessed during palpation?

A
  • Assess the presence of a prominence (for facet “locking”)
  • Assess pain
  • Assess symmetry
21
Q

What type of rotation occurs in the thoracic spine?

A

In neutral: Type 1 (side bending and rotation in opposite directions)
In flexion/extension: Type 2 (Side bending and rotation in the same direction)

22
Q

How are the rib angles assessed in sitting?

A
  • 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
23
Q

Why is the articular pillar of the T-spine difficult to palpate?

A
  • It is covered with multifidi`
24
Q

How is T-spine rotation assessed?

A
  • Provide medially, inferiorly, and anteriorly directed force on vertebra inferior to the targeted vertebra, assess segmental movement
25
Q

How is respiratory rib dysfunction assessed?

A
  • 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
26
Q

Where will the rib be tender in precordial catch syndrome?

A
  • At the junction of the sternum and the rib during either exhalation or inhalation
27
Q

How is an inhalation restriction treated?

A
  • 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)
28
Q

How can the patient be positioned when treating an inhalation restriction of the upper ribs to assist with elevation?

A
  • Sidebend to contralateral side
29
Q

Describe the treatment for an exhalation restriction.

A
  • 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
30
Q

How is flexion motion of the T-spine assessed?

A
  • Inferiorly and anteriorly directed pressure with the thenar or hypothenar eminence stabilize the inferior vertebra
  • Segmentally flex the T-spine
31
Q

How is extension motion of the T-spine assessed?

A
  • 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
32
Q

How is sidebending of the T-spine assessed?

A
  • Sidebend segmentally from superior to inferior with medially directed pressure on the ribs to localize the movement
33
Q

How is rotation of the T-spine assessed?

A
  • 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
34
Q

How is a CPA of the T-spine performed?

A
  • Pisiform grip placed on the spinous process of the vertebra with the other hand stabilizing over the top
  • Direct pressure in a PA direction
35
Q

How is a transverse pressure of the T-spine performed?

A
  • Thumb placed on the side of the vertebra, and reinforced with pressure from the other hand
  • Apply pressure medially
36
Q

How is a UPA performed on a vertebra of the T-spine?

A
  • 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
37
Q

How is a rib spring performed?

A
  • 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
38
Q

When the Cervical Rotation Lateral Flexion Test appropriate to perform?

A
  • When thoracic/ girdle pain or TOS is suspected
39
Q

What does the Cerivcal Rotation Lateral Flexion Test assess?

A

An elevated 1st rib.

40
Q

How is the Cervical Rotation Lateral Flexion Test performed?

A
  • 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”
41
Q

How is a 1st rib spring performed?

A
  • 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

MS II (20 decks)

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