Podcast
Questions and Answers
During a subjective exam for thoracic spine pain, what information is LEAST likely to be gathered?
During a subjective exam for thoracic spine pain, what information is LEAST likely to be gathered?
- Timeframe of the issue
- Activities that worsen the pain
- Patient's shoe size (correct)
- Mechanism of injury (MOI)
Which of the following outcome measures is specifically designed to assess disability related to neck pain, rather than thoracic pain?
Which of the following outcome measures is specifically designed to assess disability related to neck pain, rather than thoracic pain?
- Neck Disability Index (NDI) (correct)
- Numeric Pain Rating Scale (NPRS)
- Oswestry Disability Index (ODI)
- Patient Specific Functional Scale (PSFS)
When assessing thoracic spine ROM, why is it important to have the patient seated?
When assessing thoracic spine ROM, why is it important to have the patient seated?
- To increase the range of lateral flexion
- To allow the patient to relax more easily
- To lock out the lumbar spine and isolate thoracic movement (correct)
- To primarily observe lumbar spine movement
Which of the following instructions is MOST appropriate when assessing thoracic spine rotation ROM?
Which of the following instructions is MOST appropriate when assessing thoracic spine rotation ROM?
When performing palpation of the posterior thoracic spine, which anatomical landmark is typically located at the level of T7?
When performing palpation of the posterior thoracic spine, which anatomical landmark is typically located at the level of T7?
During palpation of the anterior chest wall, which of the following structures would be LEAST relevant to assess in relation to thoracic spine pain?
During palpation of the anterior chest wall, which of the following structures would be LEAST relevant to assess in relation to thoracic spine pain?
In a patient with suspected thoracic outlet syndrome, which muscle would you MOST likely assess strength in?
In a patient with suspected thoracic outlet syndrome, which muscle would you MOST likely assess strength in?
When assessing the strength of the middle trapezius muscle, what is the MOST appropriate patient position and action?
When assessing the strength of the middle trapezius muscle, what is the MOST appropriate patient position and action?
A therapist is performing a central PA mobilization on a patient's thoracic spine. Which hand placement technique is MOST appropriate for this mobilization?
A therapist is performing a central PA mobilization on a patient's thoracic spine. Which hand placement technique is MOST appropriate for this mobilization?
For a unilateral PA glide of the thoracic spine, how does the hand placement differ from a central PA?
For a unilateral PA glide of the thoracic spine, how does the hand placement differ from a central PA?
What is the primary direction of force applied during a first rib inferior glide technique?
What is the primary direction of force applied during a first rib inferior glide technique?
Why is it important to support the opposite side of the head during a first rib mobilization?
Why is it important to support the opposite side of the head during a first rib mobilization?
Which of the following is the MOST specific goal when assessing thoracic spine joint accessory motion?
Which of the following is the MOST specific goal when assessing thoracic spine joint accessory motion?
A patient reports increased pain with deep breathing. Which palpation would be most helpful in evaluating this patient's impairment?
A patient reports increased pain with deep breathing. Which palpation would be most helpful in evaluating this patient's impairment?
A patient is seated for ROM testing of the thoracic spine. What could be used to most effectively reduce lumbar spine involvement during testing?
A patient is seated for ROM testing of the thoracic spine. What could be used to most effectively reduce lumbar spine involvement during testing?
Which of the following test elements is part of both central and unilateral PA mobility testing?
Which of the following test elements is part of both central and unilateral PA mobility testing?
A person is unable to move their arm in horizontal abduction. What muscle could examination for strength most likely reveal?
A person is unable to move their arm in horizontal abduction. What muscle could examination for strength most likely reveal?
Which of the following considerations would warrant applying overpressure for ROM testing of the thoracic spine?
Which of the following considerations would warrant applying overpressure for ROM testing of the thoracic spine?
When finding the area of pain complaints what should be the first action of the examiner during objective testing?
When finding the area of pain complaints what should be the first action of the examiner during objective testing?
Where should the therapist stand during Central PA testing?
Where should the therapist stand during Central PA testing?
Which of the following muscles inserts on the spinous processes?
Which of the following muscles inserts on the spinous processes?
What position is the patient typically in during strength testing of the thoracic paraspinals?
What position is the patient typically in during strength testing of the thoracic paraspinals?
Palpation and assessment of what structure is most important when concerned for thoracic outlet syndrome?
Palpation and assessment of what structure is most important when concerned for thoracic outlet syndrome?
With the patient seated, what is the direction of force applied during a first rib inferior glide technique?
With the patient seated, what is the direction of force applied during a first rib inferior glide technique?
Which of the following subjective measures is best for identifying functional limitations?
Which of the following subjective measures is best for identifying functional limitations?
Which of the following is least likely a consideration during ROM testing?
Which of the following is least likely a consideration during ROM testing?
Which of the following techniques relies on a 'dummy hand'?
Which of the following techniques relies on a 'dummy hand'?
During a unilateral PA assessment, the force is applied through what structure?
During a unilateral PA assessment, the force is applied through what structure?
An inferior glide mobilization of the first rib would most likely be indicated for which diagnosis?
An inferior glide mobilization of the first rib would most likely be indicated for which diagnosis?
During subjective questioning, which of the following is most relevant?
During subjective questioning, which of the following is most relevant?
Flashcards
Thoracic Spine Mobility
Thoracic Spine Mobility
Assessing thoracic spine mobility.
Thoracic Musculature Strength
Thoracic Musculature Strength
Assessing strength of thoracic musculature.
Joint Accessory Motion
Joint Accessory Motion
Assessing thoracic spine joint accessory motion.
Pain Body Chart
Pain Body Chart
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Patient Specific Functional Score (PSFS)
Patient Specific Functional Score (PSFS)
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Numeric Pain Rating Scale (NPRS)
Numeric Pain Rating Scale (NPRS)
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Oswestry Disability Index (ODI)
Oswestry Disability Index (ODI)
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ROM with Overpressure
ROM with Overpressure
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Palpation
Palpation
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T3/T4
T3/T4
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T7
T7
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T12
T12
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Posterior Musculature
Posterior Musculature
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Sternum
Sternum
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Strength Testing
Strength Testing
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Thoracic Paraspinals
Thoracic Paraspinals
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Joint Accessory Motion
Joint Accessory Motion
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Central PA Pressure
Central PA Pressure
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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
- Thoracic Spine Exam by Adam Squires, PT, DPT, Cert SMT, Cert DN, Board Certified Specialist in Orthopedic Physical Therapy
Objectives
- Understanding and demonstrating techniques for assessing thoracic spine mobility.
- Understanding and demonstrating techniques for assessing strength of thoracic musculature.
- Understanding and demonstrating techniques for assessing thoracic spine joint accessory motion.
Subjective Exam
- Involves determining the location of pain
- This includes filling out a body chart and forming an initial hypothesis.
- Important to understand what worsens the pain
- Specifically, what activities or positions exacerbate it and how much it takes to trigger the pain.
- Also important to identify what alleviates the pain
- Determining the methods providing relief and the extent of relief they offer.
- Gathering the patient's history
- Considering the mechanism of injury (MOI) and the timeframe of the issue.
Outcome Measures
- Key outcome measures include:
- Patient Specific Functional Score (PSFS)
- Numeric Pain Rating Scale (NPRS)
- Oswestry Disability Index (ODI)
- Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH)
- Neck Disability Index (NDI)
Overview of Physical Exam
- Range of Motion (ROM) assessment.
- Palpation to identify tenderness or abnormalities
- Strength testing to evaluate muscle function
- Joint accessory movement assessment to determine joint mobility
Range of Motion (ROM)
- The patient is in a seated position during ROM assessment
- The lumbar spine is locked out.
- ROM includes flexion, extension, rotation, and lateral flexion to assess the full range of movement.
- Overpressure may be applied if movements appear limited or fail to provoke symptoms.
Palpation
- Palpation is used during various assessments
- Posterior, anterior, and lateral
Posterior Palpation
- Involves identifying the spinous processes
- Spine of scapula at T3/T4, Inferior angle at T7, and last rib which is T12.
- Includes assessing the rib angle
- Also involves evaluating posterior musculature
- Middle trap, lower trap, rhomboids, and latissimus dorsi.
- Includes palpating the first rib.
Anterior/Lateral Palpation
- Entails assessing rib angles.
- Includes evaluating the sternum.
- The sternoclavicular joint
- Sternocostal joints are included.
- Also encompasses palpating the Pectoralis (Pec) major and minor muscles.
Strength Testing
- Strength testing focuses on key muscle groups
- Thoracic paraspinals (extensors), middle trap, lower trap, and rhomboids.
Joint Accessory Motion
Central PA
- Requires the patient to be prone with the therapist standing on one side.
- The therapist uses their hypothenar eminence, similar to lumbar Central Posterior Anterior (CPA) techniques.
- Involves the "dummy" hand contacting the spinous process and applying force with the opposite hand directly anteriorly.
- Therapist may use a "Peace sign" on either side of the spinous process, applying force with the opposite hand directly anterior.
Unilateral PA
- Requires the patient to be prone with the therapist standing on one side.
- Placement of a "dummy" thumb on the chosen side at the desired level.
- Force is applied with either the opposite heel of the hand or the opposite thumb directly anterior.
- Application using the hypothenar eminence is similar to central PA but off to one side and potentially less specific.
First Rib Inferior Glide
- Requires the patient seated with the therapist behind them.
- The therapist supports the opposite side of the patient's head.
- Force is applied through the lateral MCP toward the opposite hip
- The therapist lines up their elbow with the direction of force.
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