Podcast
Questions and Answers
What is the primary focus of the subjective examination of the thoracic spine?
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?
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?
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?
During thoracic spine ROM assessment, when is it MOST appropriate to apply overpressure?
Palpation of the inferior angle of the scapula typically corresponds to which thoracic vertebral level?
Palpation of the inferior angle of the scapula typically corresponds to which thoracic vertebral level?
Which muscle is NOT directly assessed during strength testing of the thoracic spine?
Which muscle is NOT directly assessed during strength testing of the thoracic spine?
When performing a central posterior-anterior (PA) glide on the thoracic spine, what is the purpose of the 'dummy' hand?
When performing a central posterior-anterior (PA) glide on the thoracic spine, what is the purpose of the 'dummy' hand?
In performing a unilateral PA glide on the thoracic spine, how does the hand placement differ from a central PA glide?
In performing a unilateral PA glide on the thoracic spine, how does the hand placement differ from a central PA glide?
When performing a first rib inferior glide, what is the recommended positioning of the patient?
When performing a first rib inferior glide, what is the recommended positioning of the patient?
During a first rib inferior glide, what is the direction of force applied by the therapist's elbow?
During a first rib inferior glide, what is the direction of force applied by the therapist's elbow?
Which of the following outcome measures specifically assesses a patient's perceived functional limitations?
Which of the following outcome measures specifically assesses a patient's perceived functional limitations?
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?
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?
Which of the following is the BEST way to assess thoracic extension?
Which of the following is the BEST way to assess thoracic extension?
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?
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?
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?
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?
What is the primary purpose of assessing thoracic spine joint accessory motion?
What is the primary purpose of assessing thoracic spine joint accessory motion?
A patient reports pain along their ribcage that increases with deep inspiration. Which palpation assessment would be MOST appropriate?
A patient reports pain along their ribcage that increases with deep inspiration. Which palpation assessment would be MOST appropriate?
During palpation of the thoracic spine, where would you locate the spinous process of T3?
During palpation of the thoracic spine, where would you locate the spinous process of T3?
Which of the following is the PRIMARY goal of strength testing the thoracic paraspinals?
Which of the following is the PRIMARY goal of strength testing the thoracic paraspinals?
When performing a central PA on a patient with known osteoporosis, which of the following modifications is MOST appropriate?
When performing a central PA on a patient with known osteoporosis, which of the following modifications is MOST appropriate?
For a patient presenting with suspected upper rib dysfunction contributing to shoulder impingement, which manual technique would be MOST appropriate to improve scapular mechanics?
For a patient presenting with suspected upper rib dysfunction contributing to shoulder impingement, which manual technique would be MOST appropriate to improve scapular mechanics?
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?
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?
A clinician is having difficulty palpating the spinous process of T12. Which surface landmark would MOST accurately guide the clinician to this level?
A clinician is having difficulty palpating the spinous process of T12. Which surface landmark would MOST accurately guide the clinician to this level?
Which of the following conditions would be a CONTRAINDICATION for performing thoracic joint mobilization techniques?
Which of the following conditions would be a CONTRAINDICATION for performing thoracic joint mobilization techniques?
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?
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?
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?
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?
Which of the outcome measures is suitable for assessing disability related to neck pain?
Which of the outcome measures is suitable for assessing disability related to neck pain?
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?
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?
Which of the following is considered the MOST relevant component to include in the patient history of a thoracic spine examination?
Which of the following is considered the MOST relevant component to include in the patient history of a thoracic spine examination?
During palpation of the anterior chest wall, which structure is assessed to evaluate potential rib dysfunction?
During palpation of the anterior chest wall, which structure is assessed to evaluate potential rib dysfunction?
Flashcards
Subjective Exam
Subjective Exam
Subjective examination to understand the patient's history and symptoms.
Patient Specific Functional Score (PSFS)
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)
Numeric Pain Rating Scale. (NPRS)
Self-reported scale from 0-10 to measure pain intensity.
Thoracic Spine Physical Exam
Thoracic Spine Physical Exam
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Thoracic Spine ROM
Thoracic Spine ROM
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Overpressure
Overpressure
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Palpation
Palpation
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Posterior Palpation
Posterior Palpation
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Anterior/Lateral Palpation
Anterior/Lateral Palpation
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Thoracic Paraspinals
Thoracic Paraspinals
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Middle Trap Strength Test
Middle Trap Strength Test
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Lower Trap Strength Test
Lower Trap Strength Test
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Rhomboids Strength Test
Rhomboids Strength Test
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Joint Accessory Motion
Joint Accessory Motion
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Central PA
Central PA
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Unilateral PA
Unilateral PA
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First Rib Inferior Glide
First Rib Inferior Glide
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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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