Thoracic Spine

CEI 2

• Thoracic and cervical spinal structures

• The thorax

• Gastrointestinal, Cardiopulmonary and renal Systems

• Thoracic and cervical spinal structures

• The thorax

• Gastrointestinal, Cardiopulmonary and renal Systems

With thoracic dysfunction, pain may arise from… (list 3)

Thoracic Spine

The following are risk factors of pain in which region?

• concurrent MSK pain

• Growth spurt or physical abnormalities

• Lifestyle and social

• Backpack

• Postural

• Psychological

• Environmental factors

Trauma involved, age, puberty, use of corticosteroids (suspected with compression fracture), psychological factors, use of a backpack, occupation, exercise regimen, coughing and abnormal sleep patterns

What are the key targets for the T-spine? (10 key components)?

PSFS (Patient Specific Functional Scale)

Which outcome measure specifically is an activity limitation assessment?

OSPRO

Which self reported outcome measure is essentially a yellow flag scale and looks into psychological factors?

STarT Back

Which self reported outcome measure looks at stratifying those who need additional care (specifically cognitive aid)?

Orebro

Which self reported outcome measure identifies those at risk for long term problems?

Osteoporosis Scales & Fibromyalgia Impact Questionnaire

What are the 2 self report outcome measures that are disease/regional specific measures?

10 degrees

In terms of scoliosis, what is the minimum cobb angle to be categorized as scoliosis?

Prescribe a back brace

A patient who has scoliosis with a cobb angle of 20-40 degrees, this requires the provider to…..

Organs are being compressed and surgery is recommended

A patient who has scoliosis with a cobb angle greater that 40 degrees this leads us to believe that….

• Poor Posture

• Scoliosis

• Hyperkyphosis

• Kyphosis

• Thoracic Outlet Syndrome

When analyzing our patients posture we need to watch for…

Scalenes, Upper traps, Pec Major and Minor

When looking at the t-spine region, which muscles do we examine to see for tightness?

Cervical Rib (1 & 2)

Which structure could limit ROM of the upper thoracic region?

Neurogenic cause

What is a possible underlying cause of scapular winging?

Kyphosis

A breast mass could contribute to what seen in a patient’s posture?

Breast examination

Which red flag is palpation beneficial but as an test not good in ruling ( _____) out?

Henschke’s Cluster for a vertebral compression fracture

It terms of a ( ) () fracture what is the name of the cluster below

• Female

• Age >70

• Significant Trauma

• Prolonged use of corticosteroids

Cook’s cluster for a compression fracture

It terms of a ( _________) fracture what is the name of the cluster below

• Age > 52

• No Presence of leg pain

• BMI < 22

• Does not exercise regularly

• Female

Spondylodiscitis

There are not any good tests for screening (_________) besides that there is a presence of a fever.

Murphy’s Sign for Cholecystitis

What is the test used to screen the gallbladder, having the patient bend their knees, have them push out behind their head and you palpate medial to the rib angle (push in when they breath out)?

Reproduction of Pain

When palpating the liver what are we looking in terms of this examination?

4 cm or greater

When palpating the aorta what is the width that we are concerned about a possible aneurysm being present?

Rule Out Pulmonary Embolism

The following cluster is to rule out which diagnosis

• Age <50

• Pulse <100 beats/min

• Pulse ox >94%

• No unilateral leg swelling

• No hemoptysis (coughing up blood)

• No recent surgery

• No prior DVT or PE

• No oral hormone use

• PERC score = -LR 0.17

Cervical and Lumbar Spine

Which other areas do you rule out with over pressure when examining?