Christina - Beast Mode!!! > MSK: Thoracic 4B diff dx > Flashcards

MSK: Thoracic 4B diff dx Flashcards

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1
Q

2nd rib dysfunction what does medical referral say

A

shoulder impingement

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2
Q

2nd rib dysfunction subjective hx

A

post shld pain w/ no shld hx (Referred pain)

hypertonic posterior scalene

  • contractile testing
  • palpation of tendon insertions

loss of full shoulder girdle elevation

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3
Q

Pt presents with no shoulder hx, pain in posterior shoulder, you notice that her posterior scalenes is hypertonic

A

2nd rib dysfunction

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4
Q

Why is 2nd rib dysfunction have (-) contractile testing and (-) palpation of tendon insertions

A

b/c not a mm issue ruling out RC, deltoid, scapular mms not pain generators!

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5
Q

why does 2nd rib have loss of full shoulder girdle elevation

A

The clavicle and scapula depend on normal pump-handle motion of the upper ribs (especially rib 2) to allow full elevation. A hypomobile 2nd rib mechanically blocks this motion.

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6
Q

treatment for 2nd rib dysfunction

A

2nd rib mobilization

gapping HVLAT

AROM exercises (rib self mob, seated thoracic extension)

strengthening exercises (serratus punches)

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7
Q

1st rib dysfunction medical referral

A

cervical disc herniation

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8
Q

1st rib dysfunction subjective

A

can cause TOS neuro S&S

paresthesias non dermatomal - ulnar nerve

hypertonic anterior and middle scalenes

symptoms come from medial plexus C8-T1

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9
Q

Treatment for 1st rib dysfunction

A

1st rib mobilization

gapping HVLAT

AROM ex

strengthening ex

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10
Q

Pt presents to PT with numbness down pinky and you notice their anterior and middle scalenes are hypertrophic they also have limited shoulder mvmt

A

1st rib dysfunction

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11
Q

why does 1st rib dysfunction can cause TOS neuro S&S

A

1st rib is inferior border of TO —> neural irritation

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12
Q

TOS three types

A

neurogenic

venous

arterial

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13
Q

when is TOS s&s life threatening

A

esp when arm is elevated >90

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14
Q

TOS potential causes / compression sites

A

prescence of cervical rib

scalene triangle

hyperabduction syndrome

costoclavicular syndrome

pec minor

1st thoracic rib

note: whiplash, repetitive overhead

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15
Q

What can cause ulnar nerve symptoms?

A

TOS

1st rib dysfunction

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16
Q

TOS anatomic space is bordered by

A

superior border of scapula

clavicle

1st thoracic rib

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17
Q

thoracic outlet space interscalene interval includes

A

anteriorly - anterior scalenes
posteriorly - posterior scalenes
inferiorly - first rib

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18
Q

__ is charactered by symptoms attributable to compression of neural and or vascular structures pass through thoracic outlet

A

TOS

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19
Q

T4 syndrome misnamed

A

can occur from T2-T7 levels

but will always include T4

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20
Q

T4 cause

A

etiology unknown

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21
Q

T4 clinical presentation

A

hx HA, neck pain, UE pain

night pain in sidelying / supine

f>m

+ slump + ULTT

depression or prominence of 1 spinal segment

thickening of HYPOmobility of 1 segment while rest of spinal motion is normal

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22
Q

T4 treatment

A

MT

thoracic flexibility

strengthening exs

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23
Q

T4 pain pattern

A

periscapular down arm and hand on posterior side too

stocking glove pattern

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24
Q

why does T4 syndrome have + slump and + ULTT

A

due to sensitivity of NS

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25
Scheuermann Disease defect in
apophyseal ring of VB causing anterior weding
26
Scheuermann Disease clincial presentation
thoracic kyphosis pain in t extension and rotation
27
what is a schmorl node
end plate crack causing disc herniation
28
scheurmann disease treatment
severity dependent postural re ed activity modifications stretchin strengthening bracing
29
scapular fracture MOI
fall from a height major trauma
30
scapular fx RX
NWB on affected limb surgery if displaced or unstable
31
sternal fractures MOI
seatbelt in MVA tremendous force to fx sternum
32
does sternal fx typically cause damage to surrounding structures
no
33
what is a risk for sternal fractures tho
posterior dislocation of SC joint can be life threatening
34
Rx for sternal fxs
activity modication surgery rarely indicated
35
why is scapular fx rare
thick mms and nearby rib cage
36
rib fractures consider what
trauma vs repetitive stress
37
what can lacerate pleura, lung, abd organs, cause BP / vascular injury in upper ribs affected
rib fx
38
rib fx moi
fall MVA high energy blow to chest cavity
39
symptoms of rib fx
high acuity and immediate onset of pain pain with breathing flail chest segment bruising articular signs are + in all direction palpation +
40
thoracic vertebral fractures what are two types that are common
anterior wedge fx or burst fx
41
thoracic vertebral fx consider
trauma vs osteoporosis
42
MOI theracic vertebral fx
hyperflexion or axial loading
43
what has high acuity and immediate onset of pain and + articular signs in all directions
rib fx thoracic vertebrae fx
44
pain out of proportion of injury and + compression test
thoracic vertebrae fractures
45
do you want to work towards thoracic flexion with Thoracic vertebral fxs
no b/c this is MOI
46
abdominal mm strains and contusion common where
thoracic region
47
abdominal strain / contusion MOI
direct trauma or excessive muscular activity -MVA -physical alteration
48
Pt has localized pain and tenderness pain with increase isometric contraction or passive stretching
abdominal mm strain / contusion
49
abdominal mm strain / contusion pain worse with
movement deep inspiration coughing
50
rib dysfunction does it present with MOI
it can but can be insidious onset
51
clincial presentation rib dysfunction
pain with deep breathing , trunk rotation , cough, sneeze
52
clincial presentation rib dysfunction localized pain ___ from midline
3-4 cm
53
what joint may be involved in inflammatory or degenerative joint disease
costo vertebral joint
54
thoracic facet joint dysfunction dx based on ___ restrictions more than specific structures
motion
55
thoracic facet joint dysfuction what is key
palpation
56
thoracic facet dysfunction can be caused by
change in training load or ergonomic set up
57
thoracic disc pathology more common where in t spine
lower
58
thoracic disc pathology clinical presentation are variable and vague can include what 3 things
pain with active and passive motion in at least one direction + dural signs w or w/o radiculopathy + coughing
59
flatback manipulate towards ___ kyphosis towards ___
flexion extension
60
postural dysfunction neuro exam is
negative
61
hx of pain following sustained positions or postures result of overloading ligaments
postural dysfunction
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