Thoracic Spine

Question 1

What are the 3 sections of the thoracic spine

Answer 1

T1-3
T4-9
T10-12

Question 2

What are the 4 parts of the thoracic spine and rib cage

Answer 2

Transverse processes
Spinous processes
Rib tubercles - where transverse processes join giving the costotranverse joint and costovertebral joint
Intercostal space - where intercostal muscles lie

Question 3

How many joints are in the front and back of rib cage

Answer 3

12
Sternocondral joints
Costocondral junctions

Question 4

How do we palpate the thoracic vertebra

Answer 4

Rules of 3 - due ti the length of the spinous processes which changes from the upper to the lower, they become longer as we go down
T1-3 = transverse processes are level with the corresponding spinous process
T4-6= TP are 1/2 segment above the SP
T7-9 = TP are above the SP

Question 5

What are the components of the passive system of the thoracic spine

Answer 5

Has a spinal canal
Structure and position of the nervous system
The exchange between the sympathetic nervous system in the autonomic nervous system takes place in the thoracic spine

Question 6

What is involved in the active system of the thoracic spine

Answer 6

Muscular system = intercostals, abdominals, spino-scapular, spino-humeral, scapuloheral muscle groups

Question 7

How to differentiate between MSK and visceral pain in clinical examination

Answer 7

MSK =
pain affected by movement or posture
Onset usually mechanical
Pain area well defined
Pain reproduced by t spine palpation
Night pain

Visceral =
Posture and movement make no difference
Nom mechanical
Pain area diffuses
Palapation of t spine has no effect

Question 8

What are possible underlying pathologies in the thoracic spine

Answer 8

MSK =
Trauma - fracture, ligament, muscle
Degenerative joint disease
T4 syndrome
T outlet syndrome
Postural thoracic pain
Referred pain

Non- MSK
Metabolic disorders
Infections like TB
Tumours
Visceral pain

Question 9

What should be observed in objective examination

Answer 9

Scoliosis
Kyphosis
Note the chest - pigeon chest or funnel chest or barrel chest

Question 10

What ROM tests should be done for thoracic spine assessment

Answer 10

Flexion
Extension
Side flexion
Rotation
Deep inspiration
Deep expiration
Combined movement to include deep inspiration and expiration

Question 11

What PAVIMS can be done for thoracic spine assessment

Answer 11

IN SUPINE AP of costochondral, interchondral and sternocostal joints
IN PRONE PA of IV joints T1-12
Unilateral PA of facet joints
PA of the Costco-transverse joints
Longitudinal caudad of first rib
PA ribs 2-12

Question 12

What nuerodynamic tests can be done for thoracic assessment

Answer 12

Slump test
SLR
Passive neck flexion
Upper limb tension test

Question 13

What are specific disorders of the thoracic spine

Answer 13

Paget’s disease
AS
rheumatoid arthritis
OA
DISH
Scheuermanns disease
Thoracic canal stenosis
Thoracic disc herniayion

Question 14

What is thoracic outlet syndrome

Answer 14

???

Question 15

What is scheuermanns disease

Answer 15

Form of osteochindrosis with degenerative changes in the intervertebral disc and end plates
A growth disorder, anterior body grows slowly or abnormally, increasing kyphosis
Affecting T5-L1

Question 16

What is the clinical presentation of scheuermanns disease

Answer 16

Smooth rounded dorsal kyphosis, most evident on flexion
Reduced spinal mobility
Tight hamstrings
Reduced disc space

Question 17

How to treat scheuermanns disease

Answer 17

If Inactive phase =
Light exercise
Postural correction with brace
Rest from pain producing activities

If Inburnt out phase =
Encourage self management
Paced return to activity and exercise
Avoid heavy loading

Question 18

What is osteoporosis

Answer 18

Reduced bone mass resulting in reduced bone mineral density
Results from failure to achieve peak bone mass or from accelerated bone loss
Can be from oestrogen deficiency

Question 19

Typical picture of those with osteoporosis

Answer 19

More prevalent in women and elderly
Early menopause or post menopause
Sedentary lifestyle
Thin body type
Ammenhorea

Question 20

How is the female athlete triad related to osteoporosis

Answer 20

Disordered eating, ammenhorea and osteoporosis seen in females who participate in activities that emphasise a lean physique

Question 21

What are symptoms of osteoporosis

Answer 21

Pain due to bony fracture
Diffuse skeletal pain
Loss of height
Stooped posture
Sudden pain history

Question 22

Management of osteoporosis

Answer 22

Prophylaxis and eliminate risk factors
Manual therapy - soft tissue
Electro therapy
Postural assessment
Exercise
Calcium intake
Pain management

Question 23

What are special tests for thoracic spine assessment

Answer 23

Adson test
Roos test

Question 24

What is the Roos test done for and how is it performed

Answer 24

Thoracic outlet syndrome
84% sensitivity
30% specificity
Patient has both arms in 90* abduction and external rotation, shoulder and elbows are in frontal place of chest

Patient is to open and close hands slowly over a 3 minute period

+ =
heaviness
Gradual increase in neck and shoulder pain - ischaemic pain
Parathesia in foearm and fingers
Arm paleness
Inability to complete gets

Question 25

What is the Adson test

Answer 25

For thoracic outlet syndrome
79% sensitivity
76% specifity

Arm is abducted 30 degrees at the shoulder and max extended
Radial pulse is palpated
Patient extends neck and turns head toward the symptomatic shoulder and takes a deep breath in and holds
Quality of radial pulse is evaluated in comparison
+ =
Reproduction of patients symptoms or abolition of radial pulse