DPT 754 Thoracic assessment part 2

MOI for thoracic nerve root lesions

Either mechanical compression or chemical irritation

Disc lesions, facet injuries, osetophytes, scarring

Symptoms of thoracic nerve root lesions (3)

Distal (anterior) pain greater than proximal (back) pain

Neuro symptoms

Upper T-spine refers to UE

Differential dx for thoracic nerve root lesions (2 other conditions it might be)

Costochondritis also produces anterior pain

Spinal dura can produce vague symptoms up and down spine

MOI for thoracic disc lesion

Blow to rib may disrupt IVD (ribs attach to annulus)

Convex side of scoliosis or kyphosis

Most common area for T spine disc lesion

T/L junction

Most symptomatic area for T spine disc lesion

Lower T spine (may refer to abdomen or iliac crests)

Patient history for thoracic radiculopathy

Insidious onset

May be trauma related

Symptoms of thoracic radiculopathy

Aching, burning, sharp thoracic pain

Exacerbated by positions that stretch dura

Exam findings for thoracic radiculopathy

+ Slump sign

Relieved by neck or trunk extension

C spine structures that can refer pain to T spine (2)

Cervical discs

Cervical facet joints

Cervical disc lesions refer symptoms to these areas (2)

T spine

Medial borders of scapula

Define Cloward areas

Areas of discogenic pain

Define thoracic outlet syndrome

Describes compression of neurovascular structures as they exit through thoracic outlet

Pain presentation of TOS

Deep, boring, toothache-like pain in neck or shoulder

Contributing factors to TOS (3)

Posture

Vascular/neuro

Diagnosis of exclusion

Causes of TOS (4)

Scalenes

Cervical rib

Clavicular space

Hyperabduction

Describe scalenus anterior syndrome

Tone in scalenes causes TOS

Describe cervical rib syndrome

Elevated 1st rib causes TOS

Describe costoclavicular space syndrome

Decreased clavicular space causes TOS

Describe hyperabduction syndrome

Tight pec minor causes TOS

Complaints of weakness and heaviness in limb after activity may indicate what? (In TOS)

Vascular involvement

If a patient's symptoms are relieved with OH arm placement (Bakody's sign), what condition may be present?

Cervical nerve root compression (C4-5 or C5-6)

Special tests for TOS (4)

Adsons

Costoclavicular syndrome test

ROOS test

Wright maneuver

Presentation of suprascapular n injury

Atrophy and paralysis of supraspinatus and infraspinatus

Presentation of axillary n injury (post dislocation)

Atrophied deltoid and teres minor

Presentation of radial n injury

Commonly injured w humeral shaft fractures

Weakness in radial n distribution

Presentation of spinal accessory n injury

Scapular depresses and inferior angle rotates laterally

Presentation of long thoracic n injury

Scapula elevates and inferior angle rotates medially

Define a "burner" / "stinger"

Nerve injury that often occurs during sports

Traction or compression of upper brachial plexus

Pain presentation of a burner/stinger

Transient pain, numbness, paresthesia

Functional outcome measures for shoulder pain and disability (3)

DASH

SPADI

ASES

Functional outcome measures for neck pain and disability (4)

NDI

NPRS

FABQ

GROC