Thoracic Spine Mobility Deficit

Question 1

With Thoracic Spine Mobility Deficit, what are the proposed underlying cause of this condition?

Answer 1

Spondylosis
- Gradual progression of age-related joint pain
- Adaptive shortening of the joint connective tissue and periarticular soft tissue

Sprain/Strain
- Acute onset sudden awkward movement
- Gradual onset repetitive postural loading
- Muscle strain and/or ligament sprain

Question 2

What other conditions should be considered with patients with Thoracic Spine Mobility Deficit?

Answer 2

• Neck P! with Mobility Deficit
• Neck P! with Movement Coordination Deficit
• Neck P! with Radiating Pain
• Thoracic Movement Coordination Impairment
• TOS

Question 3

What system, structure, pain mechanism, and phases of healing are unique to patients with Thoracic Spine Mobility Deficit?

Answer 3

System
- Neuromusculoskeletal

Structure
- Zygopophyseal Joint and Periarticular soft tissue

Pain Mechanism
- Nociceptive

Phase of Healing
- Muscle strain 2-4 weeks, Capsular strain and cartilage injuries 10-12 weeks

Question 4

With Thoracic Spine Mobility Deficit, with subjective reports, what are General Symptoms?

Answer 4

• Central or unilateral symptoms
• Possible somatic referred along the ribs and into the UE (T4 syndrome)
• Dull ache at rest that becomes sharp with movement

Question 5

With Thoracic Spine Mobility Deficit, what are subjective reports for Spondylosis?

Answer 5

• Gradual onset with progressive loss of motion

Question 6

With Thoracic Spine Mobility Deficit, what are subjective reports for Sprain/Strains?

Answer 6

• Immediate onset of pain and loss of motion
• Recent unguarded/awkward movement or position
• Progressive onset with repetitive postural loading

Question 7

With Thoracic Spine Mobility Deficits, what are the Aggravating and Easing Factors?

Answer 7

Aggravating Factors
- Dull ache and stiffness with inactivity
- Symptoms reproduced with active movements

Easing Factors
- Staying active and changing positions
- Progressive thoracic spine movement

Question 8

With Thoracic Spine Mobility Deficit, what is the 24 hour pain behavior?

Answer 8

Morning
- May have pain and stiffness that upon waking that eases with activity and movement

Noon to Evening
- Symptom may vary throughout the day depending on the patient’s activities, may have increased pain and stiffness after being sedentary

Night
- Symptoms may disrupt sleep with changing positions depending on symptom irritability

Question 9

With Thoracic Spine Mobility Deficit, when conducting the Movement and Provocation Examinations, what 2 examinations must you do?

Answer 9

Cervical Clearing Examination
- Active ROM
- Passive Intervertebral Motion

Neurodynamic Testing
- ULTTA/ULND 1

Question 10

With Thoracic Spine Mobility Deficit, when conducting Movement and Provocation Test, what may you find with Active ROM?

Answer 10

• Thoracic ROM limitations and symptom provocation consistently reproduced at end range
• Symptom provocation with the addition of overpressure and/or combined motions

Question 11

With Thoracic Spine Mobility Deficit, when conducting the Muscle Performance Examination, which muscles will you test for Muscle coordination, endurance, strength, and length?

Answer 11

• Deep neck flexors/extensors, middle/lower trapezius, rhomboids, serratus anterior
• Upper Trapezius, levator scapulae, scalenes, suboccipitals, SCM, Pec minor/major and diaphragm

Question 12

With Thoracic Spine Mobility Deficit , what may you find during the Palpation Examination?

Answer 12

• Cervicothoracic musculature may reveal active or latent myofascial trigger points and increased resting tone

Question 13

With Interventions, what will you educate the patient on?

Answer 13

• Active lifestyle and general exercise including aerobic and strength training

Question 14

With Interventions, what exercise will you give the patient?

Answer 14

• Exercises that promote ROM and mobility of the cervicothoracic spine and ribs
• Impairment based approach to address cervicoscapulothoracic mobility, flexibility, endurance, neuromuscular control, and strength

Question 15

With Interventions, what will you do for Manual Therapy?

Answer 15

• Mobilizations and manipulation of the cervicothoracic spine and ribs

Question 16

What other conditions respond favorably to treatment in the Thoracic Spine? What is Regional Interdependence?

Answer 16

Neck pain, Shoulder Pain, and LBP

This is the Concept of Regional Interdependence
- “Impairments in one region of the body can influence the musculoskeletal system and neuromuscular function and in systems in other, remote regions of the body.

• Explanations for the benefits of this approach include the biomechanical relationships of various body regions as well as neurophysiological effects including regional pain inhibition and changes in muscles resting tone and function

Question 17

What is the Clinical Prediction Rule (by Mintken) for Thoracic Mobility Impairment with Shoulder pain?

Answer 17

Mobility of the Thoracic Spine is necessary for full; shoulder ROM

Mintken CPR 3/5
- Pain Free shoulder Flexion <120°
- Shoulder IR < 53° at 90° abduction
- Not taking medication for shoulder pain
- Symptoms <90 days

Question 18

When should we consider interprofessional or Intraprofessional referral and what are other treatment options?

Answer 18

Imaging
- In the absence of red flags and for those classified as low risk, imaging is not indicated

Medications/Injections
- NSAIDs
- Facet joint injections
- Radiofrequency ablation