Thoracic spine

Question 1

special questions

Answer 1

deep breath/ cough sneeze/ SOBOE (use of inspiratory muscles, raise intraabdominal pressure), eating/drinking- could be visceral pain, stress (more stress=more pain= more stimulate CNS), lying down, positional changes, night symptoms, bone density tests- osteoporosis, menstrual history

Question 2

special questions- continued

Answer 2

loss of height- kyphosis, osteoporosis (often 50+), family history (cancer, rheumatoid), young adults/ teens post growth spurt- change in body mechanics, blood tests- calcium deficiency, drug history- immunosuppressants/ steroid, rash, severe stiffness, general feeling of malaise, recent fracture

Question 3

objective assessment

Answer 3

obs- postural alignment, asymmetry- spine shape, functional demonstration, AROM/PROM (look for quality, range, end feel)- deep breathing, muscle length tests- scanes, SCM

Question 4

PAIVIMS

Answer 4

PA, transverse, unilateral over ZA jts, unilateral over CT junctions, unilateral over rib angles

Question 5

PPIVMs

Answer 5

patient place arms across chest, palpate Tx, place other arm across their arms, rotated towards, flex forward, or place arm under theirs to ext

Question 6

Roos stress test

Answer 6

head in neutral, arms in GH abd and LR to 90°, elbow flexed to 90°, flex and ext fingers for 3x1 mins, monitor symptoms whilst observing for dropping of arms +/- cyanosis

Question 7

adsons test

Answer 7

abd with supination, cx rotation same way, ext neck and hold breath, positive is obliteration of radial pulse (hold pulse throughout)

Question 8

muscle strength test

Answer 8

scalenes, pec major/minor

Question 9

MWM’s

Answer 9

same technique as PPIVMS, patient sit near end of bed and with legs off the bed, therapist behind patient
palpate SP with pisiform

Question 10

what is thoracic outlet syndrome

Answer 10

a group of disorders that occur when blood vessels or nerves in the space between collarbone and first rib (thoracic outlet) are compressed. this can cause pain in Sh and neck and numbness in your fingers.

Question 11

causes of TOS

Answer 11

physical trauma from a car accident, repetitive injuries from job or sports related activity, pregnancy

Question 12

S and S TOS

Answer 12

muscle wasting in the fleshy base of your thumb, numbness or tingling in your arms or fingers, pain or aches in neck, Sh or hand, weakening grip

Question 13

first narrowing area TOS

Answer 13

inter-scalene triangle- boarded by anterior scalene muscle anteriorly, the middle scalene muscle posteriorly and the medial surface of first rib inferiorly. the fact that both scalenes muscles insert onto the first rib (can cause overlapping)- leads to compression o brachial plexus and subclavian artery

Question 14

second passageway- TOS

Answer 14

costoclavicular triangle bordered anteriorly by the middle third of the clavicle, posteromedially by the first rib, and posterolaterally by the upper boarder of the scapula. subclavian vein, artery and brachial plexus. compression of these structures can occur due to congenital abnormalities, trauamt. first rib or clavicle, structural changes in the subcalvian muscle or the costocoracoid lig

Question 15

third passageway- TOS

Answer 15

sub-pectoralis minor space- beneath the coracoid process and just under pec minor tendon. shortening of pec major can lead to a narrowing of this space and therefore compression of the neurovascular structures during hyperabduction

Question 16

epidermiology- TOS

Answer 16

more frequent in women, age of 20-50

Question 17

TOS- Plexus involved

Answer 17

upper plexus (C5,6,7)- Pain in neck, and may radiate down to the ear and face, pain over rhomboids and anteriorly over clavicle and pec regions, headaches are not common, radial nerve 
lower plexus (C8,,T1)- anterior and posterior should region, radiate down into ulnar side of hand and forearm.

Question 18

TOS treatment- stage 1

Answer 18

aim is to reduce patients symptoms

patient education- bad postures (such has sleeping with arms above head in abd position, sleep on unaffected side)

Question 19

TOS treatment- stage 2

Answer 19

goal is to address the tissue which is causing the compression. strengthening of- LS, SCN, Upper traps, stretching of pec major, lower trap and scalene muscles
activation of scalene- Isometrics flex (anterior), side flex (middle), ext (posterior)