Thoracic Spine Exam

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Questions and Answers

What is the primary focus of the subjective examination of the thoracic spine?

  • Identifying the location and characteristics of the patient's pain. (correct)
  • Measuring the range of motion using a goniometer.
  • Assessing joint accessory motion through palpation.
  • Evaluating muscle strength using manual muscle testing.

Which of the following is the MOST appropriate initial step in assessing thoracic spine mobility?

  • Assessing muscle strength of surrounding musculature.
  • Performing joint accessory motion testing.
  • Observing and measuring active range of motion. (correct)
  • Applying overpressure to assess end-feel.

When performing range of motion (ROM) testing of the thoracic spine, what action helps to isolate the movement to the thoracic region?

  • Applying overpressure at the end of the range.
  • Locking out the lumbar spine. (correct)
  • Having the patient stand during the assessment.
  • Actively engaging the core musculature.

During thoracic spine ROM assessment, when is it MOST appropriate to apply overpressure?

<p>If movements are not full or are symptom-provoking. (D)</p> Signup and view all the answers

Palpation of the inferior angle of the scapula typically corresponds to which thoracic vertebral level?

<p>T7 (B)</p> Signup and view all the answers

Which muscle is NOT directly assessed during strength testing of the thoracic spine?

<p>Serratus Anterior (A)</p> Signup and view all the answers

When performing a central posterior-anterior (PA) glide on the thoracic spine, what is the purpose of the 'dummy' hand?

<p>To contact the spinous process and distribute force. (B)</p> Signup and view all the answers

In performing a unilateral PA glide on the thoracic spine, how does the hand placement differ from a central PA glide?

<p>The thumb of the 'dummy' hand is placed on the side of the spinous process. (A)</p> Signup and view all the answers

When performing a first rib inferior glide, what is the recommended positioning of the patient?

<p>Seated. (D)</p> Signup and view all the answers

During a first rib inferior glide, what is the direction of force applied by the therapist's elbow?

<p>Towards the opposite hip. (D)</p> Signup and view all the answers

Which of the following outcome measures specifically assesses a patient's perceived functional limitations?

<p>Patient Specific Functional Scale (PSFS) (C)</p> Signup and view all the answers

A patient reports that their thoracic pain is exacerbated by deep breathing and twisting motions. Which of the following exam components would be MOST relevant?

<p>Palpation of the rib angles and costotransverse joints (B)</p> Signup and view all the answers

Which of the following is the BEST way to assess thoracic extension?

<p>Seated, with hands clasped behind the head, extending backwards. (D)</p> Signup and view all the answers

A patient presents with upper back pain and limited shoulder mobility. Which thoracic assessment technique would MOST directly address the potential impact of thoracic posture on shoulder function?

<p>First rib mobility assessment (B)</p> Signup and view all the answers

In a patient with suspected thoracic outlet syndrome and upper extremity symptoms, which of the following thoracic ROM assessments would be MOST relevant to evaluate?

<p>First rib mobility (D)</p> Signup and view all the answers

What is the primary purpose of assessing thoracic spine joint accessory motion?

<p>To identify the presence and nature of joint restrictions. (C)</p> Signup and view all the answers

A patient reports pain along their ribcage that increases with deep inspiration. Which palpation assessment would be MOST appropriate?

<p>Palpation of the sternocostal joints (C)</p> Signup and view all the answers

During palpation of the thoracic spine, where would you locate the spinous process of T3?

<p>At the level of the spine of the scapula. (A)</p> Signup and view all the answers

Which of the following is the PRIMARY goal of strength testing the thoracic paraspinals?

<p>To determine the ability to maintain spinal stability. (B)</p> Signup and view all the answers

When performing a central PA on a patient with known osteoporosis, which of the following modifications is MOST appropriate?

<p>Use minimal force and closely monitor for any signs of discomfort. (A)</p> Signup and view all the answers

For a patient presenting with suspected upper rib dysfunction contributing to shoulder impingement, which manual technique would be MOST appropriate to improve scapular mechanics?

<p>First Rib Inferior Glide (B)</p> Signup and view all the answers

A patient reports difficulty with overhead activities due to limited thoracic extension and shoulder mobility. Which of the following muscle groups, when strengthened, would BEST improve thoracic extension?

<p>Rhomboids and middle trapezius (A)</p> Signup and view all the answers

A clinician is having difficulty palpating the spinous process of T12. Which surface landmark would MOST accurately guide the clinician to this level?

<p>Twelfth rib (D)</p> Signup and view all the answers

Which of the following conditions would be a CONTRAINDICATION for performing thoracic joint mobilization techniques?

<p>Acute fracture (D)</p> Signup and view all the answers

A therapist wants to reassess a patient's thoracic mobility after performing several interventions. Which of the following would be the MOST efficient and reliable method for quantifying changes in thoracic ROM?

<p>Inclinometer measurements (B)</p> Signup and view all the answers

A patient with thoracic pain also reports numbness and tingling down the arm. In addition to standard thoracic exam components, what other area of the body should be examined?

<p>Cervical spine (A)</p> Signup and view all the answers

Which of the outcome measures is suitable for assessing disability related to neck pain?

<p>Neck Disability Index (NDI) (A)</p> Signup and view all the answers

A patient presents with thoracic pain that increases with prolonged sitting and improves with standing and walking. Which of the following interventions would be MOST appropriate?

<p>Thoracic extension exercises (B)</p> Signup and view all the answers

Which of the following is considered the MOST relevant component to include in the patient history of a thoracic spine examination?

<p>Mechanism of Injury (MOI) (A)</p> Signup and view all the answers

During palpation of the anterior chest wall, which structure is assessed to evaluate potential rib dysfunction?

<p>Sternoclavicular joint (A)</p> Signup and view all the answers

Flashcards

Subjective Exam

Subjective examination to understand the patient's history and symptoms.

Patient Specific Functional Score (PSFS)

A self-reported measure that allows patients to identify activities they have difficulty with and rate their current level of function

Numeric Pain Rating Scale. (NPRS)

Self-reported scale from 0-10 to measure pain intensity.

Thoracic Spine Physical Exam

Overview of the Physical Exam

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Thoracic Spine ROM

Assessing the available range of motion in the thoracic spine, can be active or passive.

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Overpressure

Applying gentle force at the end of the available range of motion to assess end-feel and potential limitations.

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Palpation

Using hands to feel for tenderness, muscle tension, or bony abnormalities.

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Posterior Palpation

Palpating back of the Thoracic spine to identify key landmarks.

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Anterior/Lateral Palpation

Palpating the front and side aspect of the thoracic to identify key landmarks.

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Thoracic Paraspinals

Muscles that extend the thoracic spine.

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Middle Trap Strength Test

Resistance against scapular retraction

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Lower Trap Strength Test

Resistance against downward rotation/depression of scapula.

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Rhomboids Strength Test

Resistance against scapular retraction, adduction.

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Joint Accessory Motion

Assessment of the passive movements occurring within a joint.

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Central PA

Applying a posterior-to-anterior force on spinous processes.

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Unilateral PA

Applying a posterior-to-anterior force on one side of the spinous process.

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First Rib Inferior Glide

Gapping joint between 1st rib and clavicle.

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Study Notes

  • Adam Squires PT, DPT, Cert SMT, Cert DN, a Board Certified Specialist in Orthopedic Physical Therapy is presenting about thoracic spine exams.

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

  • Involves understanding where the pain is via a body chart and initial hypothesis.
  • Understanding what exacerbates the pain, including actions and extent.
  • Understanding what alleviates the pain, including actions and extent.
  • Includes history taking regarding mechanism of injury (MOI), timeframe, etc.

Outcome Measures

  • Patient Specific Functional Score (PSFS) should be taken.
  • Numeric Pain Rating Scale (NPRS) should be taken.
  • Oswestry Disability Index (ODI) should be taken.
  • Neck Disability Index (NDI) will be discussed in 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 using active movement with overpressure.
  • Palpation should be done.
  • Strength testing should be done.
  • Joint accessory movement assessment should be performed.

ROM

  • Patient seated and the lumbar spine is locked out.
  • Evaluates flexion, extension, rotation, and lateral flexion.
  • Apply overpressure if movements are not full or not symptom-provoking.

Palpation

  • Posterior palpation assesses:
  • Spinous processes
  • Spine of scapula at T3/T4
  • Inferior angle at T7
  • Last rib at T12
  • Rib Angle
  • Posterior musculature: middle trap, lower trap, rhomboids, latissimus dorsi
  • First Rib
  • Anterior/lateral palpation assesses:
  • Rib angles
  • Sternum
  • Sternoclavicular joint
  • Sternocostal joints
  • Pec major
  • Pec minor

Strength Testing

  • Assesses thoracic paraspinals (extensors), middle trap, lower trap and rhomboids.

Joint Accessory Motion Assessment

  • Central PA includes:
  • Patient is prone and the therapist is standing on one side.
  • The "dummy" hand's hypothenar eminence contacts the spinous process, similar to lumbar CPA.
  • Force is applied with the opposite hand directly anterior.
  • Alternate "peace sign" involves placing "dummy" fingers on either side of the spinous process, with force applied directly anteriorly.
  • Unilateral PA includes:
  • Patient is prone and the therapist is standing on one side.
  • Place "dummy" thumb on the chosen side at the desired level and force is applied with either the opposite heel of the hand or opposite thumb directly anterior.
  • Use the hypothenar eminence like CPA but off to one side; this method is less specific.
  • First Rib Inferior Guide includes:
  • Patient seated with the therapist behind.
  • Support opposite side of the head.
  • Force is applied through the lateral MCP toward the opposite hip.
  • Line up the elbow with direction of force

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