Thoracic Spine Treatment Flashcards
1
Q
What are you looking for using TART?
A
- tissue texture changes, asymmetry, restriction of motion, tenderness
- look at gross motion AROM and PROM
- load and spring on vertebrae
- type I and II mechanics in thoracic spine
2
Q
What are 3 prep techniques used for the thoracic spine?
A
MFR
- Prone pressure
- Prone pressure with counter pressure
- Lateral recumbant perpendicular MFR
3
Q
How would you perform prone pressure for thoracic spine?
A
- place thenar and hypothenar eminence on paravertebral muscles oppsite the sied you are
- place hand on top of other
- with elbows straight use your body weight to engage soft tissues with ventral force and move out laterally creating PERPENDICULAR stretch
4
Q
How would you perform prone pressure with counter pressure?
A
- place thenar eminence and thumb of caudad hand over thoracic paravertebral muscles opposite side of you
- hypothenar eminence of cephalad hand on paravertebral muscles on same side as you
- engage tissues with ventral force and move hands in direction they are facing creating a LONGITUDINAL stretch
5
Q
How would you perform lateral recumbent perpendicular MFR?
A
- find pads on paravertebral muscles lateral to spinous processes
- engage muscle with ventral force and move out laterally to give perpendicular stretch
- use forarms as fulcrums to increase stretch
6
Q
How do you perform HVLA SUPINE T spine (aka Kirksville crunch)?
A
- doc at side contralateral to SD rotation (rotated R, doc on L)
- pt crosses arms over chest with side of SD rotation on TOP
- place inferior thenar eminence on posterior TP
- pt elbows positioned in doc abdomen
- use superior hand/forarm to lift and position patients head and neck to localize the restrictive barrier ( F/E, SB, rotation)
- type I= SB away from doc
- type II= SB toward doc
- pt inhale adn exhale deeply and when exhale apply posterior to anterior HVLA thrust through abdomen toward the posterior PTP
- recheck 2-4 TART findings
7
Q
How would you perform HVLA prone (aka Texas Twist) for T spine?
A
- doc stand contralateral to SD rotation (rotated R doc on L)
- place hands facing opposite directions on either side of spinous process with SD
- type 1= hand facing cephalad,hypothenar eminence on PTP, hand facing caudad,thenar eminence opposite TP
- type II= hand facing cephalad,thenar eminence on PTP, hand facing cauded,hypothenar eminence opposite TP
- pt inhale adn exhale fully and as exhale follow their motion to engage barrier further
- at end of exhale a downward anterior HVLA thrust applied with counter balance pressure (twist) in the direction of the fingers
- force slightly greater on side of PTP, other hand provide counterforce
- recheck 2-4 TART findings
8
Q
How would you perform HVLA Supine KNEE fulcrum for upper and middle thoracic?
A
- pt supine with fingers clasped behind neck
- position ipsilateral knee to the PTP of dysfunctional vertebrae to act as fulcrum for HVLA
- pass hands through pts flexed UE on both sides and grasp rib cage using thenar eminences on anterolateral aspect of ribs
- have pt inhale and exhale deeply at the end of exhale quickly and gently pull patients rib cage toward PTP
- recheck 2-4 TART findings
9
Q
How would you perform ME upper T-spine for type 1 SD?
A
- pt seated place thumb adn index finger monitor TP to localize SB and rotation of segmenters treated while middle finger monitors TP of vertebrae below
- place other hand on pateitns head “neutral position”
- induce SBing by positioning thigh beneath their arm (more SBing by abducting leg)
- if TP verebrae below begins to move too much flection/extension induced
- induce rotation to the restrictive barrier by rotating head to right
- have patient hold inhalation and resist your force “return to neutral” resist for 3-5 sec then relax
- wait 1-2 sec and move into next RB and repeat 3-5 times and recheck 2-4 TART changes
10
Q
How would you perform ME for upper T-spine for type 2 SD
A
- same as SD treatment for type I but with addition of flexion/extension component
- place pt in flex/ext first then find rotational/SBing barriers
- pt will try to return to neutral then relax and move further into RB and repeat
11
Q
How would you perform ME for lower T spine for type 1 SD?
A
- pt with ipsilateral hand to PTP clasped behind neck and holding the elbow with other hand
- doc has thumb and index finger of monitoring hand on TPs of target segment and middle finger on TP or segment below
- place other hand on pt bicep by passing BENEATH arm on contralateral side of PTP first and position patient to SBing and rotation to RB
- pt inhale and hold and resist your force “return to neutral” for 3-5 sec then relax and move into next RB and repeat
- recheck 2-4 TART changes
12
Q
How would you perform ME for lower T spine for type 2 SD?
A
- same set up as ME for type 1 SD except doc arm pass OVER patients arm instead of under to contact bicep
- then induce flexion/extension in addition to SBing and rotation
13
Q
How would you perform HVLA seated for lower T spine?
A
- pt sit with ipsilateral hand to the PTP clasped behind neck and holding elbow with their other hand
- doc holds their ipsilateral thenar eminence to the PTP of dysfunctional side fr driving mechanism for HVLA
- place other hand on patients bicep by passing BELOW their arm first and position pt to the RB
- pt inhale and exhale deeply at end of exhale quick and gently rotate your upper body to cause simultanious anterior motion at pts PTP and rotation to faciliate HVLA thrust
- recheck 2-4 TART findings
14
Q
How would you perform HVLA seated knee fulcrum technique for T spine?
A
- pt sit with hands clasped behind their neck
- with stool for your foot position ipsilateral knee to the PTP of dysfunctional vertebrae act as fulcrum for HVLA treatment
- pass beneath patients arms and through flexed arms to grasp forarms proximal to wrist
- instruct patient to deeply inhale and exhale at end of exhale quickly and gently pull patient superior/posteriorly to roll PTP over knee
- check 2-4 TART findings
