Thoracic Lab Flashcards by sophia carrasco

Most rib injuries are related to what

Trauma

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What is dowager’s hump

Many anteriorly wedged vertebrae

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What is hump back

1-2 anteriorly wedged vertebrae

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What is the Upper thoracic and lower thoracic

T1-T7

T8-T12

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What respiratory assessment can u do for the ribs

Superior rib (pump handle movement)

Inferior ribs (bucket handle movement)

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When doing thoracic ROM what test is helping u look for closing and opening restriction

Quadrant testing (just do over pressure dont resist)

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If you are doing thoraciac AROM testing and there is pain with over pressure how do u test resisted testing

In neutral position

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What do u test the flexibility - hypertoniciity of the levator scap and upper trap

flex , sb away and rotate away

Flex and sb away

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How do u test the strength - inhibition/hypotonciity of

• Serratus Anterior
• Lower Trapezius
• Rotator Cuff Muscles
• Middle Trapezius
• Upper Trapezius

• Serratus Anterior- punch out

• Lower Trapezius- 135° abduction

• Rotator Cuff Muscles - IR/ ER
• Middle Trapezius- arms at 90° of abduction “T” position
• Upper Trapezius- shrug

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If you are on the SP of T6 how would u find the TP

Go up Half a level

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When do u perform the AP rib sprining joint mobility test (T1-T7)

Only performed when pt presents (+) for anterior chest pain

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For rib dysfunctions, you will more often see what subluxation

Superior subluxation of 1st and 2nd ribs

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How do you dx 1st rib dysfucntion (4)

Height: 1⁄2 inch elevation superior is (+) sign
(+) Spring Test
(+) ipsilateral ↑ scalene tone
(+) Cervical rotation lateral flexion test

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How do u know if a rib is elevated

By palpating the 1st rib on each side and if one is 1/2 inch higher than the other

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What do u do once u palpate 1st rib and u find that it is elevated (what test and how is the force)

Do spring test

Place webspace on 1st rib and SB patient head towards rib that is elevated

Forced applied shoudl be ant/med/inf

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What are the 2 1st rib assessment test

1st rib spring test

Cervical rotation/lateral flexion test

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How do u perform the cervical rotation/lateral flexion test for 1st rib assessment

Rotate head away from side being tested and flex eat to chest (assess bilaterally)

(+) if flexion blocked w head rotated contralterally ( so if u turn head to R and it is limited then it is the left rib)

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How do u palpate second rib

Find 1st rib and then move 1 thumb width inferiorly and 45° lataterally

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How do u do the 2nd rib spring test

Use pisform of 1 hand on superior surface of second rib and provide an inferior force

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When palpating the abdomen how should ur hands be to be deeper

Vertical

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What is included in the R UQ of the abdomen

liver, gallbladder, duodenum, pancreas and R kidney

V What is included in the R LQ of the abdomen

appendix, R ovary and tube

V What is included in the L LQ of the abdomen

sigmoid colon, L ovary and tube

V What is included in the L UQ of the abdomen

stomach, spleen, L kidney, pancreas

What is the normal and wide width of the **aortic pulse**

* Normal = 2-3 cm * Wide = >3 cm

When would u palpate the aortic pulse

For older popele , pulmonary problems , or cardiac problem

If pain is provoked w aortic pulse what do u do

Contact phsician for possible AAA

What is a **positive** test for **compression** testing

Provocation/reporudction of pt SYMTOMS

What is a **positive** test for **distraction** testing

Relief/reduction of pt symptoms

What is a (+) test when performing TOS test

Either disappearance or diminish of pulse or reproduction of neurologic S/S But mainly trying to reproduce s/s

What are the 3 test u could perform for **TOS**

- adsons vascular test - Costco clavicular test -Roo’s test

How do u perform the **Adsons vascular test** and what is a **postivie** test

- have pt arm in 15° of abduction and palpate radial pulse athen have patient hold breath and tilt head backwards and turn chin to affected side (+)= decreased radial pulse and/or reproduction of UE neuro symptoms

How to perfomr the **costo clavicular test** and what is **positive test** ## Footnote TOS

- pt sit w straight posture and palpate radial pulse then ask pt to retract and depress both shoulder while protruding chest t, hold x 60 secs (+)= decreased radial pulse and/or reproduction of UE neuro symptoms

How to do **Roo’s test** and what is a **positive** sign

- pt seated w B arms in 90° shoulder abduction and 90° elbow flexion and then ask pt to open and blanch fingers into/out a fist. X 3 mins (+)= decreased radial poulse and/or reproduction of UE neuro symptoms at ANY point during the test If symptoms present , test stops immediately

What is the treatment prioritization for t spine

Manual therapy —> mobility exercises —> stbailility —> traction (if needed for pain control)

When do u use traction

If pain is still present and nothing else is working

What are indication for manual therapy (6)

• Mild MSK pain • Joint hypomobility • MSK condition w/ low irritability (Pain provoked w/ motion and Pain relieved w/ rest) • Intermittent MSK pain • Pain that is relieved or provoked w/ specific motions or positions • Pain related to Δ’s in sitting or standing postures

What are the 3 goals of **manual therapy techniques**

- reduce pian - alter stiffness - pt education

What are the grades of oscillatory joint mobs

Grade 1- small amp (25%) , beg of avaiable joint play Grade 2: large amp (mid 50%) Grade 3: large amp (last 50) at end of joint play Grade 4: small amp (last 25%) at end of joint pay Grade 5: quick movmeemtn that exceeds resistance barrier

During the **cervico thoracic junction manip** there is a gappy where

C7-T1

How would u do a cervico thoracic junction manip to the R side

Place R hand on R TP of T1 and then SB pt head to the L and rotate slightly to the R and then take up slack by leaning onto R UE (on T1) and apply a quick downward (infeiror) thrust

For the supine thoracic spine gapping HVLAT if u are hitting upper t spine how should the pateitns hands be and what about lower t spine

Upper= interlaces fingers behind head Lower= folds arms to hug shoulders

How do u **lock out** pt when doing **supine thoracic spine gapping HVLAT**

Side bend pt away from PT and then rotate pt toward PT

What direction is the thrust for the **supine thoracic spine gappy HVLAT**

Quick posterior thrust

What kind of force is being applied during a **prone upper thoracic spine gapping HVLAT**

Quick anterior thrust

How do u do the prone thoracic spine gapping HVLAT

Find SP that is hypomobility and then stand hands w elbows locked around the affected SP and then take up slack by provideing a constant anterior force and use the screw mechanisms and then apply a quick anterior thrust

Where is the PT pistol grip when doing a supine rib gappying HVLAT

On Costo transverse joint (slightly lateral to SP)

When would u use a grade 1 and 2 mob rather then a grade 3 or 4 mob

Grade 1 and 2= if patient has pain Grade 3 adn 4= if patient is mainly stiff

Whar are the **contras** for manual therapy ( 16)

- systemic or localized infection * Febrile state * Acute circulatory condition * Malignancy * Open wound or sutures over/near tx site * Recent fracture * Osteoporosis * Hematoma * Hypersensitivity of skin * Inappropriate end-feel * RA (during exacerbation) * Cellulitis * Constant, severe pain * Extensive radiation of pain * Pt is afraid of/declines manual therapy treatment** main * Advanced DM