Flashcards in Thoracic Spine Deck (46):
With your patient prone on a treatment table you are attempting to palpate the left sided transverse process of T8. This can be accomplished by using which of the following anatomical landmarks?
A. Palpating left of the T9 spinous process
B. Palpating left of the T7 spinous process
C. Palpating left of the T6 spinous process
D. Palpating left of the T8 spinous process
B. palpating left of the T7 spinous process
T1-3: at same level
T4-6 one half level below
T7-9 one full level below
T10-12 = at the same level
**studies have questioned this validity
What is the action of serratus anterior?
scapular force couple of upward rotation and posterior tipping
What does tightness in pec minor result in. Where does pec minor originate?
Ribs 3-5 = origin
tightness = anterior tipping and protraction of the scapula
How can the thoracic spine create hip pain?
subcostal nerve supplies skin of abdominal wall and lateral hip region over the iliac crest
Where is the critical zone? Where is the tension point located?
T4-9 = smallest area of the spinal canal
Tension point = T6
Review thoracic spine referral from facets
Patient comes in with vague abdominal pain. Where would you suspect a disk herniation if this was a hypothesis?
According to Lee, what happens to the rib with flexion, extension
Flexion: forward rotation of the rib head
Extension = posterior rotation of the rib head
You see a patient has a + CRLF test on the R? What direction did you turn the patient's head?
L rotation with R SB
What is the CPR for manual therapy (thrust/nonthrust) to thoracic spine with primary complaints of shoulder pain?
1. Pain free shoulder flexion less than 127
2. negative Neer's
3. GH IR less than 53 at 90 deg abd
4. not taking medication for shoulder pain
5. sx less than 90 days
3/5 = 89% LR
4/5 = 100% LR
What is the arthrokinematics of the facets during R SB?
R inferior facet of superior vert glides inferolaterally and the L inferior facet of the superior vert glides superomedially
What is the coupling pattern of the thoracic spine?
Over the course of 8 studies there was no consistent coupling pattern p 4 monograph
According to Lee, what happens to the L and R rib with R rotation of the thoracic spine?
R rib: posterior rotation
L rib: anterior rotation
Where does pump handle and bucket handle occur?
pump = upper ribs
bucket = lower ribs
However in vivo study showed similar motion at all ribs in terms of expansion
How is the thoracic sympathetic chain tensioned?
flexion, contralateral SB, contralateral rotation
Describe flexion vs. extension movement impairments. Where would you see these impairments?
Flexion: impaired superior gliding of facets, reduced ant translation of the sup vert bodies, restricted anterior rotation of the rib
**often seen in upper and middle thoracic spine
Extension: impaired inferior gliding, restricted posterior rotation of the rib
**often seen in upper spine and CT junction; thoracolumbar junction
What is a common MOI for a subluxed 1st rib?
traumatic injury like whiplash and repetitive overuse of the extremity
Patient has a Murphy's sign (not murphy's percussion). What is it? What is it indicative of?
palpating R subcostal region and asking to take a full breath
What is renal colic?
flank pain with lower abdominal pain that goes into the labia/testicles
Your patient has increase in pain in the lower/mid thoracic region when lying flat. What is this an indication of?
In cases involving thoracic metastases, what were the 3 sx?
1. painful scoliosis
2. long-tract neuro signs
3. leg pain
What are the risk factors for osteoporosis?
2. hx of smoking
3. early menopause
4. thin body build
5. sedentary life
6. steroid treatment
7. excessive consumption of alcohol or caffeine
What did 1 study show regarding vertebroplasty and sham with those with chronic (>1 year) thoracic pain?
No difference in pain, function, quality of life
**vertebroplasty may be more effective in acute conditions
What is the association of postural abnormality and a history of pain in the thoracic region?
a relationship b/w pain frequency and severity and the severity of postural abnormalities was not found - there was an increase in incidence in pain with those with bad posture
You want to perform a R 1st rib manipulation thrust. Where is your body position?
R cervical SB; therapist leg under L UE
Your patient has an anterior subluxed R 6th rib. What is the positioning you will place the patient in? What is the muscle you want to fire during the contraction?
Flexion, L SB, L rotation
gently lift elbow up and out to contract serratus anterior
Your patient has an posterior subluxed L 5th rib. What is the positioning you will place the patient in? What is the muscle you want to fire during the contraction?
thoracic ext, LSB, R rotation.
pull the elbow down to contract pectorals major and provide an anterior translatory force on the L 5th rib
What shoulder condition has thoracic manipulation been shown to be good with?
What things aggravate pancreas?
Aggs: walking, lying supine
Relieve: sitting, leaning forward
worse after eating a meal
What are the 4 F's for the risk factors for cholelithiasis (gallstones) or cholecystjts (inflamed gall bladder)
Where does gall bladder pain refer?
What is an aggravator?
R shoulder/ R infrascapular pain
R UQ pain and R 10th rib pain = hot rib
1-2 hours after ingesting heavy meal - especially if fatty
What is Murphy's percussion used for?
Pain that is relieved by eating indicates?
What is the difference b/w the location of pain with gastric/peptic ulcer and a duodenal ulcer?
peptic = 8th Thoracic nerve
duodenal = 10th thoracic nerve
Where are the 3 locations of impingement for TOS?
1. interscalene triangle - anterior/middle scalene and 1st rib inferiorly
2. costoclavicular space: middle 1/3 clavicle, 1st rib, upper border of scapula
3. thoraco-coraco-pectoral space- pec minor, coracoid, ribs 2-4
When is someone braced who has scoliosis?
> 30 deg - braced
What is the most effective brace for scoliosis?
Boston brace - TLSO
next is the Milwaukee brace
When is surgery suggested for scoliosis
> 50 for skeletally mature
progressing curve > 40
double major curve > 30
> 30 with marked rotation
According to ortho secrets, what type of restriction (flexion or extension) in the thoracic spine would you see with
1. lower trap muscle weakness
2. inhibition of serratus
lower trap - extension restriction
serratus - flexion restriction
Based on patient presentation how would you differentiate b/w TOS and T4 syndrome
T4 = Bilateral
TOS: unilateral, ulnar distribution usually affected, upper Tspine usually affected --T1-4 rather than T4-7
A patient has decreased thoracic kyphosis. You want to perform a manipulation. Do you performing prone or supine thrust?
Decreased thoracic kyphosis - suggest relative ext and reduced thoracic flexion - biomechanically based - not based on research
Patient has a thoracic compression fracture. What imaging modality should be used?
What has been shown to be the most beneficial exercise routine following compression fracture?
weight bearing exercises and progressive spinal extensor muscle strengthening
Not Aquatics - not weight bearing
What is the best manual interventions for someone who has rib dysfunction?
thrust manipulation to thoracic spine in the presence of rib dysfunction (no evidence to support it)
if patient has increased tenderness at T2 and the pain increases when in prone, what manipulation is indicated - seated, prone, or supine?
prone - increases the pain
supine - patient has increase in pain/tenderness `with direction palpation