Thoracic Spine Examination

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Questions and Answers

During a subjective examination for thoracic spine pain, which of the following is the MOST relevant reason for asking the patient to fill out a body chart?

  • To precisely locate and map the distribution of the patient's pain. (correct)
  • To quantify the intensity of the pain using a visual analog scale.
  • To compare the patient's pain pattern with typical referred pain charts.
  • To assess the patient's understanding of their own anatomy.

When taking a history for thoracic spine pain, asking 'What makes your pain worse?' is MOST important for:

  • Identifying aggravating factors and potential pain mechanisms. (correct)
  • Establishing the patient's baseline pain level for comparison.
  • Determining the patient's emotional response to pain.
  • Assessing the patient's coping strategies for pain management.

Which of the following outcome measures is specifically designed to assess functional limitations across various activities chosen by the patient?

  • Neck Disability Index (NDI)
  • Numeric Pain Rating Scale (NPRS)
  • Patient Specific Functional Score (PSFS) (correct)
  • Oswestry Disability Index (ODI)

A physical therapist is evaluating a patient with mid-thoracic pain. If using the Numeric Pain Rating Scale (NPRS), what aspect of the patient's pain is being MOST directly measured?

<p>The intensity of the pain. (A)</p> Signup and view all the answers

Which of the following is the MOST appropriate initial step when starting the physical examination of the thoracic spine?

<p>Assessment of active range of motion (ROM). (B)</p> Signup and view all the answers

When assessing thoracic spine Range of Motion (ROM), what is the purpose of instructing the patient to 'lock out the lumbar spine'?

<p>To isolate movement to the thoracic region. (C)</p> Signup and view all the answers

During active thoracic spine ROM assessment, in which direction of movement is 'curling from the mid-spine' primarily intended to assess?

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

In thoracic spine ROM assessment, when is it MOST appropriate to apply overpressure at the end range of motion?

<p>If active movements are full and pain-free. (B)</p> Signup and view all the answers

When performing posterior palpation of the thoracic spine, which anatomical landmark is typically located at the level of the T7 vertebra?

<p>Inferior angle of the scapula (B)</p> Signup and view all the answers

During posterior palpation, the spine of the scapula is a key landmark for locating which thoracic vertebral level(s)?

<p>T3/T4 (A)</p> Signup and view all the answers

Palpation of the 'rib angle' in the thoracic region is BEST performed:

<p>Posteriorly, near the transverse processes. (A)</p> Signup and view all the answers

Which muscle group is NOT typically assessed during posterior palpation of the thoracic musculature?

<p>Pectoralis major (D)</p> Signup and view all the answers

Anterior palpation in the thoracic region commonly includes assessment of the:

<p>Sternum and sternocostal joints. (A)</p> Signup and view all the answers

Palpation of the sternoclavicular joint is categorized under which type of thoracic spine examination?

<p>Anterior/Lateral palpation (C)</p> Signup and view all the answers

Which of the following muscle groups is primarily tested when assessing 'Thoracic Paraspinals - Extensors' strength?

<p>Erector spinae group (A)</p> Signup and view all the answers

During strength testing of the middle trapezius, the patient is typically positioned in:

<p>Prone with arm abducted to 90 degrees and externally rotated. (D)</p> Signup and view all the answers

The primary action assessed during strength testing of the rhomboids is:

<p>Scapular retraction (D)</p> Signup and view all the answers

Joint accessory motion assessment in the thoracic spine primarily evaluates:

<p>Passive intervertebral and rib joint play. (A)</p> Signup and view all the answers

In a Central Posterior-Anterior (PA) joint mobilization of the thoracic spine, the therapist applies force in which direction?

<p>Anterior and perpendicular to the spinous process. (D)</p> Signup and view all the answers

When performing a Central PA mobilization using the 'hypothenar eminence' technique, what part of the therapist's hand is in contact with the patient's spinous process?

<p>Hypothenar eminence (base of the little finger). (C)</p> Signup and view all the answers

For a Unilateral PA mobilization technique in the thoracic spine, the force is applied:

<p>Unilaterally on the transverse process or lamina. (D)</p> Signup and view all the answers

What is the primary difference between a Central PA and a Unilateral PA mobilization technique?

<p>Specificity of vertebral segment targeted. (B)</p> Signup and view all the answers

In performing a First Rib Inferior Glide mobilization, the therapist typically stands in which position relative to the seated patient?

<p>Behind the patient. (A)</p> Signup and view all the answers

During a First Rib Inferior Glide mobilization, where is the force primarily directed?

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

What part of the therapist's hand is typically used to apply the mobilizing force during a First Rib Inferior Glide technique?

<p>The lateral aspect of the Metacarpophalangeal (MCP) joint. (D)</p> Signup and view all the answers

Which of the following is NOT a primary objective when assessing thoracic spine mobility?

<p>To measure the patient's pain threshold. (D)</p> Signup and view all the answers

Assessing the strength of thoracic musculature is important for understanding its role in:

<p>Postural control and spinal stability. (C)</p> Signup and view all the answers

Understanding thoracic spine joint accessory motion is MOST relevant for addressing:

<p>Intervertebral joint dysfunction. (D)</p> Signup and view all the answers

Which of the following best describes the sequence of a comprehensive thoracic spine examination?

<p>Subjective Exam, ROM, Palpation, Strength testing, Joint Accessory Motion. (A)</p> Signup and view all the answers

If a patient presents with limited thoracic extension ROM, which muscle group is MOST likely to be weak and require strengthening?

<p>Thoracic paraspinals (extensors). (D)</p> Signup and view all the answers

A therapist notes restricted joint accessory motion in thoracic flexion at T5/T6. Which mobilization technique would be MOST directly aimed at improving this restriction?

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

Which of the following outcome measures would be LEAST appropriate for assessing functional limitations specifically related to thoracic spine pain?

<p>Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). (C)</p> Signup and view all the answers

If a patient reports that their thoracic pain is aggravated by deep breathing, which structure is MOST likely involved?

<p>Intercostal muscles or rib joints. (B)</p> Signup and view all the answers

A patient has difficulty with thoracic rotation to the right. Which joint accessory motion mobilization technique would be MOST appropriate to initially address this limitation?

<p>Unilateral PA on the left side of the restricted segments. (A)</p> Signup and view all the answers

When assessing thoracic lateral flexion ROM, it's important to differentiate the movement from:

<p>Lumbar lateral flexion. (D)</p> Signup and view all the answers

In the context of thoracic spine examination, 'MOI' in 'History - MOI, timeframe, etc.' refers to:

<p>Mechanism of injury. (D)</p> Signup and view all the answers

Which muscle is LEAST likely to be considered part of the posterior musculature of the thoracic spine for palpation and strength testing?

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

If decreased accessory motion is found at the costotransverse joint of the 5th rib, which mobilization technique would be MOST specific to address this?

<p>Rib mobilization techniques. (A)</p> Signup and view all the answers

The primary goal of 'locking out the lumbar spine' during thoracic ROM assessment is to enhance the reliability and validity of assessing:

<p>Thoracic spine mobility. (D)</p> Signup and view all the answers

When performing a Central PA mobilization, using a 'peace sign' hand position is an alternative to the hypothenar eminence grip. The 'peace sign' hand position involves:

<p>Placing the index and middle fingers on either side of the spinous process. (D)</p> Signup and view all the answers

For effective First Rib Inferior Glide mobilization, it is crucial to ensure that the elbow of the mobilizing arm is:

<p>Lined up with the direction of force. (B)</p> Signup and view all the answers

Which of the following is the MOST important reason to reassess outcome measures after interventions for thoracic spine pain?

<p>To track changes in the patient's functional status and pain levels. (A)</p> Signup and view all the answers

Flashcards

Thoracic Spine Mobility Techniques

To understand and demonstrate techniques for assessing thoracic spine mobility.

Thoracic Muscle Strength Assessment

To understand and demonstrate techniques for assessing strength of thoracic musculature.

Thoracic Joint Accessory Motion

To understand and demonstrate techniques for assessing thoracic spine joint accessory motion.

Pain Location Documentation

Document where the pain is located. Use a body chart.

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Initial Hypothesis (Pain)

An initial assumption about the possible cause of the patient's pain.

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What Makes Pain Worse?

Identify activities or positions that worsen the patient's pain.

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What Makes Pain Better?

Identify actions or positions that alleviate the patient's pain.

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History (MOI, Timeframe)

Mechanism of injury, timeframe; how did it happen and when?

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Patient Specific Functional Scale (PSFS)

A questionnaire to assess a patient's perceived level of function performing selected activities.

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Numeric Pain Rating Scale (NPRS)

A scale used to measure the intensity of a patient's pain.

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Oswestry Disability Index (ODI)

An outcome measure looking at the impact of low back pain on daily life.

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ROM Active with Overpressure

ROM with added pressure at the end of the range.

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Palpation

Using hands to feel the location of bony anatomy.

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Strength Testing

Assessing the strength of specific muscles.

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Joint Accessory Movement Assessment

Assessment of how well a joints glide.

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ROM Patient Seated

Patient seated while performing active movements such as flexion, extension, rotation, and lateral flexion.

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Spine of Scapula

Located on T3/T4 during posterior palpation.

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Inferior Angle

Located on T7 during posterior palpation.

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Last Rib

Located on T12 during posterior palpation.

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Posterior Musculature

Muscles included are middle trap, lower trap, rhomboids, latissimus dorsi.

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Rib Angle

Refers to the ribs attachment to the vertebrae angle.

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Pectoralis Major

Involves muscles in front of the chest.

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Pectoralis Minor

Involves muscles deep in the chest.

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Sternoclavicular Joint

Attach at sternum and the clavicle

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Sternocostal Joints

The joint where the ribs meet the sternum.

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Thoracic Paraspinals - Extensors

Can be tested by having the patient lay prone while testing a trunk lift.

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Middle Trap

Can be tested by having the patient lay prone while testing arm abduction.

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Lower Trap

Can be tested by having the patient lay prone while testing internal rotation.

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Rhomboids

Can be tested by having the patient lay prone while squeezing the scapulas together.

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Central PA

Patient prone, force applied on the spinous process.

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Unilateral PA

Patient prone, force applied on one side of the process.

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First Rib Inferior Glide

Patient seated, therapist behind, force applied through the lateral MCP toward opposite hip.

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Study Notes

  • Examination of the Thoracic Spine

Objectives

  • Learners should understand and demonstrate methods for evaluating the thoracic spine's range of motion.
  • Learners should understand and demonstrate methods for evaluating the strength of the thoracic musculature.
  • Learners should understand and demonstrate methods for evaluating thoracic spine joint accessory motion.

Subjective Examination

  • Includes gathering details about the pain location using a body chart and forming an initial hypothesis.
  • Requires exploring factors that worsen or alleviate the pain and the amount of activity needed to trigger or ease the symptoms.
  • Involves taking a history that covers the mechanism of injury (MOI) and the timeframe of the issue.

Outcome Measures

  • Patient Specific Functional Score (PSFS).
  • Numeric Pain Rating Scale (NPRS).
  • Oswestry Disability Index (ODI).
  • Neck Disability Index (NDI) is covered in the Cervical section.
  • Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) is covered in UE course.

Physical Examination Overview

  • Includes assessment of Range of Motion (ROM).
  • Includes spinal palpation.
  • Includes strength testing.
  • Includes joint accessory movement assessment.

Range of Motion (ROM)

  • Patient should be seated with the lumbar spine locked out.
  • Assess flexion, extension, rotation, and lateral flexion.
  • Apply overpressure if movements aren't full or don't provoke symptoms.

Posterior Palpation

  • Includes palpation of the spinous processes.
    • Spine of the scapula corresponds to T3/T4.
    • The inferior angle corresponds to T7.
    • The last rib corresponds to T12.
  • Palpate the rib angle and posterior musculature, including the middle and lower trapezius, rhomboids, and latissimus dorsi.
  • Palpate the 1st rib.

Anterior/Lateral Palpation

  • Includes palpation of:
    • Rib angles.
    • Sternum: specifically the sternoclavicular and sternocostal joints.
    • Pectoralis major.
    • Pectoralis minor.

Strength Testing

  • Includes testing of the Thoracic Paraspinals (Extensors), Middle Trap, Lower Trap, and Rhomboids.

Central PA Joint Accessory Motion

  • The patient is in prone position, with the therapist standing on one side.
  • Apply pressure using hypothenar eminence.
    • Use a "dummy" hand on the spinous process, applying force with the opposite hand directly anteriorly, similar to lumbar CPA.
  • Use a "Peace Sign."
    • Place "dummy" fingers on either side of the spinous process and apply force with the opposite hand directly anterior.

Unilateral PA Joint Accessory Motion

  • Patient is prone, with the therapist standing on one side.
  • Apply pressure using a "Dummy" thumb.
    • Thumb should be placed on the chosen side at the desired level, applying force with either the opposite heel of the hand or opposite thumb directly anterior.
  • Apply pressure using the hypothenar eminence.
    • Similiar to a CPA but off to one side, and it's not as specific.

First Rib Inferior Glide Joint Accessory Motion

  • The patient is seated, and the therapist stands behind.
  • Support the opposite side of the head.
  • Apply force through the lateral MCP toward the opposite hip.
  • Align the elbow with the direction of force.

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