Week 1: Red Flags and Thoracic Flashcards
Clinical red flags system
(Red, yellow, orange, blue, black)
Red: signs and symptoms of serious pathology
Yellow: psychological, social and environmental factors
Orange: psychiatric conditions
Blue: work and occupational factors
Black: socio-occupational factors and system or contextual obstacles
General red flag characteristics
Severe and/or progressive symptoms
Non-mechanical pain
Night pain or pain at rest
Systemic symptoms (fever, weight loss)
Cancer red flags
Unexplained weight loss
History of cancer
Age over 50
Pain that is unrelenting and worse at night
Infection red flags
Fever
Recent bacterial infection
Intravenous drug use
Immune suppression
Fracture red flags
History of trauma or fracture
Osteoporosis
Prolonged corticosteroid use
Age >50
Severe, localised pain
Presence of contusion or abrasion
Cauda Equina red flags
Severe low back pain
Saddle anesthesia
Bladder or bowel dysfunction
Bilateral leg pain and weakness
Neurological deficits (loss of sensation, weakness, numbness)
2 structures of IV disc
Annulus Fibrosus
Nucleus Pulposus
Annulus fibrosus
(Description, composition, function)
outer layer of IV disc
Made up of tough, fibrous rings of collagen
Provides strength and flexibility, allowing for movement and weight bearing
Nucleus Pulposus
(Description, composition, function)
Inner core of IV disc
Made of gelatinous material rich in water and proteoglycans
Acts as shock absorber to distribute pressure across the disc
Types of Thoracic Pain
Muscular strain
Facet joint dysfunction
Herniated thoracic disc
Thoracic outlet syndrome
Referred pain from visceral organs
Osteoporosis or vertebral fracture
Thoracic pain - muscular Strain signs and symptoms
localised pain and tenderness in thoracic muscles
stiffness and limited ROM
pain exacerbated by movement or touch
Imaging not required unless trauma suspected
Thoracic pain - Facet joint dysfunction signs and symptoms
localised pain often described as aching or sharp
pain worsened by twisting or bending movements
Possible referred pain to shoulder or abdomen
Thoracic pain - Herniated Disc signs and symptoms
Radicular pain radiating around the chest or abdomen is common
Numbness, tingling or weakness in the affected dermatomes if radiating pain
Severe case may involve myelopathy
MRI to confirm herniation
Thoracic pain - Osteoporosis and vertebral fractures signs and symptoms
sudden onset of severe pain which worsens with activities and improves with rest
localised tenderness and possible deformity. Pain upon palpation of affected vertebrae
height loss, reduced ROM and kyphotic posture
X-ray to identify fracture
DEXA scan to assess bone density
Prolonged use of ___ can contribute to osteoporosis and vertebral fractures
corticosteroids
Thoracic pain - Thoracic Outlet Syndrome signs and symptoms
pain, numbness and tingling in the arm and hand
weakness and swelling in the affected limb
symptoms worsen with overhead activities
What is thoracic outlet syndrome
compression of neurovascular (blood vessels and nerves) structures in the thoracic outlet (space between clavicle and first rib)
What test will be positive if you have Thoracic outlet syndrome
Positive Adson’s test
Thoracic pain - referred pain from visceral organs signs and symptoms
pain radiating to the thoracic spine
associated systemic symptoms
pain may vary with meals or respiratory movements
4 types of exercises for thoracic pain treatment
Mobility
Strength
Work capacity
Motor control
When to consider surgery for thoracic pain treatment
symptoms persist despite adequate trialling of conservative treatments (3-6 months)
Progressive neurological symptoms (weakness, atrophy, numbness or tingling)
Vascular symptoms
Thoracic spine loose packed position
neutral to slight flexion
Thoracic spine closed packed position
extension
Normal ROM thoracic flexion
20-45 degs
Normal ROM thoracic extension
25-45 degs
Normal ROM thoracic rotation
70 degrees
Normal ROM thoracic lateral flexion
20-40 degs
Techniques to increase thoracic spine unilateral rotation ROM
Transverse glide
unilateral PA
Rotation PPIVM
Thoracic rotation MWM
Techniques to increase thoracic extension ROM
Central PA
Thoracic PPIVM (Extension)
Techniques to increase thoracic flexion ROM
Thoracic PPIVM (flexion)
Thoracic superior glide T1-T4
