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45 Cards in this Set
- Front
- Back
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Rule of 3's and why important to know
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1-3: S-proc at level of body
4-6: S-proc 1/2 in down from body 7-9: S-proc 1 in down from body 10-12: becoming more vertical and level with body by T12 |
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Why are disc problems uncommon in the Tsp?
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Discs are very secure due to ribs, ligs - so not much shearing
Doesn't take as much weight at Lsp |
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Types of joint play motions in T-sp
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AP, com/dis, lateral
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2 joints a rib and vertebrae make. Which one are we most concerned with?
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Costotransverse jt: Tprocess and articular tubercle
Costovertebral: head of rib and costal facet and part of IV disc. We are concerned with this one |
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Is there much flexion and extension in the T-sp?
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Not at each segment, but when you add all 12 of them up, yes. 30 to 40 deg of flexion and 20-25 deg of extension
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pump handle vs. bucket handle
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PUMP: Ribs 2-4 pull chest directly up and out
BUCKET: Ribs 8-10 are sharply curved and have upward and lateral movt |
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What do we include in our subjective hx that we didn't with lumbar?
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Any HAs? Check ppl for risk of osteoporosis - menopausal women, men > 70, and anorexic young female athelets
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What do we add into our objective eval for T-sp that we didn't do for L-sp?
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Rotation in sitting b/c more of an issue. Evaluate movt of chest (breathing) in sitting
Screen shoulder complex Rib PAs Mobility of 1st rib special test |
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What will we find in our exam if T-sp pt has a disc lesion?
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Pain from back all the way around to chest couples with loss of EXT ROM.
Deep inspiration and coughing hurt Pain with SB to SAME side b/c compress disc DifDx frmo costovertebral hypomobility by testing mobility of first rib |
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Tx for disc lesion in T-sp?
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Directional preference - almost always extension. Then progress to flexion after that.
Check strength of shoulder girdle mm and strengthen em |
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Where is scoliosis found in spine?
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T/o spine, but visualized well in T-sp.
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Kobb measurements to be aware of
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50 deg is magic number. Greater than this and it will worsen with age. 80 deg is big time problem b/c messes with CV system
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What's a Dowager?
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Overpronounced cervicothoracic junction. Due to osteoporosis and breakdown
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Difference between facet lock in T-sp vs. L-sp?
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T-sp will look just like hypomobility. Usually involves AT LEAST 2 segments. Hurts at all end ranges. Limited in Flex or Ext and one side bend. Tend to have constant achiness
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Position of pts arm when doing a PA on rib
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Overhead to upwardly rotate scapula. More motion here then in T-sp
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What do you often have to do before you can treat facet locks?
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Soft tissue work - body tries to "self-mobilize" by mm guarding
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Self-mobilizaiton ideas for pt who needs to work on ext (facet lock)
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In hard chair to use as fulcrum
Exercise ball Rolled up towel 2 tennis balls in a sock |
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Common subjective of a person with a rib lock?
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similar to L-sp facet lock - doing an activity and when done felt stiff. "I took a deep breath and it hurt"
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Tx of rib locks
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Grade 5 mobilization. One time and person is dunzo
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Female triad. How do you tx them?
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Amenhoretic, anorexia, osteoporosis. Short bursts of ex (15-20 mins) 3x/day. Make sure they aren't ex for hours on end
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MOI for compression fx for old folk. Tx?
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sneeze, cough. Doesn't take much.
Stable - so wait and let it heal. Will take much longer than 8 weeks. Start wt'd arm exercises, progress to walking program |
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2 most common fx sites for osteoporotic women
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T-sp and hip
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How do you screen for scoliosis?
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Flex forward - will see a rib hump. With flex, there will be a side bending/rotation component in these pts
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Scoliosis of 20-40 degrees? 50 degrees?
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Bracing... >50 hardware
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What can kids do with Harrington rods as far as activity goes?
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No contact sports
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What is Thoracic Outlet Syndrome?
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Involves compression of superior thoracic outlet, involving compression of neurovasculature bundle between the ANT and MID scalenes. Involves brachial plexus and subclavian a./v
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S/s of TOS
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Arm radiation - more often, "arm or hand falls asleep." Could be whole arm, just below elbow, just hand, etc. Weak grip, Non-dermatomal
DEMO: middle aged, M or F (not as active so shit tightens up) |
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Mechanism for TOS
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Scalene tightness, 1st rib hypomobility, pec minor tightness. Flexed posture (occupation = sits at desk)
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Objective eval for TOS: ROM findings?
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T-sp extra kyphotic in standing. Limited in extension ROM (especially if first rib involved).
Will find more issues in C-sp: rotation loss to side of problem with pain at end range that inc with over pressure |
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TOS special tests
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Addson: rotate head to same side and ext arm at 20 deg ABD
Roos test: chicken dance for 90 sec Wright hyperABD: pt looks to opposite side |
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What should we do objectively if we think TOS b/c of scalene tightness?
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supine off table, put head in ext and rotation. Hold for 1 minute. Did it reproduce symptoms?
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What objective things do we want to do if we suspect TOS?
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ROM in standing - T-sp and C-sp (i think). Scalene stretch and Grade 4 1st rib mobs in supine. Also test pec minor for tightness
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Modify sleep w/ TOS?
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no fetal pos'n sleeping. No prone with arm over head and head turned to side. These shorten the scalenes
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What is myofascial pain?
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Presence of trigger points that reproduce a referral pattern at a distal point. Trigger points = localized area IN MM that feels like a nodule and is tender
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Demographics for myofascial pain?
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90% F, young adults to middle aged (starting in 20s)
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What is in this trigger point nodule if you open it up?
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Sometimes find nothing. Sometimes find encapsulated and non-encapsulated nodules. Sometimes filled with mm byproducts (lactate, phoshporus).... Usually there is something
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What did the experiment that injected trigger point with corticosteroid, local anastethic, saline, and dry needle find?
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All worked... all worked the same. End result - use anasthetic one or 2x maybe (don't want scar tissue)
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5 criteria to diagnose mofascial pain syndrome
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1. pain present > 1 yr
2. s/s interfere with daily life - fatigue huge issue 3. pain always there, but variable (good days, bad days) 4. Battery of blood tests ALL NEGATIVE 5. Disturbances with sleep (soft sign) |
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Tx for myofascial pain syndrome
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CFM, strething, myofascial release, strain-counterstrain (positional release), spray and stretch
Become active - ie. do 5 arm raises Work in aerobic and strengthening, but careful how hard you push Core stability important Get pt in to yoga, pilates, aqua aerobics HEP: 1 thing - shows you understand their pain |
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Prognosis for myofascial pain syndrome
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Years - slow, forward progression. Will see frequently at first, and then 1x/wk or 1x/month to keep them progressing
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What s/s in T-sp would make you think aneurysm
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sharp, intense pain in T3-T6 region that came on very recently and changing position doesn't change pain
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What s/s would make you think cancer in T-sp?
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Constant achiness, empty end feels. Scapula and back of shoulders is referral for breast cancer
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Screen for T-sp
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ROM with overpressure
Central and rib PAs Pos scapular mm strength |
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Positional release technique
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pressure on tender spot. Shorten mm passively. Maintain pressure until pain goes away and bring back to neutral passively
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Diagnoses at T-sp (general)
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Stenosis, disc herniation, facet lock and hypomobility, tumors, osteoporosis, scoliosis, TOS, rib shit, chronic pain, overuse
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