Flashcards in Thoracic Spine - Exam Deck (41)
What are 2 characteristics of somatic T-spine pain?
- Deep, dull ache
- Changes with movement and posture
From what structure in the T-spine will a boring pain originate from?
What structures may cause electric or shooting pain?
Spinal root impingement
What is the source of burning pain?
What is the source of dull, heavy, or tight pain?
What 2 types of pain may occur in a dermatomal pattern?
What is Scheuermann's Disease?
- A form of osteochondrosis that occurs in adolescents in which the vertebrae take on a wedge shaped pattern
What 4 postural deviations should be assessed in the T-spine of individuals?
- Forward head posture
- Pes cavus
- Pigeon chest (Pectus carinatum)
- Scapular position deviations
What is the most common cause of kyphosis with increasing age?
- Progressive compression fractures of the vertebrae
What is the term for extreme kyphosis typically seen in the elderly?
- Dowager's Hump
What is Gibbus?
A wedging of the lower T-spine vertebrae or upper L-spine vertebrae that cause a "beak" like protrusion from the back.
What is scoliosis? What are the 2 types?
A curvature of the spine in the frontal plane
- Functional (correctable)
What 4 movements should be assessed during a movement screen?
- Flexion, extension, rotation, sidebending
- Deep inhalation and exhalation
- Bilateral arm reach overhead (watch T-spine examination)
- Ask Pt to do key movement reproducing symptoms
What is the rule of threes of the spinous processes?
- T1/2/3: SP @ the same level
- T4/5/6: SP @ 1/2 vertebra below
- T7/8/9: SP @ one level below
- T 10/11/12: SP @ same level
What 8 structures are palpated during examination of the T-spine?
- Spinous Processes
- Transverse Processes
- Facet Joints
- Costo Transverse Joints
- Rib angles
- Erector spinae muscles
- Costocartilage junctions
- Costosternal junctions
Since the costotransverse cannot be palpated, what is felt instead?
- The rib angle
How each rib oriented to the rib above and below it when palpating the rib angles?
- Anterior to rib below
- Posterior to rib above
What erector spinae muscle is typically tender on palpation of the rib angle?
How is the costochondral junction assessed?
- Press A --> P through strernum
- Push medially from the lateral rib and assess pain at the sternal junction
How are the transverse processes assessed during palpation?
- Assess the presence of a prominence (for facet "locking")
- Assess pain
- Assess symmetry
What type of rotation occurs in the thoracic spine?
In neutral: Type 1 (side bending and rotation in opposite directions)
In flexion/extension: Type 2 (Side bending and rotation in the same direction)
How are the rib angles assessed in sitting?
- Pt grips the contralateral shoulder to protract the scapula, and the rib angles are palpated along the lateral aspect of the rib cage 2 finger breadths from the transverse processes
Why is the articular pillar of the T-spine difficult to palpate?
- It is covered with multifidi`
How is T-spine rotation assessed?
- Provide medially, inferiorly, and anteriorly directed force on vertebra inferior to the targeted vertebra, assess segmental movement
How is respiratory rib dysfunction assessed?
- Palpate directly over the upper, middle, and lower ribs to determine which group of ribs stops moving first with either inhalation or exhalation
- May feel prominence on one side with a corresponding recess on the other side
Where will the rib be tender in precordial catch syndrome?
- At the junction of the sternum and the rib during either exhalation or inhalation
How is an inhalation restriction treated?
- Pt supine for the upper ribs, and sidelying for the lower ribs
- One hand rests the 2nd digit, and webspace against the superior rib, and guides the rib into elevation during inhalation
- Same hand resists the rib during inhalation (apply superiorly directed pressure)
How can the patient be positioned when treating an inhalation restriction of the upper ribs to assist with elevation?
- Sidebend to contralateral side
Describe the treatment for an exhalation restriction.
- Pt supine for upper ribs, sidelying for lower ribs
- Ulnar side of hand is placed on the inferior rib; The other hand grasps the humerus
- Guide the Pt's rib inferiorly during a deep exhalation, and resist superior movement of the rib during inhalation