Describe the typical pattern of rib cage motion
Pump handle (saggital plane movement) for the upper ribs and bucket handle (frontal plane) for lower ribs
Describe the cervical rotation lateral flexion test
tests for first rib hypomobility by max passive contra rotation and flexed
Describe the typical pattern of movement and positional dysfunction of the thoracic and rib cage?
Increased throacic kyphosis with inability to extend for T1-T2 or flat extended posture with inability to flex T3-7, kypohotic posture in T8 - 12 with inability to extend\
Classification system for thoracic spine and rib cage dysfunction
Tx with mobilization or manipulation: Flexion restrictions, ext restrictions, torsional rib cage restrictions - nonspecific multi segemental Tx with immobilization: rib subluxations, segemental hypermobility
How does thoracic osteoperosis present?
midline back pain in the thoracic and lumbar regions
Is there a role for thoracic spine manipulation in the treatment of mild compressive cervical myelopathy?
Yes. It was shown with the use of intermittent cerv traction and manipulation of the thoracic spine in a series of patients with mild cerv compressive myelopathy attributed to a herniated disk to substantially decrease pain and increase function
A 35 y/o man has pain and stiffness in the thoracic region which is worse in the morning. He also has limited chest expansion. What should be included in the differential Dx?
Anklyosing spondylitis which is a chronic inflammatory disease. Typically present with back pain and stiffness in 81% of patients. In the thoracic spine it will decrease chest expansion and impair pulmonary function
What is normal chest expansion?
A 44 y/o man present with pain in the right T7-9 region slightly below the inferior lateral angle of the scapula which is worse 2-3 hours after a meal. What differential dx should be included?
Pain from cholecysititis (inflamed gallbladder)
What is Scheuermann's disease? Is it safe to use manual therapy?
anterior wedging and vertebral end-plate associate with kyphosis. Also known as juvenile kyphosis, vertebral osteochondritis, and osteochondritis deformans juvenilis dori. Pt may benefit from manuaul therapy
Define T4 syndrome
a group of symptoms within T2-T7 segments with various combinations of pain in the UE, neck, upper thoracic, and scapular region with cranial headaches. Possible glovelike paresthesia and numbness in one or both hands, often noturnal in nature. P-A pressure can reproduce symptoms, may have tendereness asymmetry and limited ROM. Treated successfully in 2 sessions of thoracic manipulation
Can manipulation improve activation of the lower trap?
yes, manipulation of T8-T12 potentially can help recuirtment of these segements