thoracic spine (schuermans kyphosis, thoracic disc herniations, thoracic compression fx, facet joint impingement, rib disorders, TLJ syndrome, T4 syndrome)

thoracic spine red flags

• ____ infarction

• ____ embolis

• pneumathorax

• _____

• ulcer

myocardial, pulmonary, pneumonia

wells criteria for pulmonary embolism

• clinical symptoms of ___

• ____ more likely than other Dx

• HR > _____ bpm

• _____ >= 3 days, surgery in the last ___ wks

• previous ____/____

• _____

• _____

DVT, PE, 100, immobilization, 4, DVT< PE, hemoptysis, malignancy

wells criteria for PE

• low risk < ____

• mod risk _____

• high risk > ____

2, 2-6, 6

schuermans kyphosis = ____ of thoracic vertebrae

• causes ____ wedging of ___ deg of at least ___ segments

osteochondrosis, anterior, 5, 3

scheuermans kyphosis = thoracic kyphosis > ____ deg 

45 

most common suase of structural kyphosis in adolescence

scheuermans kyphosis

scheuermans kyphosis MOI

• _____

• possibly _____

unknown, genetic

clinical presentation scheuermans kyphosis

• tight ___, ____ and ____

• ____ posture

• ____ pelvic tilt

• increased ____

• pain at _____ of curve

  • may be ____

  • pain ___ as growth complete

pecs, hamstrings, hip flexors, crouched, anterior, lumbar lordosis, apex, asymptomatic, decreased

scheuermans kyphosis prognosis 

• larger curve = _____ risk long term complications 

increased 

scheuermans kyphosis - bracing if:

• skeletally _____

• curve < ___ deg and improves by ____ deg upon initation of bracing

immature, 65, 15

scheuermans kyphosis bracing protocol

• worn ____-____ hr/day for ____ mo than gradually decrease over the next ____ mo

• correction lost in up to ____% of people

16, 23, 18, 18, 30

surgical Tx scheuermans kyphosis

• if curve > ___ deg

• ____ pain

• refractory to ____ tx

70, thoracic, conservative

Pt interventions scheuermans kyphosis

• ther ex: strengthen trunk _____, ___ stability, stretch ___, ____ and _____

• manual 

• edu: ____ and ____

extensors, core, pecs, hs, hip flexors, posture, brace 

thoracic disc herniations = increased compression on ___ disc

anterior

thoracic disc herniations MOI: ____, ____, ____

traumatic, postural, congential

clinical presentation thoracic disc herniations

• if compressing n root

  • ____ symptoms following ____ pattern

• if compressing spinal cord

  • ____ level of lesion

  • abnormal ____

  • weakness/_____

  • ____ signs

  • ____/____ changes

  • ____ syndrome

radicular, dermatomal, below, gait, parethesias, UMN, bowel, bladder, horner

thoracic disc herniations assessment

• ____ screen 

• (+) ____/____

• pain with 

  • ____, PROM, ____/UPA

  • ____ mobility

neuro, slump, SLR, AROM, CPA, rib 

thoracic disc herniations conservatative tx if no myelopathy s/s

• ____

• NSAIDs

• ____ edu

rest, postural

thoracic disc herniations surgical tx if myelopathy s/s = no ____; ____ or ____

consensus, fusion, microdisecotomy

thoracic compression fx: compression of ____ vertebral body

anterior 

thoracic compression fx risk factors

• _____

• _____

• age _____

• Increased ____

• low ____

female, osteoporosis, 60-70, thoracic kyphosis, BMI

thoracic compression fx MOI

• ____/____

• _____ fragility fx - ____ based ADLs

fall, trauma, osteoporotic, flexion

cochrane red flags

• history ____ use

• > ____ yo

• _____

• presence of ____/____

corticosteriod, 70, trauma, contusion, abrasion

CPR - spinal fx 

• prolonged ____ use 

• age > ____

• _____

• ____

corticosterioid, 70, female, trauma 

CPR - spinal fx

2/4 = _____% SP

¾ = ______% SP

96, 100

conservative Tx of thoracic compression fx

• avoid ____

• immobilization

• _____ worn = ____-____ wks

  • discontinue with ____ signs of healing

• ____ and balance

• ____ breathing

fleixon, TLSO, 4, 12, radiographic, strength, disphragmatic

surgical Tx of thoracic compression fx

• kyphoplasty or vertebroplasty (_____ into vertebral body)

bone cement

thoracic joint impingement 

• ____ migrates into ____ and blocks it from ____

meniscoid, joint space, closing 

meniscoid = ____ folds, loose ____, and fat or ____ structures associated with ____

synovial, CT, fibrous, facet joints

MOI thoracic joint impingement 

• ____ or ____ movement

• “acute ____ mechanism”

sudden, unusual, locked-back

clinical presentation of thoracic joint impingement 

• pain related to loss of ____ (____ pattern) 

• minimal pain at ____ in position of ____

• ____ pain 

• potential ____

• overtime, ____ side may become painful d/t ____ stress 

specific motion, closing, rest, comfort, referred, muscle guarding, contralateral, asymmetric 

Tx thoracic joint impingement 

• manual: joint ___/___, MET, ____

• dry needle for ____

• therex: ____ strength, ____, ROM/____

• modalities for ____

mob, manip, SNAG, mm spasm, postural, stretching, mobility, pain

rib sublux

• costovertebral = rib sublux ____ or ____

• interchondral = rib ____

anterior, posterior, elevates

MOI rib subluxation

• direct _____

• quick ____

• ____ overuse

• ____ (d/t instability)

trauma, mm contraction, repetitive, RA

clinical presentation of rib sublux/disloaciton 

• pain with deep ____

• pain with ___/____

• pain with motions: ____, ____, ____

costovertebral joint 

• pain ____ to spinous processes 

• pain radiates ___ and ___

sternocostal joint 

• ____, ____ pain 

• pain may radiate ___ and ____

inhale, coughing, sneezing, flexion, ipsi rotation, ipsi lateral fleixon, lateral, laterally, anteriorly, sharp, localized, laterally, posteriorly 

Tx rib sublux

• highly successful with ____ manip

supine pistol

thoracolumbar junction syndrome: spinal n irritation at TLJ (____ or ____), could be ____, ____ or ____ degeneration, d/t abnormal forces at TLJ from transitioning ____

T12, L1, ligament, capsule, facet, facet orientation

MOI thoracolumbar junction syndrome

• spinal ____ or ____

• ____ or ____ injury of medial branch of the superior cluneal n

extension, rotation, entrapment, iatrogenic

clinical presentation thoracolumbar junction syndrome

• TTP _____

• ____ LBP

  • pain may be refered to structures innervated by ____-___

  • ____ changes in same direction 

T11-L2, unilateral, T11-L2, cutaneous 

Tx thoracolumbar junction syndrome

• therex: strengthen ___ mm, ____, ____ based

• manual: mob/manip for ____, STM

• _____

segmental, prosture, flexion, opening, dry needling

T4 syndrome: ____ of the upper thoracic spine affect ____ outflow to _____

hypomobility, sympathetic

T4 syndrome always involes ____, may involve ____

T4, T2-T7

risk factors for T4 syndrome: ____

women 

clinical presentation T4 syndrome

• pain (____, ___, ___ chest)

• ____ that interrupts sleep

• ____ pain and paresthesias

  • ____ or _____

  • possible ____ distribution

• increased pain with sustained ____

• possible ___ or ____ findings

headaches, neck, periscapular, night pain, UE, unilateral, bilateral, glove, flexion, trophic, sudomotor

assessment of T4 syndrome

• faulty ____

• ____ hypomobility

• pain at ____ ROM

• UE s/s are ____

• possible (+) ___, ____

posture, T4, end range, nondermatomal, slump, ULTT

DDx T4 syndrome

• ____ radiculopathy

• _____

• ____n entrapment

• ____ neruopathy

• _____

• ____ tumor

cervical, TOS, peripheral, peripheral, cardiac, pancost

pancost tumor = ____ cancer at _____

lung, apex of lung 

pancost tumor

• may compress ____

• _____ pain = initial symptom

• UE _____, parestheisas, ____ n distribution

• may involve _____ (____ syndrome)

bracial plexus, shoulder, weakness, unlar, sympathetic, horner

Tx T4 syndrome

• manual: mob/manip, ___, self ____

• therex: ____/____ mm

MET, mobilization, scap, thoracic