Thoracic 4B

Question 1

The thoracic is the most ________ region of the spine

Answer 1

Stiff

Question 2

What are the 3 major areas of dysfunction in the thoracic spine

Answer 2

1. Costo-vertebral Jt
2. TLJ
3. CTJ

Question 3

Trauma/specific event injuries are more common with ______ in the thoracic region

Answer 3

ribs

Question 4

Insidious onset injuries (postural) in the thoracic region are most common w/

Answer 4

Thoracic spine

Question 5

What do we need to rule out when examining thoracic complaints

Answer 5

Visceral symptoms

Question 6

Patient history red flags for thoracic

Answer 6

Heart problems

smoking

DM

HTN medication

Smoking

non-positional pain

surgery

bedridden

breathing difficulty

infection/illness

Question 7

Patient history red flags

Answer 7

Fall/MVA

Coughing up sputum

Relieved w/ eating

Fatty foods increase symptoms

UTI

KIdney stone

Flank pain that comes on suddenly

Question 8

Where does angina usually refer

Answer 8

Jaw, neck, scapular pain, medial UE, mid thoracic

Question 9

Chest pain, pallor, sweating, dyspnea, nausea, palpitations,

symptoms over 30 mins

Answer 9

Myocardial infarction

Question 10

Tumor compressing C8-T1

Answer 10

Apical pancoasts tumor

Question 11

Chest, shoulder , upper abdominal pain w/ significant difficulty breathing

Answer 11

EMERGENT!

pulmonary embolism

Question 12

Chest pain that increases or decreases with breathing,

pt w/ decreased breath sounds

Answer 12

Pneumothorax

EMERGENT!

Question 13

Mimics joint lesion, pain w/ breathing and thoracic movement

“knife like pain”

Answer 13

Pleural pain

Question 14

C4 dermatome d/t irritation of diaphram w/ digestion and eating

Answer 14

Cholecystitis/gall bladder

Question 15

Crippling chest pain that can radiate to back, not positional

Answer 15

emergent!!!

Dissecting aortic aneurysm

Question 16

Relevant question to ask if you suspect a person may have an infection in the thoracic region

Answer 16

have you had any injections recently

Question 17

What is the most narrow portion of the spine and affected by spinal stenosis in the thoracic

Answer 17

T4 - T 9

Question 18

Disc protrusions are more common in the _______ thoracic spine

Answer 18

lower

Question 19

Increased pain w/ stress fatigue

difficult to reproduce in exam

negative neuro exam

Answer 19

Postural dysfunction

Forward head posture, abnormal pelvic tilt

Question 20

Thoracic disc pathology 3 positive signs

Answer 20

Pain w/ active and passive motion

positive dural signs with or without radiculopathy

positive symptoms w/ coughing

Question 21

recommendations for postural dysfunction

Answer 21

ergonomic advice, t-spine mobility ex, strengthening ex, pt education

Question 22

thoracic disc pathology recommendations

Answer 22

Axial distraction ,mechanical traction

Surgery rarely recommended

Question 23

What are the most common levels to have a thoracic disc pathology

Answer 23

T3-T8 most common

followed by T9-T11

Question 24

Where will t1-t2 disc pathology refer?

Answer 24

Medial arm, forearm

Question 25

where will T2-T3 (rarest type) disc pathology refer

Answer 25

Toward clavicle, scapular spine, medial arm

Question 26

Where will T3-T8 disc pathology refer?

Answer 26

pain or neuro symptoms at lateral or anterior portion of truck

Question 27

Where will T9-T11 disc pathology refer?

Answer 27

Pain can radiate into buttocks and mimic lumbosacral radiculopathy bilateral symptoms weakness suggesting myelopathy

Question 28

What is the key for determining thoracic facet joint dysfunction

Answer 28

palpation

Question 29

Pt recently increased training load or ergonomic set up

Answer 29

possible thoracic facet joint dysfunction

Question 30

pain w/ deep breathing, trunk rotation, coughing, sneezing localized pain 3-4cm from midline

Answer 30

Possible rib dysfunction near costo-vertebral joint

Question 31

Localized pain and tenderness pain worse with movement, deep inspiration,coughing pain w/ isometric contractions and/or passive stretching Typically caused by MVA, physical altercation

Answer 31

Abdominal muscle strains and contusion

Question 32

Whats a common cause of thoracic vertebral fractures

Answer 32

osteoporosis

Question 33

Osteoporosis typically causes ___________ fx in the thoracic or a burst fx

Answer 33

anterior wedge fracture

Question 34

Pt w/ positive compression test articular signs are positive in all directions immediate onset of pain

Answer 34

thoracic vertebral fracture

Question 35

Pt has flail segment (unstable rib fx) what do you do?

Answer 35

call ambulance immediately

Question 36

Precautions for scapular fx

Answer 36

NWB on that arm

Question 37

Posterior dislocation of SC joint can be _________

Answer 37

life threatening call ambulance now

Question 38

What is Scheurmann disease

Answer 38

Found in 10% of the population excessive juvenile kyphosis deficit in apophysial ring of vertebral body causing anterior wedging

Question 39

What is T4 syndrome

Answer 39

Can be anywhere between T2-T7 no known etiology Dr Arnold says there will be hypomobile segment Positive slump test positive ULTT

Question 40

MD refers for cervical disc herniation Paresthesia that are NOT dermatomal Symptoms in C8-T1 Hypertonic scalene muscles

Answer 40

1st rib dysfunction

Question 41

Loss of full Shoulder elevation negative contractile testing posterior shoulder pain w/o a "shoulder" history

Answer 41

2nd rib dysfunction

Question 42

Whats the most common way to differentiate a 2nd rib dysfunction

Answer 42

shoulder pain with negative contractile testing

Question 43

Whats the most common way to differentiate a 1st rib dysfunction

Answer 43

paresthesias in a non-dermatomal pattern

Question 44

stiffness >30 min, back pain decrease w/ movement but not rest, night pain, alternating buttocks pain; likely to occur in young males; key finding limited chest expansion

Answer 44

Ankylosing Spondylitis

Question 45

What is tietze syndrome? Which rib does it normally effect?

Answer 45

local inflammation of costo-sternal cartilage (typically 2nd rib); self-limiting condition that may last from weeks to years

Question 46

Where do osteoporetic fractures normally occur in the t-spine?

Answer 46

Between T9-T11

Question 47

What are the potential compression sites for TOS?

Answer 47

Presence of cervical rib Scalene triangle* Hyperabduction syndrome Costoclavicular syndrome Pectoralis minor 1st thoracic rib

Question 48

TOS can be limb threatening, especially with ______________ most TOS cases are _______

Answer 48

arm elevated above 90 neurogenic

Question 49

In what direction do you apply the force for 1st rib springing

Answer 49

anterior/medial/inferior