TSPINE/RIBS Examination Flashcards
1
Q
Special consideration for screening questions with Tspine/Ribs patient:
A
- Pain referral from cardiopulmonary/ hepatobiliary/ gall bladder/ esophageal/ renal systems
- Fracture (rib vs. vertebra)
- Neoplasm
- Ankylosing Spondylitis
- Screening for other non-musculoskeletal health condition or musculoskeletal condition where referral is indicated
2
Q
What is the traditional cobb method when looking at imaging of kyphosis angle?
A
- Perpendicular extensions of lines drawn from superior border of T4 & inferior border of T9
- also used with anterior view to measure scoliotic curvature
3
Q
Visually inspect for Dowager’s Hump:
A
- osteoporotic fractures with increase age)
- Can aid with muscular intervention
4
Q
Visually inspect for Scheuermann’s disease:
A
- wedging of vert
- malnutrition, injury to end plates
5
Q
Visually inspect for Scheuermann’s disease:
A
- wedging of vert
- malnutrition, injury to end plates
6
Q
Visually inspect for Pectus Carinatum:
A
bird chested
7
Q
Visually inspect for barrel chest:
A
COPD, CF
8
Q
Visually inspect for pectus excavatum:
A
- concave curvature
- effect rib function – thoracic rom
9
Q
What does the systems review help us find out?
A
What body regions:Anything else we need to look at in addition to our patient’s primary concern
10
Q
UMN neuro screening tests include?
A
pathologic reflexes, coordination, hyper-reflexia
11
Q
LMN Neuro screening tests include?
A
Diminished sensation, weakness, hypo-reflexia
12
Q
What is the elimination Percussion test? Procedure? Positive test?
A
- Tests for compression fracture
- Procedure: lightly percuss along the length of the spine with a closed fist
- Positive Test: Pt reports sudden, sharp, severe pain
13
Q
Clinical implications of percussion test?
A
Use cautiously if fracture is suspected
14
Q
What is the Wright test?
A
Elimination test for TOS
15
Q
Procedure of the Wright test?
A
- Patient seated and examiner to side
- Radial pulse palpated
- Pt is instructed to abduct the shoulder to 90 degrees & flex the elbows to 90 degrees, and horizontally abduct the shoulders
- The patient rotates the neck to the contralateral direction
- The position is held for 1-2 minutes
16
Q
What is a positive Wright test?
A
reproduction of paresthesia or a decrease in radial pulse
17
Q
What are the clinical implications of the Wright test?
A
- Generally limited research investigating diagnostic properties
- Neither +/- LR compelling with shifting post-test probability
18
Q
What is the Adam’s Forward Flexion test?
A
Elimination test for scoliosis
19
Q
What is the procedure for Adam’s Forward flexion test?
A
The patient is instructed to stand with the feet at shoulder-width, place the hands together, and slowly bend forward (reaching toward the floor)
20
Q
What is a positive Adam’s Forward flexion test?
A
presence of an observable rib hump
21
Q
Structural stress testing (AROM) thoracic flexion procedure:
A
Patient Position: sitting, fingers interlocked behind neck, elbows close to approximation
Procedure: The patient is instructed to bring the elbows toward the umbilicus
22
Q
Structural stress testing (AROM) thoracic extension procedure:
A
Patient Position: sitting, fingers interlocked behind neck, elbows close to approximation
Procedure: The patient is instructed to bring the elbows toward the ceiling
23
Q
Structural stress testing (AROM) thoracic rotation procedure:
A
Patient Position: sitting, arms crossing the chest
Procedure: The patient is instructed to rotate the trunk
24
Q
Structural stress testing (AROM) thoracic lateral flexion procedure:
A
Patient Position: sitting, arms at side & fingers interlocked behind the head
Procedure: The patient is instructed to bring the elbow (on the tested side) toward the lateral pelvis
25
Structural stress testing (PROM) thoracic flexion procedure:
Patient Position: sitting, fingers interlocked behind neck, elbows close to approximation
Examiner Position: standing, facing patient’s side
Ventral arm placed over the patient’s UEs, hand grasping contralateral shoulder
Dorsal hand placed at the patient’s lower thoracic spine
Procedure: The patient is passively flexed at the thoracic spine; the trunk is maintained over the center of mass
26
Structural stress testing (PROM) thoracic extension procedure:
Patient Position: sitting, fingers interlocked behind neck, elbows close to approximation
Examiner Position: standing, facing patient’s side
Ventral arm placed under the patient’s UEs, hand grasping mid/ proximal upper arm
Dorsal hand placed at the patient’s mid/lower thoracic spine
Procedure: The patient is passively extended at the thoracic spine by bringing the patients arms upward and the trunk forward; the trunk is maintained over the center of mass
27
Structural stress testing (PROM) thoracic rotation procedure:
Patient Position: sitting, arms crossing the chest
Examiner Position: standing, facing patient’s side
Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder
Dorsal hand placed at the patient’s scapula (closest to the examiner)
Procedure: The patient is passively rotated in the direction away from the examiner; the trunk is maintained over the center of mass
28
Structural stress testing (PROM) thoracic lateral flexion procedure:
Patient Position: sitting, arms crossing the chest
Examiner Position: standing, facing patient’s side
Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder
Dorsal hand placed at the patient’s trunk (opposite the examiner)
Procedure: The patient is passively laterally flexed in the direction away from the examiner; the trunk is maintained
29
Structural stress testing thoracic flexion resistive testing:
Patient Position: sitting, arms crossing the chest (arm closest to patient under contralateral arm)
Examiner Position: standing, facing patient’s side
Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder
Dorsal hand placed at the patient’s mid-back
Procedure: isometric resistance applied to trunk with extension moment on trunk
30
Structural stress testing thoracic extension resistive testing:
Patient Position: sitting, arms crossing the chest (arm closest to patient under contralateral arm)
Examiner Position: standing, facing patient’s side
Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder
Dorsal hand placed at the patient’s mid-back
Procedure: isometric resistance applied to trunk with flexion moment on trunk
31
Structural stress testing thoracic rotation resistive testing:
Patient Position: sitting, arms crossing the chest (arm closest to patient under contralateral arm)
Examiner Position: standing, facing patient’s side
Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder
Dorsal hand placed at the patient’s scapula (closest to the examiner)
Procedure: isometric resistance applied to trunk with rotation moment on trunk (directed away from examiner)
32
Structural stress testing thoracic lateral flexion resistive testing:
Patient Position: sitting, arms crossing the chest (arm closest to patient under contralateral arm)
Examiner Position: standing, facing patient’s side
Ventral arm placed between the patient’s UEs, hand grasping proximal upper arm/ shoulder; shoulder contacts patient’s shoulder
Dorsal hand placed at the patient’s trunk (opposite the examiner)
Procedure: isometric resistance applied to trunk with lateral flexion moment on trunk (directed away from examiner)
33
What Scapulothoracic Musculature MMT performed?
Mid Trap
Lower Trap
Serratus Anterior
34
What rib at superior scapula? At inferior angle of scapula?
Superior - 2nd rib
| Inferior - 7th rib
35
What Passive Accessory Intervertebral Mobility Testing (PAIVM) done on the thoracic spine?
CPA: Central Posterior-Anterior
UPA: Unilateral Posterior-Anterior
36
Passive Accessory Intervertebral Mobility Testing (PAIVM) done on the ribs?
PA
37
Joint mobility testing of flexion of Lower Cpine and Upper thoracic vert:
Palpation Finger: Between SP C6/C7
Stabilization: Crown
Procedure:
Slightly flex neck (cranially to caudally)
Palpate until motion has stopped, move inferiorly a segment
Expect “opening” of gap between spinous processes
Repeat to test C7/T1
38
Joint mobility testing of flexion of mid and lower Tspine:
Patient Position: sitting, fingers interlocked behind neck, elbows close to approximation
Examiner Position: standing, facing patient’s side
Ventral arm placed over the patient’s UEs, hand grasping contralateral shoulder
With the contralateral hand, the examiner palpates for gapping of spinous processes at each segment
Procedure: The patient is passively flexed at the thoracic spine; motion segmentally assessed from cranial to caudal segments
39
Joint mobility testing of extension of mid and lower Tspine:
Patient Position: sitting, fingers interlocked behind neck, elbows close to approximation
Examiner Position: standing, facing patient’s side
- Ventral arm placed under the patient’s UEs, hand grasping mid/ proximal upper arm
- With the contralateral hand, the examiner palpates for approximation of spinous processes at each segment
Procedure: The patient is passively extended at the thoracic spine by bringing the patients arms upward; motion segmentally assessed from cranial to caudal segments
40
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Prone Posterior-Anterior (P-A)/ Spring Testing
Indication -
Direction of force -
Target Force -
Relative structural movement -
```
Indication: Provocation (Spring), Passive Accessory Motion Testing (joint mobility)
Direction of Force: ventral force
Target Force:
- Mobilizing: spinous process through pisiform (or bilateral articular pillars)
- Stabilizing: N/A
Relative Structural Movement: spine segment on adjacent segments (facet joints, IVJ)
41
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Prone Unilateral Posterior-Anterior (UPA)
Indication -
Direction of force -
Target Force -
Relative structural movement -
```
Indication: Provocation (Spring), Passive Accessory Motion Testing (joint mobility)
Direction of Force: ventral force
Target Force:
- Mobilizing: just lateral to spinous process (with thumb-over-thumb position)
- Stabilizing: N/A
Relative Structural Movement: spine segment on adjacent segments (facet joints, IVJ
42
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Costotransverse Joint Springing
Indication -
Direction of force -
Target Force -
Relative structural movement -
```
Indication: Provocation (Spring), Passive Accessory Motion Testing (joint mobility)
Direction of Force:
Costal force: ventral, caudal, ipsilateral lateral
Thoracic force: stabilizing
Target Force:
- Mobilizing:
- Thoracic: dorsal surface contralateral articular pillar
- Rib: dorsal surface
Relative Structural Movement: rib on transverse process of thoracic spine
43
What are 3 confirmation tests for TOS?
1. Roo’s Test
2. Hyperabduction Test
3. Adson’s Test
44
What are 2 confirmation tests for restricted 1st rib?
1. Cervical Rotation Lateral Flexion Test
| 2. 1st Rib Spring Test
45
What is a confirmation test for Disc/ Sympathetic Nervous System?
Thoracic slump test
46
Roo's confirmation test for TOS:
| Procedure -
- The patient is instructed abduct and externally rotate the shoulders 90 degrees (elbows flexed 90 degrees)
- Pt instructed to rapidly open/ close the hands; this is done for 1 minute
47
Roo's confirmation test for TOS:
| Positive test -
reproduction of concordant symptoms
48
Clinical implications for Roos confirmation test for TOS?
- Generally limited research investigating diagnostic properties
- High false positive rate
- Poor +/- LR reported in higher quality studies
- Clinical feasibility with time required for test??
49
Hyperabduction confirmation test for TOS:
| Procedure -
1. The radial pulse on the symptomatic side is palpated
2. The patient is instructed to abduct the shoulders 90 degrees & fully externally rotate the shoulders (with elbows flexed 90 degrees)
3. The position is held for 1 minute
4. The examiner palpates the radial pulse
50
Hyperabduction confirmation test for TOS:
| Positive test -
change in radial pulse and patient report of paresthesia
51
Adson's confirmation test for TOS:
| Procedure -
1. The radial pulse on the symptomatic side is palpated throughout the procedure
2. sitting with shoulders at ~15 degrees of abduction
3. The patient is instructed to inhale deeply & hold the breath, tilt the head back & rotate the neck toward the examined side
52
Adson's confirmation test for TOS:
| Positive test -
A change in the radial pulse and report of paresthesia
53
Cervical Rotation Lateral Flexion confirmation Test for Restricted 1st rib:
Procedure -
1. patient sitting
2. The neck is passively rotated away from the affected side
3. The neck is passively laterally flexed toward the chest
54
Cervical Rotation Lateral Flexion confirmation Test for Restricted 1st rib:
Positive test -
A bony restriction that blocks lateral flexion
55
First rib spring test confirmation Test for Restricted 1st rib:
Procedure -
1. Patient supine
2. The patient’s head is passively rotated toward the assessed rib
3. Mobilizing hand placed posterior to the first rib (contacting with 2nd MCP joint)
4. Caudal/ ventral force applied to the rib
5. The opposite side is assessed
56
First rib spring test confirmation Test for Restricted 1st rib:
Positive test -
The rib is “stiff” compared to the contralateral side
57
Thoracic slump confirmation test for Disc/ Sympathetic Nervous System:
Procedure -
1. Pt Position: Long sitting on treatment table, knees flexed to ~45 degreees, hands placed behind back
2. Examiner position: standing at the patient’s side
3. Resting symptoms assessed
4. places a caudal load through the patient’s shoulders with his or her cranial UE; symptoms re-assessed
5. patient assumes exaggerated forward head posture (flexed lower c-spine & extended upper c-spine) ; symptoms re-assessed
6. Thoracic spine is passively flexed and/or rotated (ipsilaterally) ; symptoms re-assessed
7. LE on the symptomatic side is straightened to lie flat on the table & the ankle is dorsiflexed; symptoms re-assessed
58
Thoracic slump confirmation test for Disc/ Sympathetic Nervous System:
Positive test -
asymmetry, reproduction of concordant pain, & sensitization
