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MSK basics > Thoracic spine - 1 > Flashcards

Thoracic spine - 1 Flashcards

1
Q

what is TOS

A

compression or a tension event that compromises the neurovascular structures in the cervicoaxillary canal

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2
Q

what is the cervicoaxillary canal

A

Cervicoaxillary canal is bounded anteriorly by the clavicle, posteriorly by the scapula, and medially by the first rib.

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3
Q

what is Vascular TOS

A

compression of the brachial plexus and subclavian artery or vein

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4
Q

is it easy to treat vscular TOS

A

no, hard to treat vascular TOS conservatively

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5
Q

Arterial [ATOS] rare or common

A

rare

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6
Q

what are the signs and symtoms of Arterial [ATOS]

A
  • Secondary to repetitive activities leading to claudication
  • Pain, numbness in non-radicular pattern. Associated fatigue with activity that is relieved at rest
  • Cramping in the hand with use
  • Skin cool to touch; increased sensitivity to cold; Reynaud’s phenomenon
  • Pale discoloration
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7
Q

what are the tests for o Arterial [ATOS]

A
  • Allen’s test
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8
Q

what is the purpose of allens test

A

used to rule out distal arterial occlusion

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9
Q

what is the procedure of allens test

A

Position:
 Arms should be on the table and the PT should be across from them

Procedure
 Find the pulse in the radial and ulnar artery – either sides of the wrist
 Occlude both hand and have PT open and close hand (hand turns white)
 Open up on side – hand should return to red, do for the other side

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10
Q

how do we confirm Arterial [ATOS]

A

Confirmed through Doppler ultrasound and angiography

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11
Q

what are the symptoms of Venous [VTOS]

A
  • Deep pain in chest, shoulder, & entire upper extremity
  • Distal limb edema with paresthesia in hand & fingers; skin tightness; fatigue; cyanosis discoloration
  • Venous distension and heaviness of extremity may be observed after activity – should diminish with rest. If not, then possible venous thrombosis - refer to MD
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12
Q

how do we confirm VTOS

A

lab tests

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13
Q

is VTOS rare or common

A

rare 3-5%

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14
Q

what is NTOS due to

A

compression of the brachial plexus

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15
Q

what is True neuro NTOS

A

symptoms + 2 provaction test

EAST test is always +

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16
Q

how do we confrim NTOS

A

neurophysiological testing (EMG, NCV)

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17
Q

what is Disputed neuro TOS

A

there is no confirmation from standard diagnostic testing

  • Neurophysiological testing; negative vascular tests; negative imaging.
  • Based on symptoms below & at least 2 (+) provocation tests. Cyriax Release test often (+).
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18
Q

what is NTOS often associated with

A

previous trauma

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19
Q

what are the general symptoms seen with TOS

A

Pain, paresthesia, numbness, and/or weakness

Cold intolerance (Reynaud phenomenon) due to Sympathetic over activity, not ischemia.

Decreased finger dexterity possible.

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20
Q

Upper Plexus Irritation (C5,6,7) NTOS

A

Occipital headache.

Pain and paresthesia in anterior chest, periscapular area, radial aspect of arm to dorsum of hand and index finger.

Provoked by head movements or lifting.

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21
Q

Lower Plexus Irritation (C8,T1) NTOS

A

Pain & paresthesia in suprascapular area, posterior neck, medial side of arm & forearm and ulnar digits of the hand.

Provoked by activities that depress the shoulders (lifting, carrying a brief case)

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22
Q

what are the two presentation of neuro TOS

A

compressor and releasor

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23
Q

compressor presentation

A
  • Symptoms during the day, especially with overhead activities. Increase in tension or compression of the brachial plexus.
  • Compression at costoclavicular &/or pectoralis minor spaces
  • Usually no night pain unless sleep with arm overhead
  • Occupation often involves working with arms overhead
  • Since compression is intermittent, the blood supply returns when arm is lowered & symptoms are relieved
  • Often unilateral
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24
Q

does releaser NNTOS have a good prognosis

A

yes

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25
Q

what are the signs and sym of releaser NTOS

A
  • Brachial plexus under constant tension due to poor posture, weight of the arms during the day.

o Usually sedentary occupation; long periods of sitting doing repetitive activities (keyboard).

o Poor posture, especially shoulder girdle mal-alignment.

o May have large, heavy arms.
* Release phenomenon revealed during examination.

  • In bed, the tension is released; blood flow returns; axonal flow returns; patient feels paresthesia.
    o Symptoms at night, awakened with paresthesia.
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26
Q

what is the postive test for releaser NTOS

A

Cyriax Release Test

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27
Q

what test do you for NTOS

A
  • Roos Test (EAST Test)
  • Adson’s – Scalene triangle
  • Costoclavicular (Military Brace) –
  • Wright’s (Hyperabduction) –
  • Upper Limb Tension (ULTT) –
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28
Q

how do you the cyriax release test

A

pt seated with arms flexed 90 deg
supported on the table

wrist and forearm in neutral

therapist support arms to create scapular elevation

hold this position for 2-3 minn

29
Q

what is a positive cyriax release test

A

recreation of the patient parathesis

(this is unloading the plexus and allowing blood flow return)

30
Q

what is the procedure fro EAST (roos test)

A

pt sitting with arms 90 abd, ER, and head position in neutral

therapist can manually depress shoulders while patient open and closes fist

31
Q

what is a positive EAST (roos test)

A

unable to hold elvated arm position due to pain, para, and heaviness (fatigue)

(this is loading the brachial plexus through the TOS container)

32
Q

what does a positive TOS tell us

A

that the patients problem is more TOS the cervogenic

33
Q

what is the procedure for adsons test

A

assess the radial pulse

deep inhalation and hold

extend and rot that neck towards the tested side and extend your shoulder

hold this position for 1 min

34
Q

do we like the adsons test

A

no because we are looking for something neuro related by looking at vasculature

there needs to be a big change in for it to be relevant

35
Q

what does a positive adsons test look like

A

the absence of a radial pulse or the onset of symtoms

36
Q

what is the procedure for wrights test

A

assess the radial pulse with the pt arm at there side

passivly abd shoulder 90 and horizontally abd

hold this position for 1 min

37
Q

what is a positive wright test

A

chnage in the pulse or a chnage in the patients sym

38
Q

what is wright test testing

A

the retropectorial minor space

39
Q

how do we do a ULTT - median nerve

A

arm - 90 abd, arm ER, forearm supination, thumb and index and wrist into ext

pull the elb out into felxion

40
Q

what approach is best for NTOS

A

conservative approach

41
Q

what is the sensitivity of a cluster of two TOS test

A

.90

42
Q

what is the basis fro the conservative treatment for TOS

A

based on anatomy posture and biomechanics

  • there is no standard of treatment
  • comprehensive indivdual approach
43
Q

what are the signs and symptoms of a rib or thoracic segment displacement

A
  • Pain is often local to the area of involvement
  • Radicular pain: Follows the intercostal space around the trunk to one side.
  • Not as common, the viscera and the ribs protecting
44
Q

what can be wrong with the ribs

A

they can be elvated or depressed

45
Q

what ribs do we normally focus on

A

4-8

46
Q

what are the signs and symptoms of rib dysfunction

A

Has MOI
o Painful onset – sharp pain
o Sudden change in status – fine to painful quickly

Patient has difficulty taking a deep breath without increasing local pain.
o Increases with inhalation.

Pain lingers – cannot get to the source of pain

47
Q

what can be wrong with the segments in the thoracic region

A

flexed bilat

ext bilat

rotated L or R

48
Q

what are signs and sym of segmental issue with the thoracic region

A

Pain may be less localized
o Until the segment is palpated and mobilized during examination.

Gradual (insidious) onset
o No specific trauma

Breathing not affected

Postural/repeated loading
o Stiff, sore, persistent pain

49
Q

what is some of the dermatone testing you can do in the thoracic region

A

T4, 5

T7,8

T10, 11

T12

50
Q

T4, 5 local

A

nipple region in adult males

51
Q

T7,8

A

in the epigastric area

below the xphoid process

52
Q

T10, 11

A

umbillicus in the lower abdominal areas

53
Q

T12

A

abdominal areas near the the level of the ASIS

54
Q

what is the additional reflex testing we do for

A

superficial abd relfex

UMN
LMN DTR

55
Q

what is the superficial abd relfex used of for

A

T7-T12

56
Q

how do we perfrom the superficial abd reflex test

A

we stroke the four quadrents of the abdominal wall in a diagonal fashion from around the belly button

57
Q

what is normal response for the superficial abd reflex test

A

the skin and belly button should twitch in the direction of the stroke

58
Q

thoracic and UMN signs

A

should be absent

59
Q

thoracic and LMN sigsn

A

bilaterally different

60
Q

what are the steps in the examination of a thoracic

A

AROM - neck, shoulder, Tspine (PROM)

MARM

spring testing

positional testing

61
Q

what is MARM

A

manuel assessment of the respiratory muscles

hands on the ribs - looking at how the rib cage contracts and relaxes with breathing

62
Q

what are we spring testing

A

the ribs - collective and indivdual

segments

63
Q

what does if feel like if a segment is rotated right

A

Right TP more shallow and left TP more deep

64
Q

what are the interventions for a misaligned segment - rot

A

mid thoracic thrust

PA thrust

65
Q

what does the mid thoracic thrust look like

A

o Prone, piston grip over effected segment, side lying, roll over and apply A-P
 Knuckle – TP, shallow side

  • Turn hand 45-degrees
     Finger gun space – SP (galaxy dot)

o Pt cross arms, tuck chin, and curls up

o Take up the slack and apply a thrust

66
Q

what other movement diagram do we use mid thoracic thrust

A

restricted flexion

67
Q

what is the procedure for a Costo-transverse Thrust - hand position

A

Approximate thumb and index finger
* Intersection between thumb and pointer – costo-transverse joint (green dot)
* Tip of index – over a SP
* Thenar eminence over rib
o Descending angle of hand (angle of rib)

68
Q

what is the procedure for a Costo-transverse Thrust - thrust part

A

o Pt rolls to side to face PT, then rolls on back
 Places hands around their shoulders

o PT SB pt away from them at the thoracic level

o Pt curls up and rotates on top of PT hand

o PT takes up the slack and then applies a thrust

o Side: want to work directly on the skin

69
Q
A

MSK basics (20 decks)

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