Podcast
Questions and Answers
During a subjective exam for thoracic spine pain, which question is LEAST likely to provide valuable information for diagnosis?
During a subjective exam for thoracic spine pain, which question is LEAST likely to provide valuable information for diagnosis?
- Where is the pain located?
- What makes the pain better?
- What makes the pain worse?
- What is your favorite color? (correct)
Which of the following is an example of an outcome measure used in the subjective exam for thoracic spine assessment?
Which of the following is an example of an outcome measure used in the subjective exam for thoracic spine assessment?
- Oswestry Disability Index (correct)
- Thoracic Paraspinals assessment
- Central Posterior-Anterior assessment
- Palpation
When assessing thoracic spine ROM, what action helps to isolate the movement to the thoracic region and minimize lumbar involvement?
When assessing thoracic spine ROM, what action helps to isolate the movement to the thoracic region and minimize lumbar involvement?
- Locking out the lumbar spine (correct)
- Having the patient stand
- Applying overpressure at end range
- Having the patient seated
If a patient has limited and painful active ROM in thoracic extension, when should overpressure be applied during the ROM assessment?
If a patient has limited and painful active ROM in thoracic extension, when should overpressure be applied during the ROM assessment?
When performing palpation of the posterior thoracic spine, the inferior angle of the scapula typically aligns with which spinous process?
When performing palpation of the posterior thoracic spine, the inferior angle of the scapula typically aligns with which spinous process?
During palpation of the anterior chest wall, which of the following structures is located most laterally?
During palpation of the anterior chest wall, which of the following structures is located most laterally?
To accurately assess the strength of the middle trapezius muscle, in what direction should the resistance be applied?
To accurately assess the strength of the middle trapezius muscle, in what direction should the resistance be applied?
Which muscle is primarily being assessed when a patient is prone and the therapist resists shoulder adduction and downward rotation?
Which muscle is primarily being assessed when a patient is prone and the therapist resists shoulder adduction and downward rotation?
When performing a central PA, what bony structure is the ‘dummy’ hand in contact with?
When performing a central PA, what bony structure is the ‘dummy’ hand in contact with?
How does the hand placement for a unilateral PA differ from a central PA?
How does the hand placement for a unilateral PA differ from a central PA?
During a first rib inferior glide, what is the purpose of supporting the opposite side of the patient’s head?
During a first rib inferior glide, what is the purpose of supporting the opposite side of the patient’s head?
What is the primary movement being assessed when strength testing the thoracic paraspinals?
What is the primary movement being assessed when strength testing the thoracic paraspinals?
Which of the following is palpated on the anterior aspect of the thoracic region?
Which of the following is palpated on the anterior aspect of the thoracic region?
In the context of assessing thoracic spine mobility, what does ROM refer to?
In the context of assessing thoracic spine mobility, what does ROM refer to?
During thoracic ROM assessment, what should be done if the patient experiences pain?
During thoracic ROM assessment, what should be done if the patient experiences pain?
Why might a therapist choose to perform joint accessory movement assessments on a patient's thoracic spine?
Why might a therapist choose to perform joint accessory movement assessments on a patient's thoracic spine?
What is understood from the patient filling out a body chart during a subjective exam?
What is understood from the patient filling out a body chart during a subjective exam?
Why is it important to ask patients what makes their pain better or worse during the subjective exam?
Why is it important to ask patients what makes their pain better or worse during the subjective exam?
What aspect of the patient's history primarily informs the timeframe component of the subjective exam?
What aspect of the patient's history primarily informs the timeframe component of the subjective exam?
How does the use of the Numeric Pain Rating Scale (NPRS) contribute to the subjective assessment of a patient with thoracic pain?
How does the use of the Numeric Pain Rating Scale (NPRS) contribute to the subjective assessment of a patient with thoracic pain?
What is the significance of assessing the spine of the scapula during palpation of the posterior thoracic spine?
What is the significance of assessing the spine of the scapula during palpation of the posterior thoracic spine?
Which of the following best describes the sequence for a comprehensive physical exam of the thoracic spine?
Which of the following best describes the sequence for a comprehensive physical exam of the thoracic spine?
What information does palpating the rib angle provide during an examination?
What information does palpating the rib angle provide during an examination?
During palpation of the anterior/lateral aspect of the chest, what can be determined from the sternocostal joints?
During palpation of the anterior/lateral aspect of the chest, what can be determined from the sternocostal joints?
During strength testing, what muscle would you expect to be atrophied in a patient with thoracic outlet syndrome?
During strength testing, what muscle would you expect to be atrophied in a patient with thoracic outlet syndrome?
What type of reasoning is used by a clinician to determine the location of the source of pain by palpation?
What type of reasoning is used by a clinician to determine the location of the source of pain by palpation?
When performing a central PA, what structure is receiving the primary treatment?
When performing a central PA, what structure is receiving the primary treatment?
When performing a first rib inferior glide, what is the intended motion that is produced?
When performing a first rib inferior glide, what is the intended motion that is produced?
How is strength testing of the thoracic paraspinals performed?
How is strength testing of the thoracic paraspinals performed?
How is strength testing of the middle trapezius performed?
How is strength testing of the middle trapezius performed?
Flashcards
What is a subjective exam?
What is a subjective exam?
A subjective exam involves gathering information about the patient's pain, what makes it worse or better, and their history.
What does PSFS stand for?
What does PSFS stand for?
PSFS stands for Patient-Specific Functional Score, used to assess function.
What does NPRS stand for?
What does NPRS stand for?
NPRS stands for Numeric Pain Rating Scale, used for pain intensity.
What does ODI stand for?
What does ODI stand for?
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What does NDI stand for?
What does NDI stand for?
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What does QuickDASH measure?
What does QuickDASH measure?
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How to assess thoracic ROM
How to assess thoracic ROM
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What does palpation involve?
What does palpation involve?
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What does posterior palpation include?
What does posterior palpation include?
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What does anterior/lateral palpation assess?
What does anterior/lateral palpation assess?
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Muscles for Strength Testing
Muscles for Strength Testing
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What is a central PA?
What is a central PA?
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What is a unilateral PA?
What is a unilateral PA?
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What is first rib inferior glide?
What is first rib inferior glide?
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Study Notes
- The exam focuses on the thoracic spine
- Adam Squires PT, DPT, Cert SMT, Cert DN is a Board Certified Specialist in Orthopedic Physical Therapy
Objectives
- Understand and demonstrate techniques for assessing thoracic spine mobility
- Understand and demonstrate techniques for assessing strength of thoracic musculature
- Understand and demonstrate techniques for assessing thoracic spine joint accessory motion
Subjective Exam
- Determine where the pain is, filling it out on a body chart and forming an initial hypothesis
- Determine what makes the pain worse, including what specifically aggravates it and how much activity it takes to provoke symptoms
- Determine what makes the pain better, including specific relieving factors and how much they help
- Take a detailed history, including mechanism of injury (MOI) and timeframe of the issue
Outcome Measures
- Patient Specific Functional Score (PSFS) is an option
- Numeric Pain Rating Scale (NPRS) is used
- Oswestry Disability Index (ODI) is an option
- Neck Disability Index (NDI) will be discussed in the Cervical section of the class
- Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) will be discussed in UE course
Physical Exam Overview
- Range of Motion (ROM) should be assessed, actively with overpressure
- Palpation is important
- Strength testing is needed
- Joint accessory movement assessment is included
ROM Assessment
- The patient sits and the lumbar spine should be locked out
- Assess flexion, extension, rotation, and lateral flexion
- Apply overpressure if movements are not full or symptom-provoking
Palpation
- Essential for identifying tenderness or structural abnormalities
Posterior Palpation
- Locate and palpate the spinous processes
- The spine of the scapula is at T3/T4
- The inferior angle is at T7
- The last rib is at T12
- Palpate the rib angle
- Examine posterior musculature like the middle trap, lower trap, rhomboids, and latissimus dorsi
- Identify the 1st rib
Anterior/Lateral Palpation
- Palpate rib angles
- Examine the sternum
- Palpate the sternoclavicular joint and sternocostal joints
- Assess Pec major and Pec minor
Strength Testing
- Focus on thoracic paraspinals (extensors), middle trap, lower trap, and rhomboids
Joint Accessory Motion
- Involves specific techniques to assess joint play
Central PA
- The patient is prone, and the therapist stands on one side
- Use the hypothenar eminence, similar to lumbar CPA, with the "dummy" hand on the spinous process, applying force anteriorly with the opposite hand
- Alternatively, use the "Peace Sign" method, placing dummy fingers on either side of the spinous process and applying force anteriorly
Unilateral PA
- The patient lies prone, and the therapist stands on one side
- Place the "dummy” thumb on the chosen side at the desired level and apply force with either the opposite heel of the hand or opposite thumb anteriorly
- Use the hypothenar eminence similar to CPA but off to one side; this technique is less specific
First Rib Inferior Glide
- The patient is seated, and the therapist stands behind them
- Support the opposite side of the head
- Apply force through the lateral MCP toward the opposite hip, lining up the elbow with the direction of the force
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