Thoracic Spine Examination and Intervention

Question 1

Thoracic Back Pain Incidence

Answer 1

Not as common

Potential for referred pain from organs

Question 2

Thoracic Sources of Pain

Answer 2

Disk
Ligaments
Costosternal Joint
Costotransverse Joint
Costovertebral Joint
Intervertebral joint
Internal Organs

Question 3

1st Order classification

Answer 3

Is it a nuisance or something more?

Question 4

Special Questions

Answer 4

General health questions*
Medications
Imaging
Functional Questionairres

Question 5

Roland Morris Disability Questionnaire

Answer 5

Used for general low back pain

Question 6

Oswestry (Lumbar spine index)

Answer 6

Sometime used with lower thoracic

Question 7

Changes with inspiration/expiration..

Answer 7

Ribs indicated

Question 8

Coughing, sneezing, or straining are all…

Answer 8

Examples of the valsalva maneuver

Question 9

Bilateral changes in lower extremities could be…

Answer 9

Infection

Question 10

Problems with digestion could be

Answer 10

Too many painkillers

Question 11

When is cervical spine screen indicated?

Answer 11

When symptoms are proximal to the inferior angle of the scapula

Question 12

Thoracic Observation

Answer 12

Posture
Gait
Integument
Structural Asymmetry

Question 13

AROM Flexion

Answer 13

80 degrees

Question 14

AROM Extension

Answer 14

25 degrees

Question 15

AROM Rotation

Answer 15

45 degrees

Question 16

AROM Side-Bending

Answer 16

35 degrees

Question 17

AROM movements tested in…

Answer 17

Sitting

Question 18

AROM measurements tested in….

Answer 18

Standing except for rotation

Question 19

Thoracic RMT

Answer 19

Sitting

Flx/Ext/Rotation

Question 20

PROM Thoracic

Answer 20

Sitting
Flx/Ext/Rotation/Sidebending
PVIM sitting or side-lying

Question 21

Passive accessory motion testing

Answer 21

Performed in prone
CVP
UVP
TVP
PA over angle of rib

Question 22

Muscle performance testing

Answer 22

Not normally MMT
Resisted isometrics
Endurance Testing

Question 23

Special Testing

Answer 23

Thoracic Outlet Syndrome
Neurological Involvement
General Medical Screening

Question 24

Slump test

Answer 24

Determines neurodynamics

UNLT Test or SLR depending on location of symptoms

Question 25

Tests for neurological Symptoms

Answer 25

Slump test DTR/MSR Dermatomes Thoracic Outlet special tests

Question 26

Thoracic Outlet Special Tests

Answer 26

Roo's Test Adson's Test Allen Maneuver

Question 27

Other special tests

Answer 27

``` Compression/Distraction (symptom provocation) Heel drop test (Fx) Percussion over spinous process Rib spring Cervical Rotation lateral flexion test ```

Question 28

Palpation

Answer 28

Tissue texture and temperature Boney landmarks Abdominal screen in chemical presentaiton

Question 29

Systemic Origins of thoracic pain

Answer 29

``` Cardiac Pulmonary Renal Gastrointestinal Acromegaly Breast Cancer ```

Question 30

Indications of systemic pain

Answer 30

Pt has near normal objective values and doesnt respond to mechanical intervention

Question 31

Liver and gallbladder refer to

Answer 31

Right Trap/Right stomach/ posterior right

Question 32

Lung and diaphragm refer to

Answer 32

Left trap

Question 33

Heart refers to

Answer 33

Left chest/down arm/Back between scapulae

Question 34

Pancreas refers to

Answer 34

Mid stomach or mid/low left back

Question 35

Interventions

Answer 35

``` RPM Pain/Inflammation control Neuromobilization Pt Education Stability Thrust/Non-thrust manips ```

Question 36

Thoracic Directional Preference

Answer 36

``` Repeated movements in direction that reduces symptoms or centralizes peripheral symptoms Ext. over roll Prone press up Rotation toward painful side Flexion in sitting ```

Question 37

Hypomobility intervention

Answer 37

``` Thrust and Non thrust to spine or ribs Soft tissue mobilization and stretching or CT AROM/PROM in to restriction Postural education Muscle performance training (Planks) ```

Question 38

Hypermobility intervention

Answer 38

``` Do not see often but.. Local modalities motor learning/stabilization strengthening postural muscles ```

Question 39

Neuromobilization

Answer 39

Pt presenting with mechanical and neurological symptoms Positive neurodynamic testing Test can be used as the treatment

Question 40

Patient Education

Answer 40

``` Limitations concerning the stage of healing How to manage symptoms independentyl Postural Awareness Prevention of future episodes HEP (What, why, how often, how long) ```