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TSPINE/RIBS Examination Flashcards

1
Q

Special consideration for screening questions with Tspine/Ribs patient:

A
  1. Pain referral from cardiopulmonary/ hepatobiliary/ gall bladder/ esophageal/ renal systems
  2. Fracture (rib vs. vertebra)
  3. Neoplasm
  4. Ankylosing Spondylitis
  5. Screening for other non-musculoskeletal health condition or musculoskeletal condition where referral is indicated
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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
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3
Q

Visually inspect for Dowager’s Hump:

A
  • osteoporotic fractures with increase age)

- Can aid with muscular intervention

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4
Q

Visually inspect for Scheuermann’s disease:

A
  • wedging of vert

- malnutrition, injury to end plates

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5
Q

Visually inspect for Scheuermann’s disease:

A
  • wedging of vert

- malnutrition, injury to end plates

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6
Q

Visually inspect for Pectus Carinatum:

A

bird chested

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7
Q

Visually inspect for barrel chest:

A

COPD, CF

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8
Q

Visually inspect for pectus excavatum:

A
  • concave curvature

- effect rib function – thoracic rom

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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

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10
Q

UMN neuro screening tests include?

A

pathologic reflexes, coordination, hyper-reflexia

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11
Q

LMN Neuro screening tests include?

A

Diminished sensation, weakness, hypo-reflexia

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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
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13
Q

Clinical implications of percussion test?

A

Use cautiously if fracture is suspected

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14
Q

What is the Wright test?

A

Elimination test for TOS

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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
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16
Q

What is a positive Wright test?

A

reproduction of paresthesia or a decrease in radial pulse

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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
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18
Q

What is the Adam’s Forward Flexion test?

A

Elimination test for scoliosis

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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)

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20
Q

What is a positive Adam’s Forward flexion test?

A

presence of an observable rib hump

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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

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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

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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

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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
Q

Structural stress testing (PROM) thoracic flexion procedure:

A

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
Q

Structural stress testing (PROM) thoracic extension procedure:

A

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
Q

Structural stress testing (PROM) thoracic rotation procedure:

A

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
Q

Structural stress testing (PROM) thoracic lateral flexion procedure:

A

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
Q

Structural stress testing thoracic flexion resistive testing:

A

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
Q

Structural stress testing thoracic extension resistive testing:

A

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
Q

Structural stress testing thoracic rotation resistive testing:

A

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
Q

Structural stress testing thoracic lateral flexion resistive testing:

A

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
Q

What Scapulothoracic Musculature MMT performed?

A

Mid Trap
Lower Trap
Serratus Anterior

34
Q

What rib at superior scapula? At inferior angle of scapula?

A

Superior - 2nd rib

Inferior - 7th rib

35
Q

What Passive Accessory Intervertebral Mobility Testing (PAIVM) done on the thoracic spine?

A

CPA: Central Posterior-Anterior
UPA: Unilateral Posterior-Anterior

36
Q

Passive Accessory Intervertebral Mobility Testing (PAIVM) done on the ribs?

37
Q

Joint mobility testing of flexion of Lower Cpine and Upper thoracic vert:

A

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
Q

Joint mobility testing of flexion of mid and lower Tspine:

A

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
Q

Joint mobility testing of extension of mid and lower Tspine:

A

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
Q 
Prone Posterior-Anterior (P-A)/ Spring Testing
Indication - 
Direction of force - 
Target Force - 
Relative structural movement -
A

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
Q 
Prone Unilateral Posterior-Anterior (UPA)
Indication - 
Direction of force - 
Target Force - 
Relative structural movement -
A

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
Q 
Costotransverse Joint Springing
Indication - 
Direction of force - 
Target Force - 
Relative structural movement -
A

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
Q

What are 3 confirmation tests for TOS?

A
  1. Roo’s Test
  2. Hyperabduction Test
  3. Adson’s Test
44
Q

What are 2 confirmation tests for restricted 1st rib?

A
  1. Cervical Rotation Lateral Flexion Test

2. 1st Rib Spring Test

45
Q

What is a confirmation test for Disc/ Sympathetic Nervous System?

A

Thoracic slump test

46
Q

Roo’s confirmation test for TOS:

Procedure -

A
  • 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
Q

Roo’s confirmation test for TOS:

Positive test -

A

reproduction of concordant symptoms

48
Q

Clinical implications for Roos confirmation test for TOS?

A
  • 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
Q

Hyperabduction confirmation test for TOS:

Procedure -

A
  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
Q

Hyperabduction confirmation test for TOS:

Positive test -

A

change in radial pulse and patient report of paresthesia

51
Q

Adson’s confirmation test for TOS:

Procedure -

A
  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
Q

Adson’s confirmation test for TOS:

Positive test -

A

A change in the radial pulse and report of paresthesia

53
Q

Cervical Rotation Lateral Flexion confirmation Test for Restricted 1st rib:
Procedure -

A
  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
Q

Cervical Rotation Lateral Flexion confirmation Test for Restricted 1st rib:
Positive test -

A

A bony restriction that blocks lateral flexion

55
Q

First rib spring test confirmation Test for Restricted 1st rib:
Procedure -

A
  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
Q

First rib spring test confirmation Test for Restricted 1st rib:
Positive test -

A

The rib is “stiff” compared to the contralateral side

57
Q

Thoracic slump confirmation test for Disc/ Sympathetic Nervous System:
Procedure -

A
  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
Q

Thoracic slump confirmation test for Disc/ Sympathetic Nervous System:
Positive test -

A

asymmetry, reproduction of concordant pain, & sensitization

MSK (18 decks)

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