Thoracic Eval & Treatment

Question 1

History: what type of pain may be provoked or alleviated by movement or posture?

Answer 1

Musculoskeletal pain

Question 2

History: what type of pain may be provoked by respiration?

Answer 2

Rib or pleuritic pain

Question 3

History: what type of pain may be provoked by eating or drinking?

Answer 3

Gastric pain

Question 4

History: what type(s) of screen(s) should be conducted for patients with both T spine and chest wall complaints?

Answer 4

Neurological

Systemic disease

Question 5

Referral patterns for visceral organs: Thorocolumbar

Answer 5

Male genitalia

Question 6

Referral patterns for visceral organs: Thorocolumbar T10-L2

Answer 6

Bladder/ureter

Question 7

Referral patterns for organs: Right T7-9

Answer 7

Liver, gall bladder

Question 8

Referral patterns for organs: T2-4

Answer 8

Lung

Question 9

Referral patterns for organs: Right mid/lower T spine

Answer 9

Appendix

Question 10

Referral patterns for organs: T6-T10

Answer 10

Stomach

Question 11

Referral patterns for organs: T10-L1

Answer 11

Kidney

Question 12

Referral patterns for organs: T1-5

Answer 12

Heart

Question 13

Non-musculoskeletal T spine pain sources

Answer 13

Malignancy, viscera, shingles, cardiac or pulmonary issues

Question 14

Cancers that commonly metastasize to spine

Answer 14

Prostate
Thyroid
Breast
Lungs
Kidneys

Remember “PT Barney Loves Kids”

Also GI tract

Question 15

Outcome measures for T spine

Answer 15

NDI above T4

ODI below T4

Question 16

Upper rib motion

Answer 16

Anterior-posterior, “pump handle”

Ribs 1-4 or 5

Question 17

Lower rib motion

Answer 17

Medial-lateral, “bucket handle”

Question 18

Muscles contributing to respiratory dysfunction

Answer 18

Scalenes, intercostals, pec minor, serratus anterior, diaphragm, quadratus lumborum

Question 19

Muscle attachments to ribs: scalenes

Answer 19

Ribs 1-2

Question 20

Muscle attachments to ribs: pec minor

Answer 20

Ribs 3-5

Question 21

Muscle attachments to ribs: serratus anterior

Answer 21

Ribs 3-9

Question 22

Muscle attachments to ribs: diaphragm

Answer 22

Ribs 6-12

Question 23

Muscle attachments to ribs: quadratus lumborum

Answer 23

Rib 12

Question 24

What is an inhalation restriction?

Answer 24

Occurs when a rib or ribs do not rise with inhalation, but move freely with exhalation

Key rib is the uppermost affected rib

AKA exhalation dysfunction

Question 25

What is an exhalation restriction?

Answer 25

Occurs when a rib or ribs do not lower with exhalation, but move freely with inhalation Key rib is the lowermost affected rib AKA inhalation dysfunction

Question 26

Med conditions resulting in T spine pain: Cardiac pain

Answer 26

Pain from myocardium as a result of decreased bloodflow Squeezing, sub-sternal sensation; tightness or pressure

Question 27

Med conditions/diff dx: acute MI

Answer 27

Intolerable gripping or crushing sensation substernally; sweating, shortness of breath Also sx in jaw, neck, left chest and arm Send to ED ASAP

Question 28

Med conditions/diff dx: Angina pectoris

Answer 28

Increased cardiac pn with exertion, relieved by rest Physician referral

Question 29

Med conditions/diff dx: Aortic dissection

Answer 29

Sudden, severe, unrelenting pain substernally or btwn scapulae; pt may be pale or cyanotic BP usually normal, distal pulses diminished or absent Send to ED ASAP

Question 30

Med conditions/diff dx: pericarditis

Answer 30

Mild to severe chest pain aggravated by respiration, cough, motion, relieved by sitting and forward bending Possible fever, chills, weakness, tachycardia, cough Pn substernal, infrasternal, L upper trap

Question 31

Med conditions/diff dx: Mitral valve prolapse

Answer 31

Sharp, stabbing pn; also can be dull pn Chest pn, angina-like pn; non-exertional pn Stethoscope: systolic non-ejection click, late holosystolic murmur Physician referral

Question 32

Med conditions/diff dx: Esophageal disorer

Answer 32

Mild to severe burning in epigastric or retro-sternal area Pn often worse at night C/o brackish taset, frequent belching Pn diagram: horizontal band across chest or back, similar to radicular pn

Question 33

Med conditions/diff dx: Tracheobronchial Pn

Answer 33

Pn referred to upper and lateral sternum

Question 34

Med conditions/diff dx: Pleurisy

Answer 34

Sharp or stabbing pn at end of inspiration or exhalation Pn felt over site of pleurisy or chest wall

Question 35

Med conditions/diff dx: Pulmonary embolism

Answer 35

Use Wells criteria to dx, dyspnea and tachypnea also very common High risk: unilateral extremity swelling and chest pn Send to ED ASAP

Question 36

Med conditions/diff dx: Cholecystitis

Answer 36

Pn typically occurs 1-2 hours after a meal Pn peaks after 2-3 hours and resolves in 10 hours Pn in upper right abdominal quadrant and/or right subscapular area Fever, chills

Question 37

Med conditions/diff dx: Peptic ulcer disease

Answer 37

Burning pn below xiphoid process or left upper abdominal quadrant Frequent, consistent NSAID use Possibly relief via antacid use

Question 38

Med conditions/diff dx: Renal disease

Answer 38

Pn at costovertebral angle Signs of UTI Fever, chills, sweats Physician referral