Lecture 4b: Thoracic Spine And Rib Exam And Evaluation Flashcards
1
Q
What is the most important region for load transfer b./t upper body and lower body
A
Thoracic spine
2
Q
What are the 3 major areas of MSK dysfunction in the thoracic spine
A
• 1st Costo-vertebral (CV) joints
• 2nd Thoraco-lumbar (TL) junction
• 3rd Cervico-thoracic (CT) junction
3
Q
T/F: MSK origins of pain/symptoms are less common in t-spine
A
T
4
Q
Where can T spine pan refer distally
A
• Groin, pubis
• Lower abdominal wall
5
Q
How is the onset of symptoms for mm or ligament issue and bone issue
A
- muscle or ligament may be immediate or delayed several hours or days
- bone pain is usually immediate
6
Q
How is visceral pain usually
A
Vague and dull , hard for patient to pinpoint
7
Q
Where does gallbladder pain refer to
A
Upper T thoracic/ scapular pain
8
Q
What is usually the patient hx for aortic aneurysm
A
40-70 y/o w/ no clear MO, no hx of trauma , non mechanical symptoms
Pulsating abdomen when physical exam
9
Q
What is a non msk thing that could cause pain in mid back
A
Cardiac
10
Q
What non msk thing can mimic rib dysfucntion
A
Pleurisy
11
Q
Where is Angina pain going to be for non msk thoracic pain
A
L , R or B jaw , neck, scapular pain , medial board of UE , mid thoracic pain
12
Q
How may a patient present w myocardial infaraction
A
-chest pain
-pallor
- sweating
- dyspnea
-nausea
- palpation
- SYMTOMS > 30 mins
13
Q
What are the 3 lung medical causes of thoracic pain
A
- apical (pancoasts tumor)
- pulmonary embolus (emergent)
- pnemorthorax (emergent)
14
Q
Where in the spine does the apical (pancoast’s) tumor compress
A
C8-T1
15
Q
Where is the pain and what is difficult with a pulmonary embolus
A
Chest, shoulder , or upper abdomen pain
Hard to breath
16
Q
What is present w a pneumothorax
A
Chest pain that increases or decreased w breathing and have decreased breath sounds
17
Q
Where is there pain with a pleura and what does it feel like
A
Pain w breahing and thoracic movements (mimics joint lesion),
Feels like knife like pain
18
Q
What is a chlecystitis
A
C4 dermatome d/t irrigation of diaphragm
19
Q
Is a dissecting aortic aneurysm urgent or emergent and what is it
A
Emergent
Sudden onset of chest pain that can radiate to the back
Not relieved by position change
20
Q
What are the most common primary tumors that casues thoracic pain
A
Breast , lungs or colon
21
Q
What are 2 inflammatory disease that can causes thoracic pain (non MSK)
A
- ankylosing spondy
RA
22
Q
What is the key finding for ankylosing spondylitits
A
- young males
- limited chest expansion **
- night pain
- buttocks pain
23
Q
What are the 4 neurogenic MSK causes of thoracic pain
A
- SC
- sensory nerve root infection
- nerve root palsy
- spinal stenosis
24
Q
What is the critical zone for spinal stenosis
A
T4-T9
25
What are the 4 **articular MSK** **causes** of thoracic pain
- costo transverse sand costo vertebral Jong
- costo chondral and stereo chondral
- sterno manubrial
- z joint
26
What can **Costo-transverse and costo-vertebral joints** thoracic pain be from
- traumatic sprain from excessive spinal rotation
- subluxation after MVA , forceful rotation or direct truma
27
**Disc pain** is more common where in the thoracic region
Lower t spine
28
Does disc problems in the T spine require sx
Nah
29
What is **Tietze syndrome**
Local inflammation of costo sternal cartilage (typically 2nd rib)
Self limiting condition that may last from weeks to years
30
For thoracic spine dysfucntion , __ pain is common
Referred
31
It is importnat to DDx back pain in the t spine .. what are they (4)
• Visceral origins
• Serious origins
• T-spine dysfunction
• Rib dysfunction
32
What may **visceral pain** be accompanied by
Nausea and sweating ( pain tends to be vague and dull)
33
What should u ALWAYS do in a systems review
Take vitals
34
What should u clear in the systems review secondary to spinal cord susceptibility
UMN S/S (B UE symtoms , intermittent reposrts of LOB, decreased coordination in LEs)
35
How does MSK pain tend to present
Sharp and more localized and changes w specific positions and movements
36
What would make us thing it is serious pathology
No changes in pain based on position + night pain + unexplained weight loss
37
what kiind of dysfucntion is common in t spine
postural
38
what kind of HX of pain will ppl w **postural dysfunctions** have
pain following sustained positions or postures
39
is ti easy or hard to reproduce pain w exam for a postural dysfucntion
hard
40
will the neuro exam for a postural dysfunction exam be + or -
-
41
where in the t spine is thoracic disc patholody more comon
lower t spine
42
what is important to distinguish between with a **thoracic disc patholofy**
myelopathy and radiculopthy
43
**thoracic disc path** typicaltl results of what 2 things
* Narrow spinal canal and lateral foramina
* Degenerative △’s
44
The clinical presentations for **thoracic disc path** is widely variable and vague but what are 3 things that are common
* Pain w/ active and passive motion in at least 1 direction
* (+) dural signs w/ or w/o radiculopathy= (+) slump
* (+) coughing
45
If there a thoracic disc path at **T9-T11** where will pain radiate
Into buttocks and mimic lumbosacral radiculopathy
Bilateral symptoms/ weakness may suggest myelopathy
46
If there a thoracic disc path at **T3-T8** where will pain radiate
Pain and/or neuro SYMTOMS at lateral or anterior portions of trunk
47
If there a thoracic disc path at **T2- T3** where will pain radiate
RAREST TYPE
Pain and/or neuro symptoms toward clavicle , scapular spine or medial arm
48
How is the dx of **thoracic facet joint dysfunction** made
Based on motion restrictions (8 potential joint or soft tissue restrictions
8 joints
2 articular facet + 2 costo-vertebral + 2 costo-transverse + 2 intervertebral
49
What is **KEY** in **determining location** of **thoracic facet joint dysfucntion**
palpation
if it is off to one side then we are thinking it is more a rib dysfucntion
50
What can **causes** **thoracic facet joint dysfucntion**
Change in training load or ergonomic set up
51
What is the Rx for **thoracic facet joint dysfucntion**
HVLAT
Active exercseis
Pt education
52
For a **rib dysfucntion** the ___ ___ joint may be invovled in inflammatory or degenerative joint disease
Costo vertebral
53
What is the clinical presentation for **rib dysfucntion**
* Pain w/ deep breathing, trunk rotation, coughing, sneezing
* Localized pain 3-4 cm from midline
54
What is the RX for **rib dysfucntion**
Manual therapy
Local injections
55
T/f: abdominal mm strains and contusions re common in the t spine
True
56
What is clinical presentation of **abdominal mm strains and contusions**
* Localized pain and tenderness
* Pain ↑’s w/ isometric contraction and/or passive stretching
* Pain worse w/ movement, deep inspiration, coughing
57
What is the RX for **Abdominal Muscle Strains and Contusions**
: RICE, anti-inflammatory meds, activity modifications, gradual strength training and passive stretching as tolerated
58
What are 2 things u should consider with **thoracic vertebral fx**
Trauma vs osteoporosis q
59
What is the MOI for **thoracic vertebral fx**
Hyperflexion or axial loading
60
How are the articuluar signs for **thoracic vertbral fx**
Positive in all directions
61
What test is usually postive with **thoracic vertebral fx**
Compression
62
**Osteoporotic fx** typically occur between what **vertebral bodies**
9th adn 11th
63
What should u consider w rib fx
Trauma vs repetitive stress
64
What can **rib fx lacerate** thru
Pleura
Lung
Abdominal organs
65
What can rib fx casues if in the **upper ribs**
Brachial plexus or vascular injury
66
How is the **onset** of pain for **rib fx**
Immediate
68
How is the articular signs and palpation for rib fx
(+)
69
What is the MOI for **sternal fx**
Seatbelt (very rare tho tbh)
70
During a sternal fx what can be life threatening
Posterior dislocation of SC joint
71
What is **scheuermann Disease** (AKA scheuermann kyphosis , juvenile kyphosis)
Defect in apophyseal ring of vertebral body causing anterior wedgin
72
What is a **Schmorl node** in scheuermann disease
Where end playe cracks causing disc herniation
73
What is the clinical presention with **scheuermann disease**
* Thoracic kyphosis
* Pain w/ thoracic extension and rotation
74
What is the etiology for **T4 syndrome**
Unknown
Can occur from T2-T7 but will always include T4
75
Is **T4 syndrome** more common in females or males
F
76
What test are (+) with **T4 syndrome**
Slump test and ULTTs
77
What is teh **clinical presentation** with T 4 syndrome
- hx of HAs , neck pain , UE pain
- night pain in sidelying or supine
- TTP on bony landmarks
-depression or prominence of 1 spinal segment
- thickening or hypomobility of 1 segment while rest of spinal motin in normal
78
What is the pain pattern for T4 syndrome
Non predicable
79
The thoracic outlet is an anatomic space boarded by what 3 things
- 1st thoracic rib
-clavicle
- superior border of scapula
80
What is the interscalence trinagle of the thoracic outlet bordered by anteriorly , posteriorly and inferiorly
Anteriorly: anterior scalence mm
posteriorly: middle scalence mm
Inferiorly- 1st rib
81
What syndrome is characterized by SYMTOMS attributable to compression of nerual and /or vascular structures that pass thru the thoracic outlet
TOS
82
What are the potential causes/compression sites for TOS
- presence of cervical rib
- scalence triangle **
- hyper abduction syndrome
- costoclavicualr syndrome
- pec major **
- 1st thoracic rib
83
T/f: tos can be limb threatening
Yes
84
How is teh dx for **thoracic outlet syndrome**
Subjective hx and physcial exam
85
86
1. Neurogenic - compression of BP at scalence triangle (most common)
2. Venous- compression of subclavian vein by structures making up the costoclavicaulr junction
3. Arterial- compression due to abnormal bony or ligamentous structures at thoracic outlet region
87
What may the **medical referral** from **1st rib dysfucntion say**
Cervical disc herniation
88
If it is parasthesias w non dermatome a pattern is it radic?
No bc it is no dermatomal
89
What mm is **hypertonic** in **1st rib dysfucntion**
Posterior scalence muscle
90
Common SYMTOMS of 1st rub dysfunction come from what
Medial plexus (C8-T1)
91
What is the Rx for 1st rib dysfucntion
Gapping HVLAT
AROM exercises
Strengthening exercises
92
**2nd rib dysfucntion** medical referral may say what
Shoulder impingement
93
What is the 1st clue of **2nd rib dysfucntion**
Posterior should pain w/o a shoulder history
94
How is the **contractile testing and palpation of tendon insertions** for 2nd rib dysfucntion
(-)
95
What is **loss** in **2nd rib dysfucntion**
Shoulder girdle elevation
96
97
What are the 3 types of TOS
1. Neurogenic - compression of BP at scalence triangle
2. Venous- compression of subclavian vein by structures making up the costoclavicaulr junction
3. Arterial- compression due to abnormal bony or ligamentous structures at thoracic outlet region
98
What is ‘**flail chest/segment** for rib fx
Paradoxical movement of chest wall during respiration ; indication chest wall instability and multiple fx
