Thoracic Spine Examination and Intervention - Lecture 14

Question 1

Which position would someone who has a thoracic fracture not want to be in?

Answer 1

Lying supine will hurt
* as they lie on their back they’re contracting their abbs which pulls them forward making that fracture feel painful

Question 2

What is the most common sight for thraocic fractures

Answer 2

T12 / L1 (normally more pathological fractures)

Question 3

What is the diagnostic cluster for vertebral compression fractures? How many do you need to rule it in?

Answer 3

1) Age > 70
2) Female
3) Prolonged corticosteroid use
4) Trauma (major trauma in younger individuals, minor for older)

Needs 2/4

Question 4

Know visceral refferal patterns

Question 5

Upper throacic / arm and neck = use NDI

If symptoms from thoracic spine extend into the back and legs use ODI

higher number = more disability is present

Question 6

A cobb angle less than what = not scoliosis

Answer 6

10

however if its greter than 36 its considered moderate to severe

Question 7

w/ thoracic spine is it more likely that the thoracic spine is creating head / neck / shoulder pain or more likely that the neck and shoulders are creating the thoracic pain

Answer 7

more likely that neck and shoulders are creating that thoracic pain

Question 8

what is the wainer cluster for radiculopathy

Answer 8

1) cervical rotation less than 60 degrees
2) ULTT1 is posititve
3) Cervical distraction takes away comparabile symptoms
4) Spurlings A (ipsilatearl side flexion w/ closing down)

Question 9

Adverse neural dynamics 3 things

Answer 9

1) side to side difference greater than 10 degrees (measured at elbow and knee)
2) Sysentize or desensitize symptoms
3) Doing the test (ULTT) brings on the symptoms YOU CAME IN WITH TODAY

Question 10

KNOW: Most common thoracic spine issue is thoracic outlet syndrome

Question 11

WHat muscle normally causes thoracic outlet syndrome?

Answer 11

Scalenes

Question 12

KNOW: Most thoracic outlet issues are caused by a soft tissue issue and not an osseous cause (bone)

Question 13

KNOW: A cervical rib can cause thoracic outlet syndrome

so can a prominent C7 transverse process

Displacement of calus from first rib

malunited calviclr or first rib fracture

AC or SC joint injury or dislocation

Osseous tumor

Question 14

KNOW: 90% of thoracic outlet cases are neurogenic (something is pressing on the nerve and causing the symptoms) - brachial plexus

other 10% is vasculogenic causing nerves to be cut off

Question 15

Thoracic Outlet Syndrome Test Item Cluster:

How many do you need?

Answer 15

Adson’s
Roos
Wrights
* hyperabduction for pulse
* HyperABduction for symptoms
Tinel at supraclavicular space

Need all 5 being positive

Question 16

NOTE: TOS is not the most common thing - check lots of other stuff first

Question 17

What kind of injury causes most TOS?

Answer 17

traction style injuries (arm getting pulled)

Question 18

What age group gets TOS? gender?

Answer 18

20-50

female more likely

Question 19

What nerves can get entrapped w/ TOS?

Answer 19

Ulnar, radial, and median nerve entrapment

Question 20

What things would you want to rule out before desiding its TOS?

Answer 20

Remember - TOS typically affects the ulnar, radial or median nerve

Carapal Tunnel
Cervical radiculopathy
Complex regional pain syndrome
Pancoast tumor (easy red flag)
Paget-Schroetter (subclavian compression within costoclavicular space)

Question 21

KNOW: For TOS what can we do?
* strengthening of parascapular muscles (think rhomboids - rotato cuff, - scalenes)
* Stretching of suspect muscle
* rib mobilization / manipulation / contract-relax
* glenohumeral shoulder mobilizations
* Neural sliders for suspect nerves (median > ulnar)
* fix posture

Question 22

KNOW: T4 syndrome can be anywhere from T2-5

Basically T4 syndrome is the stimulation of sympathetic nerve bundles converging around T4 (overstimulated)

Symptoms normally around T4 and and down the back of their arm and their entire forearm feels like its in a glove
* “doesnt feel like its my own hands”
* Or heaviness of hand
* no traumatic MOI

NOTE: We think about this once we’ve ruled out TOS and everything before that including
* Carpal tunnel
* Ulnar nerve
* cervical radiculopathy
* cervical myelopathy
* visceral referrals (heart, stomach [left = spleen lung diaphragm] [right = those +thymus])
* Complex regional pain syndrome
* Cardiac disease (MI, CAD)

Question 23

KNOW: know where T1-T2 refer (like entire scap and shoulder)

Question 24

KNOW: A patient w/ a dull achy scapula first thought is cervical facet / cervical radiular symptoms

Question 25

How would you decide if T1 or T2 was bringing on symptoms?

Answer 25

Mobilize it

Question 26

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what is a cavitiation?

Answer 26

Pop

Question 27

100% of shoulder pain pts had upper thoracic restrictions (because they dont use it and it gets stiff)