Ortho III Final- T/S

Question 1

In the T/S the spinous processes _ _, and in general _ in size from superior to inferior. The vertical facet joints are in the _ _, and there are facet joints on _ and _ for _ _.

Answer 1

Spinous processes SLOPE DOWNWARD, and in general INCREASE in size from superior to inferior.

The vertical facet joints are in the CORONAL PLANE and there are facet joints on BODY AND TP’S FOR RIB ARTICULATION

Question 2

According to research article ‘new model for palpation of TP’S’: TP’s in the thoracic spine are anatomically located at the level of the _ _ _ of the _ of the vertebrae _ _ _. Except for? How do you confirm which level you are on?

Answer 2

TP’s in the t/s are anatomically located at the level of the MOST PROMINENT POINT of the SP of the vertebrae ONE LEVEL ABOVE.
- except for T11 AND T12 which were highly variable

To confirm: use a unilateral PA on the TP below (or even with the SP) and confirm if movement of SP occurs

Question 3

Humans have _ _ of true ribs each with it’s own connection to the _. The _, _ and _ ribs join with the costal cartilages of the ribs above and are known as _ _. The _ and _ ribs, or _ _, do not have any connection anteriorly.

Answer 3

Humans have 7 ROWS of true ribs each with its own connection to the the STERNUM

The 8th, 9th, and 10th ribs join with the costal cartilages of the ribs above and are known as FALSE RIBS

The 11th and 12th ribs, or FLOATING RIBS do not have any connection ANTERIORLY

Question 4

The _ of the rib is the end closest to the vertebral column.

Answer 4

The HEAD of the ribs the end closest t other vertebral column

Question 5

Typical ribs (ribs 3-9) have _ _ for attachment to the corresponding _ on the vertebral bodies. _ _ _ attaches to other superior vertebral body, and the _ _ _ attaches to the inferior vertebral body.

Answer 5

Typical ribs (ribs 3-9) have TWO FACETS for attachments to the corresponding DEMIFACETS on the vertebral bodies.

SUPERIOR RIB FACET attaches to the superior vertebral body, and the INFERIOR RIB FACET attaches to the inferior vertebral body.

Question 6

Ribs 3-9: have _ _ on head, and an _ _ for the costotranverse joint.

Answer 6

Have 2 FACETS on head and an ARTICULAR TUBERCLE for the costotranverse joint

Question 7

The first rib has a shaft that is _ and nearly _ and has the _ _ of the 7 true ribs. It’s head has a _ _ to articulate with the T1. It also has _ _ for the subclavian vessels which are separated by the _ _.

Answer 7

Has a shaft that is WIDE and nearly HORIZONTAL and has the SHARPEST CURVE of the 7 true ribs.

It’s head has a SINGLE FACET to articulate with T1

It also has TWO GROOVES for the subclavian vessels which are separated by the SCALENE TUBERCLE

Question 8

The second rib is _, _ _, and _ than the first rib. It has _ _ to articulate with _ and _ and a _ for muscles to attach to. It is atypical due to its attachment anteriorly to both the _ and _.

Answer 8

The second rib is THINNER, LESS CURVED, AND LONGER than the first rib. It has TWO FACETS to articulate with T1 and T2 and a TUBERCLE for muscles to attach too.

It is atypical due to it’s attachment anteriorly to both the STERNUM AND MANUBRIUM

Question 9

Which ribs only have 1 facet on their head? (4)

Answer 9

Rib 1, 10, 11, 12

Question 10

The 11th and 12th ribs are _, with no _ or _ and terminate in the _ _ before fusing with the _ _.

Answer 10

The 11th and 12th ribs are SHORT, with no NECKS OR TUBERCLES and terminate in the ABDOMINAL WALL before fusing wit the COSTAL CARTILAGES

Question 11

Which ribs have double costovertebral facets? Which have demifacets on the vertebral bodies?

Answer 11

Which ribs have double costovertebral facets- Ribs 2-9

Which have demifacets- Ribs 1-9

Question 12

Ribs 1-10 attach to the corresponding _ _, unlike ribs 11 and 12 which do not have an attachment.

Answer 12

Ribs 1-10 attach to the corresponding TRANSVERSE PROCESSES

Question 13

Ribs 1-5/6 are _ and TP is _ allowing for rotation or flexion in the Sagittal plane during _.

Answer 13

Ribs 1-5/6 are CONCAVE and the TP’s are CONVEX allowing for rotation or flexion in the Sagittal plane during INSPIRATION

Question 14

Lower ribs (7-12) the costotranverse joint is _ allowing for _ or _ in the frontal plane

Answer 14

Joint is PLANAR allowing for WIDENING OR ABDUCTION in the frontal plane.

Question 15

What is the angle of the zygoapophyseal joints in the thoracic and lumbar spine?

Answer 15

Thoracic- 60 degrees

Lumbar- 90 degrees

Question 16

The facet joints of the t/s (zygoapophyseal) allow for considerable _ and _. Injuries occur with excessive amounts of _ and _.

Answer 16

Allow for considerable FLEXION AND EXTENSION

Injuries occur with excessive amounts of ROTATION AND EXTENSION

Question 17

Facet joint irritation can cause _ _ _

Answer 17

Facet joint irritation can cause SHARP LOCALIZED PAIN

Question 18

The T/S _ are less likely to be injured, making up less than 1% of _ _. Why?

Answer 18

T/S DISCS are less likely to be injured, making up less than 1% of DISC HERNIATIONS.

Why: because the rib articulations increase the stability

Question 19

Thoracic spinal nerves exit openings _ _ _ _, and innervate _ of _ as well as _ _. Irritation of the spinal nerves can lead to _ pain, and _ _ _ along the _ of the ribs.

Answer 19

Thoracic spinal nerves exit openings BETWEEN ADJACENT THORACIC VERTEBRAE, and innervate MUSCLES of THE BACK, as well as VISCERA ORGANS.

Irritation of the spinal nerves can lead to INTERCOSTAL pain, and SHARP SHOOTING PAINS along the PATH of the ribs

Question 20

The T/S spinal nerves have an increased susceptibility to _, usually attacks _ _ spinal nerve root.

Answer 20

Have an increased susceptibility to SHINGLES, usually attacks ONLY ONE spinal nerve root

Question 21

There are _ _ _ responsible for the majority of trunk movements and they are a common source of _ and _. Symptoms are usually characterized by a _ _ _.

Answer 21

There are MANY SMALL MUSCLES responsible for the majority of trunk movements and they are a common source of PAIN AND INJURY

Symptoms are usually characterized by a DULL GENERALIZED ACHE

Question 22

Thoracic musculature: muscles in spasm produce excess _ _ that excess causes a _ _. _ _ _ carries it away from the muscle. How is this induced?

Answer 22

Muscles in spasm produce an excess of LACTIC ACID, that excess causes a BURNING SENSATION.

FRESH FLOWING BLOOD carries the lactic acid away from the muscle.

Can be induced by heat, manual pressure, other modalities that cause the muscle to relax which allows the blood vessels to open up

Question 23

What are some special questions that would be important to ask? (4 examples)

Answer 23

Do you have bilateral tingling in the feet or disturbance of gait?

Medical history regarding cancer/ diseases or any recent weight loss?

Recent X-rays taken? If so when and why?

Taking any medications? (Osteoporosis or steroids can make manipulation contraindicated)

Question 24

An MI can cause _ _ pain or _, _ and pain radiating to the _ and _.

Answer 24

An MI can cause ANTERIOR CHEST PAIN or HEAVINESS and pain radiating to the BACK AND ARM

Question 25

What possible visceral pathology/ emergency can cause: pain in the jaw, neck, chest, and upper back; pain that is severe, unrelenting and comes on suddenly; pain that is not relieved by change in position; can also be accompanied by coughing, hoarseness or difficulty breathing? Associated %?

Answer 25

Dissecting thoracic aneurysm 50% of pts' die

Question 26

What can cause a boring pain from epigastric to middle T/S, can cause T/S pain triggered by eating? Can be caused by prolonged _ _.

Answer 26

Peptic Ulcer Can be caused by prolonged NSAID USE

Question 27

What visceral pathology can cause right upper quadrant pain and tenderness with inspiration; right infra scapular pain; moderate fever, nausea and vomitting; symptoms occuring 1-2 hours after a heavy meal

Answer 27

GALL BLADDER

Question 28

What can cause abdominal pain that radiates to the thoracolumbar junction; abdominal pain and tenderness that worsens with eating but eases by leaning forward or curling in a ball; nausea and vomitting

Answer 28

Pancreatitis

Question 29

_ or _ _ can cause pain in the costovertebral angle or flank area; pain accompanied by fever, nausea, vomitting; flank pain accompanied by lower abdominal pain that spreads to the labia/ testes (aka _ _). Patients will often have a history of _ _.

Answer 29

KIDNEY OR RENAL PATHOLOGY . . . . Flank pain accompanied by lower abdominal pain that spreads to the labia/ testes (aka RENAL COLIC) Patients will often have a history of ONGOING UTI'S

Question 30

Red flags to consider? (4)

Answer 30

FINI - fractures (traumatic or osteoporotic) - inflammation (ankylosing spondylitis) - Neoplasm (uncommon- check for previous HX of cancer) - infection (uncommon- fever is the hallmark sign)

Question 31

What is a deformity that causes protrusion ofthe chest wall at the sternum? also known as? (3)

Answer 31

Pectus Carinatum AKA: Keel chest, pigeon chest, bird chest

Question 32

Pectus Carinatum occurs 75% of the time in _, may affect _ (_) and cause _ affects.

Answer 32

Occurs 75% ofthe time in BOYS, may affect RESPIRATION (EXHALATION) and cause PSYCHOSOCIAL affects

Question 33

What is cavitation (hollowing) of the sternal costal joint called? AKA? (4)

Answer 33

Pectus Excavatum AKA: Hollow, cobblers, sunken, funnel chest

Question 34

Pectus Excavatum can have _ (_) and _ implications and _ effects.

Answer 34

Can have RESPIRATORY (INSPIRATION) and CARDIAC implications and PSYCHOSOCIAL EFFECTS

Question 35

2 treatment suggestions for patients with a barrel chest deformity: _ _ breathing, and avoiding _ _.

Answer 35

TRIPOD POSITION breathing And avoiding BRONCHIAL IRRITANTS

Question 36

Flexed position fault in the t/s will cause: SP and TP's to be _ at the level of the flexed segment; a _ space between the SP of the flexed segment and the segment below; a _ space between the SP of the flexed segment and the segment above

Answer 36

Flexed positional fault: - SP and TP's to all be ELEVATED at the level of the flexed segment - an INCREASED space . . . BELOW - a DECREASED space . . . ABOVE

Question 37

Extended positional fault will cause: SP and TP to be _ at the level of the extended segment; will cause a _ space between the extended segment and the segment above; will cause a _ space between the extended segment and the segment below

Answer 37

Extended positional fault: -SP and TP to be DEPRESSED - INCREASED space . . . ABOVE - DECREASED space . . . BELOW

Question 38

Rotated left positional fault (vertebral body turned left) will cause: SP to move _ of midline; _ TP is elevated towards and deeper than the TP of the segment _; _ TP is depressed away and more superficial than the TP of the segment _.

Answer 38

Rotated left positional fault: -SP to move RIGHT of midline - RIGHT TP is elevated towards and deeper . . . Segment ABOVE - LEFT TP is depressed and more superficial . . . Segment BELOW

Question 39

Dermatomes in the thoracic spine follow? Myotomes?

Answer 39

Follow the level of the ribs Myotomes don't have corresponding muscles to test

Question 40

UNLT is performed for? LLNT is performed for?

Answer 40

UNLT- upper T/s LLNT- lower t/s

Question 41

PAIVM: Central PA's apply force to _ _. Unilateral PA's? Rib PA? (3) Transverse pressure?

Answer 41

Central PA's- BILATERAL LAMINATE Unilateral PA's- TRANSVERSE PROCESSES Rib PA's- COSTOVERTEBRAL JOINT, COSTOTRANSVERSE JOINT, RIB ANGLE Transverse PA's- SPINOUS PROCESS

Question 42

Which muscle is being described: originates on the upper borders of ribs 6-12 and inserts on the lower borders of ribs 1-6; actions include bilateral extension, erect posture, unilateral lateral flexion and Ipsilateral rotation? What are the two associated pain referral patterns?

Answer 42

Iliocostalis Thoracis Pain referral pattern: T6 and T11 (can be felt anteriorly and posteriorly around the given spinal level)

Question 43

Which muscle is being described: originates on the common tendon origin in sacrum, illiac crest and lumbar vertebrae; inserts at the T1-T12 TP's; Actions are the same as iliocostalis. 3 common pain referral patterns

Answer 43

Longissimus Throacic Pain referral patterns: L1, T10, T11 (all pain is posterior lower Throacic into buttock)

Question 44

Which muscle is being described: originates in the commons tendon origin of the sacrum illiac crest and lumbar vertebrae; inserts in the T3-T8 spinous processes and has the same action as both iliocostalis, and longissimus.

Answer 44

Spinalis Thoracis

Question 45

What disease is being described: local anterior chest wall pain at the bony cartilaginous junction, may radiate down arm, usually affects ribs 2-5, has occasional swelling, idiopathic onset, can occur at any age? AKA? It is _ a _ disease, but _ _ _ diseases. What can put you at an increased risk? (3)

Answer 45

COSTOCHONDRITIS It is NOT A SERIOUS disease, but MIMICS OTHER SERIOUS diseases. AKA: Teitze's disease At an increased risk if you have ANKYLOSING SPONDYLITIS, RA, REITERS SYNDROME

Question 46

Scoliosis is a lateral curvature of the spine greater than _ _ accompanied by _ _. _ scoliosis is a multi-gene dominant condition with variable phenotypic expression and no clear cause. Multiple causes exist for _ _.

Answer 46

Scoliosis is a lateral curvature of the spine greater than 10 DEGREES IDIOPATHIC scoliosis is a multi-gene . . . . Multiple causes exist for SECONDARY SCOLIOSIS

Question 47

Homocystinuria, Marfan syndrome and Ehler's Danlos Syndrome are all examples of _ _ for _ due to _ _ _ disorders.

Answer 47

Are all examples of SECONDARY CAUSES FOR SCOLIOSIS due to INHERITED CONNECTIVE TISSUE DISORDERS

Question 48

Ehler's Danlos syndrome is characterized by _ skin and _ joints and is treated with _. What other inherited tissue disorder has _ joints?

Answer 48

Is characterized by STRETCHY skin and HYPERMOBILE joints and it tested with STABILIZATION MARFAN SYNDROME also has HYPERFLEXIBLE joints (Michael phelps)

Question 49

Tethered cord syndrome, syringomyelia, spinal tumor, neurofibromatosis, muscular dis trophy, CP, polio, friedeich's ataxia, familial dysatonomia, and Werdnig-Hoffman's disease are all examples of _ _ that can be?

Answer 49

All expanses of NEUROLOGICAL DISORDERS that can be SECONDARY CAUSES FOR SCOLIOSIS

Question 50

Leg length discrepancy, developmental hip dysplasia, osteogenesis imperfecta, and Klippel Feil syndrome are all examples of?

Answer 50

All examples of MUSCULOSKELETAL DISORDERS that can cause SECONDARY SCOLIOSIS

Question 51

Idiopathic scoliosis occurs in about _-_% of kids ages 10-16 years old. Ratio of girls to boys with small curves (less than 10 degrees) is? Larger curves (greater than 30 degrees)? Scoliosis tends to progress more often in _.

Answer 51

Occurs in about 2-4% of kids aged 10-16 Ratio of girls: boys - small curve the ratio is approx. equal - larger curves 10:1 Scoliosis tends to progress more often in GIRLS

Question 52

Of adolescents with scoliosis on 10% have a curve progression that requires medical intervention- the 3 determinants are: patient _, future _ _, and _ _ at the time of diagnosis.

Answer 52

3 Determinants: | -patient GENDER, future GROWTH POTENTIAL and CURVE MAGNITUDE at the time of diagnosis

Question 53

What is the old and new method of grading scoliosis and how do each of them work?

Answer 53

New- Risser Grade (measures progression of bony fusion of the ilia apophysis Old- Tanner stages (looks at breast growth to determine stage of puberty)

Question 54

Range and meaning for Risser grades of scoliosis

Answer 54

Range: 0-5 (no ossification to complete bony fusion at the Apophysis) The lower the grade the higher the potential for progression

Question 55

Back pain _ _ _ _ in patients with scoliosis.

Answer 55

Back pain IS NOT SIGNIFICANTLY HIGHER in patients with scoliosis

Question 56

Curves in untreated adolescents with curves at the time of maturity _ than _ _ are _ to progress.

Answer 56

With curves at the time of maturity LESS THAN 30 DEGREES are UNLIKELY to progress

Question 57

Curves _ than _ _ at maturity progress _ _ _ _ . Up to _% of females with curves _ than _ _ have significant _ _.

Answer 57

Curves GREATER THAN 50 DEGREES at maturity progress 1 DEGREE PER YEAR Up to 19% of females with curves GREATER THAN 40 DEGREES have significant PSYCHOLOGICAL ISSUES

Question 58

Life threatening effects on pulmonary function do not occur until?

Answer 58

Do not occur until curve is GREATER THAN 100 DEGREES

Question 59

According to the American academy of Orthopedic surgeons girls should be screened at _ and _; boys should be screened at _ or _ for scoliosis.

Answer 59

Girls should be screened at 11 AND 13; boys should be screened at 13 OR 14

Question 60

According to the American Academy of Pediatrics children should be screened at _, _, _, and _ years of age.

Answer 60

Children should be screened at 10, 12, 14, and 16 years of age

Question 61

What test is being described: The patient (without shirt, sports bra) is asked to lean forward with his or her feet together and bend 90 degrees at the waist. Examiner observes for any Assymetry in the trunk or abnormal spinal curves

Answer 61

Adams forward bend test

Question 62

Screening hints when checking for scoliosis: shoulders are _ _, or one is more _ than the other; head is _ _ _ above the pelvis; appearance of a _ or _ _; _ _ are at different heights

Answer 62

Shoulders are DIFFERENT HEIGHTS, or one is more PROMINENT than the other Head is NOT CENTERED above the pelvis Appearance of a RAISED OR PROMINENT HIP RIB CAGES are at different heights (rib hump)

Question 63

Screening hints for scoliosis: uneven _; changes in _ or _ of _ overlying the spine (_, _ patches, _ changes); leaning of _ _ to _ _.

Answer 63

Uneven WAIST Changes in LOOK or TEXTURE of SKIN overlying the spine (DIMPLES, HAIRY patches, COLOR changes) Leaning of ENTIRE BODY to ONE SIDE

Question 64

What are the 2 ways to measure scoliosis and how are they performed?

Answer 64

Scoliometer (inclinometer) -pt bends over until curve is observed, scoliometer is placed on the back and measures the highest point of the curve of the upper back, pt continues to bend until the curve can be seen in the lower back, measures that apex Cobb Method -using an X-Ray image the most tilted vertebrae above and below the apex of the curve is chosen and the an angle between intersecting lines is drawn perpendicular to the superior and inferior vertebrae

Question 65

Red flags on Physical Exam for scoliosis: _ _ thoracic curve (may affect _ _), _, significant _, and abnormal _ _.

Answer 65

LEFT SIDED thoracic curve (may affect CARDIAC FUNCTION) PAIN Significant STIFFNESS Abnormal NEUROLOGIC FINDINGS

Question 66

When should you refer out: curve in degrees? Associated Risser grades? (3)

Answer 66

20-29 DEGREES, Risser grade 0-1 and 2-4 29-40 DEGREES, Risser grade 0-1 and 2-4 Greater than 40 DEGREES, Risser grade 0-4

Question 67

When is surgery often required as a treatment for scoliosis?

Answer 67

If curve is GREATER THAN 40 DEGREES

Question 68

Most common type of brace for scoliosis? AKA? Braces have a _% _ _ at _ curve progression. Does _ _ scoliosis, but may _ _ _. Usually worn until the patient reaches a Risser grade of _ or _.

Answer 68

Most common type of brace: BOSTON BRACE AKA: THORACO-LUMBAR-SACRAL orthosis Braces have a 74% SUCCESS RATE at HALTING curve progression Does NOT CORRECT scoliosis, but may PREVENT SERIOUS PROGRESSION Usually worn until the patient reaches a Risser grade of 4 OR 5

Question 69

Bracing for scoliosis: length of wearing time _ with _. At least _ _ per _ leads to best chance of preventing curve progression.

Answer 69

Length of wearing time CORRELATES WITH OUTCOMES At least 16 HOURS PER DAY leads to the best chance of preventing curve progression

Question 70

If surgery is required (for curves greater than 40 degrees): skeletally mature patients can be observed until the curve reaches _ _. _ _ _ is the best choice for thoracic curves. _ _ _ is the best treatment for thoracolumbar and lumbar curves

Answer 70

Skeletally mature patients can be observed until the curve reaches 50 DEGREES POSTERIOR SPINAL FUSION is the best choice for thoracic curves ANTERIOR SPINAL FUSION is the best treatment for thoracolumbar and lumbar curves

Question 71

Post op treatment: post fusion _ _ does occur (more common in _ fusions). Usually out of hospital in _-_ days and back in school in _ _. Ok to participate in athletics after _-_ _ (should avoid _ _)

Answer 71

Post fusion BACK PAIN does occur (more common in DISTAL fusions) Usually out of hospital in 4-5 days and back in school in 2 WEEKS OK to participate in athletics after 9-12 MONTHS (should avoid CONTACT SPORTS)

Question 72

A review of the rate of complications from scoliosis surgery states that it has a _ _ _ rate of complications. Recommends _ _ for all spinal implants _ _ _.

Answer 72

Review of the rate of complications from scoliosis surgery states that it has a VARYING BUT HIGH rate of complications Recommended MANDATORY REPORTING for all spinal implants SHOULD BE ESTABLISHED

Question 73

In a study looking at specific exercises performed in the period of brace weaning can help _ the _ _ in the brace weaning period for Adolescent Idiopathic Scoliosis (AIS)

Answer 73

Specific exercises performed in the period of brace weaning can help REDUCE THE CORRECTION LOSS in the brace weaning period for AIS

Question 74

A study on 'conservative treatment for AIS: can it reduce the incidence of surgical treatment?' Used bracing (Milwaukee and under arm brace) and which to types of exercises? Describe each.

Answer 74

Side Shift Exercise - exercises performed to side shift/ side glide torso TOWARD CONCAVITY The Hitch Exercise -exercises using the QL to hitch the him on the side of LUMBAR CONVEXITY

Question 75

Results from stay on conservative treatment for AIS: part time bracing (full time better) plus _ is _ in _ _ intervention. Patients who need surgical intervention presented with Cobb angles of _ _ _ _.

Answer 75

Part time bracing (full time better) plus PT IS EFFECTIVE IN PREVENTING SURGICAL intervention Patients who need surgical intervention presented with Cobb angles of AT LEAST 45 DEGREES

Question 76

Conclusions from study on 'The significance of posture re-education in scoliosis' found: _% of kids with scoliosis _ _ require surgical intervention. _ are much more likely than _ to require intervention. _ _ _ is recommended for curves greater than 45-50 degrees.

Answer 76

- 90% of kids with scoliosis WILL NOT require surgical intervention - GIRLS are much more likely than BOYS to require intervention - SPINAL FUSION SURGERY is recommended for curves greater than 45-50 degrees

Question 77

Conclusions from study titled 'The significance of posture re-education in scoliosis': _ can _ _ of many curves and significantly _ _ for surgery. _ can help avoid _ of _ _ by bracing.

Answer 77

BRACING can SLOW PROGRESSION of many curves and significantly REDUCE NEED for surgery EXERCISE can help avoid LOSS OF CORRECTION GAINED by bracing.

Question 78

_ _ is a chronic inflammatory joint disease of axial joints, especially the SI joints. AKA? Usually occurs in _ and begins in _.

Answer 78

ANKYLOSING SPONDYLITIS is a chronic inflammatory . . . AKA: MARIE-STUMPELL disease Usually occurs in MALES and begins in ADOLESCENCE

Question 79

Ankylosing spondylitis has a strong tendency to _ _ and association with the _-_ (_% positive). Reported prevalence is _%

Answer 79

Has a strong tendency to FAMILIAL AGGREGATION and association with HLA- B27 (90% positive) Reported prevalence is .2%

Question 80

Ankylosing spondylitis is characterized by _ and _ of the back, with variable involvement of the _ and _. Gradual loss of _ _. Symptoms are typically worse in the _ and in the _ of the _.

Answer 80

Characterized by PAIN AND STIFFNESS of the back, with variable involvement of the HIPS AND SHOULDERS Gradual loss of SPINAL MOBILITY Symptoms are typically worse in the MORNING and in the MIDDLE OF THE NIGHT

Question 81

Pathology- Synovitis: affects _ and _ _ joints; causes destruction of _ _ and _ _; leads to _ _; _ involvement can lead to diminished _ _.

Answer 81

Affects SI and VERTEBRAL FACET joints; causes destruction of ARTICULAR CARTILAGE and PERIARTICULAR BONE Leads to BONY ANKYLOSIS COSTOVERTEBRAL involvement can lead to diminished RESPIRATORY EXCURSION

Question 82

AS- pathology: inflammation of the _-_ _ of _ joints and tendons ( affects _ _, _ ligaments, _ _, _ _ and bony insertion of _ _.

Answer 82

Inflammation of FIBRO-OSSEOUS JUNCTION OF SYNDESMOTIC joints and tendons (affects IV DISCS, SI ligaments, SYMPHYSIS PUBIS, MANUBRIUM STERNI and bony insertion of LARGE TENDONS.

Question 83

Clinical features of Ankylosing Spondylitis: disease starts _; teenager/ young adults complains of _ and _; symptoms are worse in the __ and after _. In later stages there will be diminished _ _, increased _ _, may be FFD of _ and _ and marked loss of _ _.

Answer 83

Disease starts INSIDIOUSLY; teenager/ young adult complains of BACKACHE AND STIFFNESS; symptoms are worse in the MORNING and after INACTIVITY In later stages there will be diminished SPINAL MOVEMENT, increased THORACIC KYPHOSIS, may be FFD of HIPS AND KNEES, marked loss of CERVICAL EXTENSION

Question 84

X-RAY findings for patients with AS: _ _ (_ at several levels), _ and _ of the SI joints and later _ _.

Answer 84

BAMBOO SPINE (BRIDGING at several levels), EROSION AND FUZZINESS of the SI joints and later BONY ANKYLOSIS

Question 85

PT treatment for AS: encourage patients to _ _ (_ but don't _ _),and _ and _ exercises. _ and _ are contra-indicated.

Answer 85

Encourage patients to REMAIN ACTIVE (EXERCISE but don't IRRITATE JOINTS) and BACK and POSTURE exercises REST AND IMMOBILIZATION are contra-indicated.

Question 86

What are 4 complications seen with Ankylosing spondylitis?

Answer 86

SLuSH - spinal cord compression - lumbosacral nerve root compression - spinal fractures - hyperkyphosis

Question 87

What are 5 exams and tests for Ankylosing spondylitis?

Answer 87

G SoCCoR - Gaenslen's test (SI joint test) - Schober's test - chin-brow measurement - chest expansion - ROM (lumbar flexion, extension, lateral flexion, rotation)

Question 88

What test is being described: Mark spine 5 cm below and 10 cm above the iliac crest, have pt bend forward as far as possible, measure increase in distance between two points. Should be at least?

Answer 88

Schober's test Should be at least 20 cm (gain of 5 cm)

Question 89

With the chin-brow measurement the _ the _ the _ the condition.

Answer 89

The GREATER THE ANGLE THE WORSE the condition

Question 90

_ _ _/ _ _ is a clinical pattern that involves UE paresthesia and pain with or without symptoms into the neck and/ or head. Can apply to segments _-_.

Answer 90

UPPER THORACIC SYNDROME/ T4 SYNDROME is a clinical pattern that involves . . . . Can apply to segments T3-T7

Question 91

Upper thoracic or T4 syndrome: the _ remains unclear; symptoms are reproduced or eliminated with _ of an _ _ _ (most commonly _); _ segment may indicate involvement of a _ _ structure. The _ __ may provide a pathway for referral but it is not _ _.

Answer 91

The MECHANISM remains unclear; symptoms are reproduced or eliminated with MOBILIZATION of an UPPER THORACIC VERTEBRAE (most commonly T4) HYPOMOBILE segment may indicate involvement of a SYNOVIAL JOINT STRUCTURE. The SYMPATHETIC NERVOUS SYSTEM may provide pathway for referral but it is not CLEARLY UNDERSTOOD.

Question 92

Typical presentation for T4 syndrome: Age _ than _; presenting posture- _ head with _-_ _ _, thoracic spine may be _; Occupational posture- may demand lots of _ _; possible previous diagnosis of: _ _, _ or _/ _ problems; onset- often follows the onset of a _ _ or _ of _ practice.

Answer 92

- Age GREATER than 35 - Presenting posture: FORWARD head with CERVICO-THORACIC JUNCTION KYPHSIS, thoracic spine may be FLAT - Occupational posture: may demand lots of FOWARD BENDING - Possible diagnosis of: THORACIC OUTLET, CARDIAC or STOMACH/ GUT problems - Onset often follows onset of a NEW JOB or CHANGE of WORK practice

Question 93

Symptoms of T4 syndrome usually present: may be _ or _; _-_ _; hands feel _/ _ and may actually _ _; arm may feel _; hands feel _ and may actually _ _; aches and pains that are _-_ in _ and/ or _; pains may be _ , _ or feel like a tight band.

Answer 93

- May be UNILATERAL OR BILATERAL - GLOVE-TYPE PARESTHESIA - hands feel HOT/ COLD and may actually be so - arms may feel HEAVY - hands feel SWOLLEN and may actually BE SO - aches and pains that are NON-DERMATOMAL in ARM and/ or FOREARM - pains may be CRUSHING, BURSTING or feel like a tight band

Question 94

Symptoms of T4 syndrome SOMETIMES present: pain and stiffness radiating around _ _ or _ _ of pain _ or _; _ ache or pain and stiffness; _ _ pain; _ (sensation of _ _ on _); _ will often be positive with typical symptoms; _ _ spine symptoms

Answer 94

- pain and stiffness radiating around CHEST WALL or SMALL AREAS of pain ANTERIORLY OR POSTERIORLY - INTERSCAPULAR ache or pain and stiffness - SLEEP INTERRUPTING pain - FORMICATION (sensation of ANTS CRAWLING on SKIN) - NEURODYNAMICS will often be positive with typical symptoms - CONCOMITANT CERVICAL spine symptoms

Question 95

T4 syndrome- possible observation findings: hands may _ (appearing _ or _ and feel _ or _); "_ and _" _

Answer 95

Hands may be DISCOLORED (appearing RED OR PURPLE and feel HOT OR COLD) "POKE AND STOOP" POSTURE

Question 96

T4 Syndrome findings: symptoms _ _ by _ _ movements; _ segmental motion on _, may _ or _ symptoms; _ of _ _ may _ symptoms, especially _ _.

Answer 96

Symptoms NOT AFFECTED by ACTIVE spine movements STIFF segmental motion on PALPATION, may ELICIT OR REDUCE symptoms PALPATION OF RIB ANGLES may ELICIT symptoms, especially DISTAL TINGLING

Question 97

Treatment for T4 Syndrome: _ of upper _ _, _ or lower _ _, | _ _ _, _ _, _ retraining, thoracic _-_, office/ work _.

Answer 97

MOBILIZATIONS of upper THORACIC SPINE, RIB ANGLES, or lower CERVICAL SPINE HOME EXERCISE PROGRAM, CHIN TUCKS, POSTURAL retraining, thoracic SELF-MOBILIZATIONS, office/ work ERGONOMICS

Question 98

A study titled 'Thoracic spine manipulation for the managment of patients with neck pain: a randomized clinical trial' looked at _ subjects, broken into 2 groups (_ and _; _, _ and _), patients had 5 visits over a _ _ _, _ were performed on the 1st, 3rd, and 5th visits.

Answer 98

- Looked at 45 subjects - Broken into 2 groups (E-STIM and MODALITIES; E-STIM, MODALITIES, and MANIPULATIONS) - patients had 5 visits over a 3 WEEK PERIOD - MANIPULATIONS were performed on the 1st, 3rd and 5th visits

Question 99

Thoracic spine manipulation for the managment of patients with neck pain study: Used what type of manipulation technique? How many times?

Answer 99

Used thoracic thrust treatment (bear hug technique with patient sitting) Maximum of 2 attempts per visit (1st, 3rd, 5th)

Question 100

Results of study on thoracic manipulation for patients with neck pain: those who received thoracic manipulation experienced _ _ in _, cervical _, and _. Results _ for _ _ at the 2 week follow up. And for _ at the 4 week follow up.

Answer 100

Those who recieved thoracic manipulation experienced GREATER IMPROVEMENTS in PAIN, cervical ROM, and DISABILITY Results PERSISTED for ALL 3 at the 2-week follow up And for PAIN at the the 4 week follow up.

Question 101

A study on the 'effects of thoracic mobilization and manipulation on function no mental state in chronic low back pain' found: application of _ or _ has a _ effect on _, _ _ and _ in patients with low back pain. How many groups? Describe each.

Answer 101

Application of MOBILIZATION or MANIPULATION has a POSITIVE effect on FUNCTION, MENTAL STATE, and ROM in patients with LBP 3 GROUPS - A: mobilization group - B: manipulation group - C: control group

Question 102

TOS can be caused by compression of the nerve in the _ _, _ _ _ and/or _ _ _.

Answer 102

Can be caused by compression of the nerve in the SCALENE TRIANGLE, PECTORALIS MINOR SPACE, and/ or COSTO-CLAVICULAR SPACE

Question 103

Scalene triangle: posterior border of _ _, anterior border of the _ _ and superior border of the _ _. The _ _ in the superior portion houses the _ , _ , _ nerve roots.

Answer 103

Posterior border of the ANTERIOR SCALENE Anterior border of the MIDDLE SCALENE Superior border of the 1ST RIB The CERVICAL OUTLET in the superior portion houses the C5, C6, C7 nerve roots.

Question 104

What are the 3 components of the pec major space?

Answer 104

PaCT - pec minor - coracoid process - thoracic cage

Question 105

The costo-clavicular space is made up of: the inferior border of the _ and the superior aspect of the _ _. The _ _ or _ and _ or _ of the _ _ pass through.

Answer 105

- inferior border of the CLAVICLE and the superior aspect of the FIRST RIB - the SUBCLAVIAN ARTERY or VEIN and DIVISIONS or CORDS of the BRACHIAL PLEXUS pass through it.

Question 106

What are the 5 tests used to look at thoracic outlet syndrome?

Answer 106

CAH Wants Action -Costo-clavicular syndrome test -Adson manuever -Halstead manuever -Wright's maneuver -Allen manuever -

Question 107

Wright's test looks for compression of vasculature in the _ _ _ and _ _

Answer 107

Compression of vasculature in the PEC MINOR SPACE and COSTO-CLAVICULAR SPACE

Question 108

Allen's test, Adson's manuever and the Halstead maneuver look at compression of vasculature occurring in the _ _.

Answer 108

Occurring in the SCALENE TRIANGLE

Question 109

The costo-clavicular test looks at compression in the _ _

Answer 109

Compression in the COSTO-CLAVICULAR SPACE

Question 110

What are possible treatments for TOS? (6)

Answer 110

RC PyGMy'S - Rib mobilization (1st Rib) - Cyriax Release manuever (add pillows/ towels under flexed forearms to slowly unweight and elevate shoulders) - Proximal Neural mobilization (depress 1st rib and have pt laterally flex head towards and away) - Glenohumeral mobilization - Manual scalene stretch with 1st rib mobilization - Self rib mobilization with scalene stretch