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Semester 3 PM Exam 4 > Thoracic Spine Clinical Presentation > Flashcards

Thoracic Spine Clinical Presentation Flashcards

(103 cards)

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1
Q

Subjective Exam

A 
Nature
Area
Behavior
Present Hx
Past Hx
Special Questions
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2
Q

Special questions to ask

A 
Imaging that has been done?
Difficulty/Sx with breathing or coughing
Sx parallel rib position
Surgeries
Autonomic sx
Relevant medical hx
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3
Q

mm strain/imbalance/weakness - Onset

A

Traumatic or insidious

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4
Q

mm strain/imbalance/weakness - Screening

A

Screening above and below will depend on their presenting behavior
Would be neck/cervical and lumbar

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5
Q

mm strain/imbalance/weakness - large mm of spine and shoulder girdle
Sup and Deep mm

A

Potential source of thoracic region sx
Superficial - Trap, rhomboids, lat
Deep - Erector spinae

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6
Q

mm strain/imbalance/weakness - small mm are associated with

A

Ribs, TP, Costo-vertebral region
Semispinalis, multifidus, rotatores
Serratus post, intercostals, diaphragm
Subcostals, levator costarum, intertransversarii

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7
Q

mm strain/imbalance/weakness - Erector spinae

A

Within TFL

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8
Q

mm strain/imbalance/weakness - Quadratus Lumborum

A

Lumbar spine, 12th rib, and pelvis attachments

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9
Q

mm strain/imbalance/weakness - Int/Ext obliques

A

Have costal attachments

Can impact posture

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10
Q

mm strain/imbalance/weakness - Rotatores Thoracis

A

Deep with rotational component

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11
Q

mm strain/imbalance/weakness - levator costarum and Intertransversarri

A

Small mm - patient might pinpoint location of pain

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12
Q

mm strain/imbalance/weakness - primary mm of ventilation

A

Diaphragm
Intercostals
Abdominal mm (IO, EO, TA, RA)

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13
Q

mm strain/imbalance/weakness - secondary mm of ventilation

A

Scalene
SCM
Pec Major and Minor
Quadratus Lumborum

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14
Q

mm strain/imbalance/weakness - scalene

A

life rib cage up to help with inspiration (upper ribs)

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15
Q

mm strain/imbalance/weakness - SCM

A

Move rib cage sup in pump handle when neck is fixed

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16
Q

mm strain/imbalance/weakness - Pec Minor

A

Can help raise rib 3, 4, 5

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17
Q

mm strain/imbalance/weakness - Quadratus Lumborum

A

Expiratory mm, stabilizes diaphragm with attachment onto 12th rib

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18
Q

mm strain/imbalance/weakness - Examination

A
  1. Posture/Observation
  2. Breathing assessment
  3. Mm length and strength
  4. Palpation
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19
Q

mm strain/imbalance/weakness - Intervention

A

Posture education, tx mm imbalance, trigger point, SCS, modalities for mm injury

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20
Q

Facet Dysfunction - onset

A

Trauma, degenerative, insidious

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21
Q

Facet Dysfunction - location/quality

A

Local sharp pain
referred pain
Costotransverse or Costovertebral joints

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22
Q

Facets are

A

Thin and flat with not a lot of tilt - as get to thorcolumbar junction are more vertical though

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23
Q

Facets - transverse and frontal plane

A

60 degrees to trans plane

20 degrees to frontal plane

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24
Q

SP slope

A

inf from T5-T8 and overlap SP of the adjacent inferior vertebrae

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25
Rule of 3's - T1 to T3
SP are level with the vertebral body of the same level
26
Rule of 3's - T4 to T6
SP are level with the disc of the inferior level
27
Rule of 3's - T7 to T9
SP level with the body of the vertebrae below
28
Rule of 3's T10
Level with the body of the vertebrae below
29
Rule of 3's T11
Level with the disc of the vertebrae below
30
Rule of 3's T12
Level with its own vertebral body
31
At the top of the rib cage the ribs are
relatively horizontal - run more obliquely downward as the rib cage descends, by the 12th rib it is more vertical though
32
Anteriorly the ribs are | Posteriorly
``` Ant = subcutaneous Post = covered with mm ```
33
Rib articulations (7)
``` Manubriosternal Xiphisternal Costovertebral Costotransverse Costochondral Chondrosternal Interchondral ```
34
Manubriosternal and Xiphisternal joints are what type
Synchondrosis
35
Manubriosternal ossifies
in 10% of older adults
36
Xiphisternal ossifies
by age 40-50
37
Costovertebral Joint is what type of joint
Synovial
38
Costovertebral joint is formed by what
Rib, two vertebral bodies, and the IVD
39
Costovertebral joints - which ribs attach with only 1 vertebrae
Rib 1, 10-12
40
Costovertebral joints - other characteristics
Fibrous capsule surrounds the entire articulation | Radiate ligament and capsular ligament for AP support
41
Costotransverse joints is what type
Synovial
42
Costotransverse joints is formed by
costal tubercle of rib with costal facet on TP of corresponding vertebrae Ligamentous support
43
Costotransverse joints present at
T1-T10 | ribs 1-10
44
Costochondral and Chondrosternal Joints are what type
Synchondroses surrounded by periosteum with no ligament support
45
Costochondral joint is formed by what
Ribs articulate with costal cartilage
46
Chondrosternal joints are formed by
Costal cartilage of rib attaching to sternum
47
Interchondral joints are what type
Synovial
48
Interchondral joints attach what
Cartilage of rib to cartilage of rib above them
49
Interchondral joints - for ribs 8 to 10
this is their only attachment to sternum
50
Interchondral joints - in old age
Become fibrous and fuse
51
Coupled Movements - Upper thoracic
Rot and LF in same direction
52
Coupled Movements - Middle/Lower thoracic
More variable among individuals - some say based on hand dominance or depending on which motion was introduced first
53
Coupled movements - Lower thoracic
In neutral = Rot and LF in opp In flex/ext = Rot and LF in same T11 = tends to have more pure rot T12 = just like lumbar
54
Rib kinematics - flexion
Inf facets glide sup and fwrd on the sup facets of the vert below Ant rib rotation
55
Rib kinematics - extension
Inf facets of sup vert glide backward and downward on sup facets of vert below Post rib rotation
56
Rib kinematics - facets close with
Shoulder flexion | - thoracic ext with ipsilateral LF/ROT
57
Rib kinematics - Manubrium rotates toward
shoulder flexed
58
Rib kinematics - lateral flexion
Not a lot due to rib approximation
59
Rib kinematics - Rotation - if rot L
the left rib will post rot (externally) | the right rib will ant rot (internally)
60
Rib Actions - pump handle action
During inspiration - ribs 1-6 pulled upward and forward Accompanied by elevation of manubrium ?? add more
61
Rib Actions - bucket handle action
Ribs 7-10 movement in lateral dimension | Upward and back to inc infrasternal angle OR downward and forward to dec infrasternal angle
62
Rib Actions - Caliper action
Ribs 8-12 move laterally to inc lateral diameter Move with respiration Thumbs come together post and fingers apart ant
63
Structural Rib Dysfunction
More bony in nature - we cant really change this
64
Torsional Rib Dysfunction
Twisting of the rib Will feel like it sticks out a little in front and back More of a soft tissue torsion but can have bony torsion too
65
Respiratory Rib Dysfunction
Issue with breathing
66
Bucket Bail Lesion
Stuck in bucket handle position | Bucket handle position is displaced more than pump handle position because of its more lateral position
67
Ant/Post Ribs
Ant = deeper post, more prominent ant Post = deeper ant, more prominent post Compare to other side Fixed rib has diminished respiratory movement
68
Examination - Rib Dysfunction
``` Seatbelt injury, cough, sneeze Posture eval Breathing assessment Rib palpation ROM Joint mobility Muscle testing ```
69
Intervention - Rib Dysfunction
Tx thoracic first, could do manipulation to ribs, breathing exercises, stretching and strengthening
70
Stenosis
Narrowing laterally or centrally in spinal cord Usually degenerative Symptoms of cord compression may result
71
Disc Pathology
Relatively uncommon - more common at TL junction or lower thoracic spine Limited thoracic spine so difficult to reproduce sx with ROM
72
Age changes in disc
``` Degeneration - 50-60% age 40 Disc narrowing Loss of translation Vertebral body wedging Loss of thoracic extension ```
73
Scheuermann's Disease
Most common in M 12-18 yo Mild to moderate pain Excessive kyphosis, loss of flex/ext ROM Schmorles nodes
74
Scheuermann's Disease - PT intervention
Rest/postural education
75
Chest deformities -
Structural kyphosis
76
Signs of structural kyphosis
Excessive thoracic kyphosis Wedging Loss of flex/ext ROM
77
Interventions - structural kyphosis
Bracing Surgical correction PT - rest, postural ed, breathing ex, gradual mob of other areas post op
78
Osteoporosis - what is it
Loss of bone density Inc concavity Loss of vert height
79
Osteoporosis - interventions
Weight bearing activities but no spinal flexion, nutrition ed, fall prevention
80
Osteoporosis vs. Osteopenia
Penia - low bone density but not the disease process where bones are deteriorating
81
Peak bone mass
around age 30
82
Spinal tumors
May cause neuro dysfunction from cord compression
83
Spinal tumors - sx
Back pain is primary sx - worse at night | Sx may or may not be activity related
84
Spinal tumors - Dx
Radiographs, CTs, MRI, Biopsy
85
Ankylosing Spondylitis
Chronic inflammatory arthropathy Stiffening or fusion of spine or SIJ More common and sever in M
86
Ankylosing Spondylitis - Sx
Low back ache Maybe radicular sx Low back stiffness especially in am
87
Ankylosing Spondylitis - Intervention
Meds, surgery | PT - Ext flexibility, postural strengthening, chest expansion, breathing ex
88
T4 syndrome
Usually T3-T5, Can be T2-T7 Autonomic NS involvement Facet involvement
89
T4 Syndrome presentation
Generalized HA U or B pain/paresthesia Associated neck, upper thoracic, scap pain
90
T4 Syndrome - exam
``` Local tenderdness Joint hypomobility Soft tissue texture changes Prominent/depressed SP Pos neurodyn testing Non derm or multi derm (glove) pattern ```
91
T4 Syndrome - Intervention
Mob/manipulation if not contraindicated Postural ed/ex Tx neural tissue
92
Scoliosis
Deformity with one or more lateral curves of the Lx or T spine
93
Two types of scoliosis - Non Structural
Non structural - Poor posture, nerve root irritation, leg length discrepancy
94
Two types of scoliosis - Structural
Genetic, idiopathic, wedge/hemi-vertebra
95
Scoliosis - curve pattern named according
to the apex of the curve | in the direction of the convexity
96
Scoliosis - Vertebral rotation
Bodies rotate toward the rib hump Causes rib movement post - rib hump Narrowing of thoracic cage on one side
97
Intervention - structural scoliosis
Sometimes need surgical
98
Intervention - nonstructural scoliosis
Look at if there is mm imbalance, posture
99
Chest deformities - Pectus Carinatum
Pigeon chest Sternum projects forward, inc the AP dimension of chest Restrict ventilation volume
100
Chest deformities - Pectus Excavatum
Funnel chest Sternum pushed post by an overgrowth of the ribs AP chest dimension dec affects respiration May result in kyphosis
101
Chest deformities - Barrel Chest
Sternum projects forward AP diameter inc Seen with emphysema
102
Thoracic Referred pain
If sx in the thoracic region are not reproduced through mechanical tests, serious pathology may be present Refer to physician
103
Referred pain from cervical spine
Cervical discs Cervical facets Medial scapular border Cloward areas

Semester 3 PM Exam 4 (1 decks)

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