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PT 621 Clinical Ortho > Thoracic Spine > Flashcards

Thoracic Spine Flashcards

(48 cards)

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1
Q

Thoracic spine problems are less common. T/F?

A

True

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2
Q

TS can be equally painful & disabling as cervical/lumbar disorders. T/F?

A

True

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3
Q

Treating TS can help resolve TS & Rib Dysfunction. T/F?

A

True

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4
Q

Treating TS can help resolve pain and movement disorders in other spine regions and peripheral joints. T/F?

A

True

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5
Q

Regional Interdependence?

A

Theory that dysfunction of one body part imparts dysfunction upon another

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6
Q

Sources of symptoms for TS?

A 
Vertebral body
Intervertebral disc
Facet joints
Costovertebral  joints
Costotransverse joints
Tips
Nerve Root
Muscles/Myofascial tissue
Intersegmental ligaments
Dura
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7
Q

Muscles that effect near TS?

A

Traps
Rhomboids
Paraspinals

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8
Q

Identifying the exact source of your patient’s TS symptoms is difficult and often unknown. T/F?

A

True

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9
Q

Identifying the source is based on our understanding of anatomy, accurate manual assessment and recognition of clinical patterns. T/F?

A

True

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10
Q

Bilateral, intermittent tingling and weakness in both legs is a clinical pattern for…

A

T/S Central Cord Lesion

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11
Q

T/S Central Cord Lesion?

A

Central space occupying lesion compressing on spinal cord, producing serious neuro problems

i.e. tumor, vertebral body fx, central HNP, osteomyelitis

**Uncommon!

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12
Q

Evidence of what sources of pain in the TS?

A

Cervical/Thoracic facets
Costovertebral joints
Costotransverse joints

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13
Q

Determining pain from the cervical vs thoracic?

A

Differentiate the neck…

1) does moving your neck cause thoracic pain
2) AROM of CS
3) CS segmental mobility
4) reproduction of pain?

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14
Q

Determining which TS segments are painful/dysfunction?

A

Postural observation
AROM
Segmental mobility
Palpate myofascia

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15
Q

Forward neck can cause difficulty of what other movement/joint?

A

GHJ, flexing
…due to T1-T4 positioned in flexion

CS rotation
…due to upper/mid CS positioned in extension

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16
Q

Common TS posture?

A

Forward neck posture
Excessive upper TS flexion (kyphosis(
Excessive upper CS extension

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17
Q

For each AROM determine…

A

1) Amount of movement available
2) Location and type of symptom felt
3) Movement - symptom relationship

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18
Q

Facet orientation of TS

A

More vertical from proximal to distal
More flexion from proximal to distal
Less rotation from proximal to distal

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19
Q

What changes the mobility of the spine?

A

Facet orientation
CTJ
TLJ

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20
Q

Segmental Mobility Exam Assess?

Study These Flashcards
A

1) Amount of motion
2) Amount of stiffness
3) Symptom response at each spinal segment

21
Q

Reliability of segmental mobility exam is poor. T/F?

Study These Flashcards
A

True. Pain provocation better than motion assessment.

22
Q

Palpate Myofascia

Study These Flashcards
A

Adjacent to the segment, feel for tenderness/increased resistance

23
Q

Theories on vertebral motion dysfunction? Hypomobility.

Study These Flashcards
A

1) Alteration in arthro, lack of congruency.
2) Altered length/tone of muscles controlling joint motion. Adaptive shortening can affect joint mechanics.
3) Entrapment of synovial material between 2 joint surfaces (meniscoid tissue)
4) altered biomechanics/biochemical properties of myofascial elements

24
Q

Theories on vertebral motion dysfunction? Hypermobility.

Study These Flashcards
A

1) Disease states (Marfan)
2) Physiologic. “Born loose”
3) compensatory due to area of hypo

25
Treatments for TS Mobility
1) PA/Rotation Mobs 2) MWM 3) HVLA
26
Duration of treatment?
As long as there's an improvement, patient is making gains, and I can tolerate... 30s bouts, 3x5reps
27
CT Rotation Mobs C7-T3 Improves...
CTJ rotation - Transverse - Unilateral PA w/ rotation
28
MWM goal:
Restore segmental motion w/ movement in a pain free manner
29
MWM vs PA
1) Patient is active vs passive 2) WB vs NWB 3) More dynamic: engages muscles/joints 4) Potential to incorporate other body regions
30
When is HVLA performed?
When patient is right for it...
31
Rib dysfunction
Onset of pain and dysfunction is related to blunt trauma to chest wall/upper body injury
32
Thoracic vs Rib?
Is breathing an issue?
33
Rib treatments:
Rib mobilization * Angles become more oblique * Coordinate w/ breathing
34
TOS
Neuro structures compressed at 1st rib Classification: Neurogenic (brachial plexus) Vasogenic (subclavian artery/vein) Non-specific (subclinical neurogenic)
35
TOS entrapment sites
1) CS intervertebral foramina 2) Inter-scalene triangle 3) Elevated 1st rib 4) Tight Pec Minor 5) Tight Pronator Teres 6) Carpal Tunnel
36
What test is used for 1st rib position?
CRLF * rotate away from rib tested * flex to chest (+) = limited lateral flexion
37
1st rib caudal glide (supine) | A&T
Sideband towards rib being tested Contact 1st rib w/ index MCP Inferior direction
38
1st rib caudal glide (sitting) | A&T
``` PT 1/2 kneeling Sideband towards rib being tested Contact 1st rib w/ index MCP Inferior direction *Coordinate breathing ```
39
When to STM Pec Minor?
Hx: repetitive arm use, prolonged sitting O: forward shoulder girdle A: muscle length test, provocation w/ palpation T: restore muscle length/nerve mobility R: UE movement
40
MOI muscles in TS?
``` Blunt trauma Strain/tear Unaccustomed overuse Activities w/ non-optimal mechanics Postural adaptations ```
41
Muscle tx goals?
``` Strengthen weak muscles Stretch tight muscles Correct faulty movement patterns Promote healing environment Provide hope/encouragement ```
42
Exercises should...
Complement your manual interventions!
43
JoNeCaLiMuBuDiMe
``` Joint Nerve Capsule Ligament Muscle Bursa Disc Meniscus ```
44
Pulmonary system: ASK...
``` New onset of coughing Increased sputum Hemoptysis SOB Orthopnea Auscultation (+) ```
45
GI system: ASK...
Abdominal pain Pain before/after eating Change in bowel habits Change of weight since onset
46
TIM VaDeTuCoNe - differential dx
``` Trauma Inflammation/Infection Metabolic Vascular Degenerative Tumor Congenital Neuro/Psycho ```
47
HVLA - Grade 5 Reasoning
1) Subjective, appropriate for PT 2) AROM TS, movement painful/limited 3) Segmental mobility (Central/Unilateral PA) 4) Identified specific TS segments (hypo/pain) 5) No Contraindications 6) Skill to implement 7) Reassess AROM & TS segment mobility 8) If + change, provide HEP to maintain AROM & prevent, correct faulty movement patterns w/ re-education 9) If no change, self reflect...
48
Contraindications for HVLA
Lack pt consent Lack dx Patient positioning cannot be achieved Bone pathology Neuro - myelopathy, cord compression, cauda equina, nerve root compression w/ increasing neuro deficit Vascular - VBO/Aortic aneurysm/Hemophilia Pregnancy

PT 621 Clinical Ortho (2 decks)

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