Thoracic Spine Lab

Question 1

Thoracic serious pathology

Answer 1

• Pulmonary Embolus
• Myocardial Infarction
• Pneumonia
• Pleurisy
• Thoracic Spine Compression Fracture
• Rib Fracture(s)
• Visceral Referral
• Shingles(herpes zoster)

Question 2

Osteoporosis risk factors

Answer 2

• Female
• Age ≥65
• Caucasian & asian
• Family Hx
• Prior Fx after age 50
• Diet for vitamin D
• Physical activity
• Tobacco use
• Medications: glucocorticoids, anti-seizure drugs, & thyroid hormone
• Low body weight

Question 3

What deformity is characteristic of a compression fracture

Answer 3

• Wedge deformity

Question 4

Which ribs are true, false, and floating

Answer 4

• True: 1-7
• Flase: 8-10
• Floating: 11-12

Question 5

What are the different chest types

Answer 5

• Barrel
• Funnel
• Pigeon

Question 6

Describe the dynamics of respiration

Answer 6

• Ribs move as a “bucket handle”
• Sternum moves as a “pump handle”
• Inhale: diaphragm contracts & lowers while ribs expand

Question 7

Describe self assessment for diaphragmatic breathing

Answer 7

• Begin by slow & deep breathing
• Add pursed lip breathing: smell the roses & blow out the candles
• Place both hands on lower ribs & feel for expansion AP & laterally
• Place one hand on bellybutton & other on sternum
• Try to breath with only expanding the diaphragm (lower hand moves > upper hand)

Question 8

How can you increase motor control while diaphragmatic breathing

Answer 8

• Add deep neck flexor isometric
• Cue different regions of the ribs & diaphragm if needed

Question 9

Describe a barrel chest

Answer 9

• More rounded than a normal chest
• Chest cavity has a 1:1 ratio for AP diameter to transverse diameter
• Associated with COPD

Question 10

Symptoms of a blue bloater/chronic bronchitis

Answer 10

• Chronic productive cough
• Purulent sputum
• Hemoptysis
• Mild dyspnea initially
• Cyanosis
• Peripheral edema
• Crackles/wheezes
• Prolonged expiration
• Obese

Question 11

Symptoms of a pink puffer/emphysema

Answer 11

• Dyspnea
• Minimal cough
• Increased minute ventilation
• Pink skin, pursed-lip breathing
• Accessory muscle use
• Cachexia
• Hyperinflation, barrel chest
• Decreased breath sounds
• Tachycardia

Question 12

Describe a funnel chest

Answer 12

• AKA pectus excavatum
• A dip in the sternum creating a “funnel”

Question 13

Describe a pigeon chest

Answer 13

• AKA pectus carinatum
• Protrudes outward from the sternum creating a “peak”

Question 14

Describe the lumbar locked position

Answer 14

• Patient in on their knees and puts one forearm on the ground infant of them and rotate as far as they can to the opposite side
• Potentially identifies any thoracic dysfunction
• Compare symmetry

Question 15

What are your landmarks for a thoracic PA spring test

Answer 15

• Spine of scapula at T3
• Inferior angle scapula at T7

Question 16

Describe how to perform a mid-thoracic sitting manipulation

Answer 16

• Distraction gliding manip
• Position towel roll on the PT’s chest
• Ask patient to criss-cross arms with elbows stacked & lean back onto the therapist
• PT takes up the slack to achieve pre-thrust tension
• Thrust is a chest bump with combined j-stroke lifting in & up to direct the force over the towel roll

Question 17

Describe a C-T junction sitting manipulation

Answer 17

• Ask patient to place their hands behind their neck
• Place towel roll just below the C-junction
• PT links hands in behind & adducts elbows in around the patient’s ribs (laterally)
• Ask patient to lean back & relax
• Several reps of mini manias trying to feel pre-thrust tension
• Deliver the thrust upwards with the hands & elbows while using a chest bump
• Avoid pressing the neck forwards

Question 18

Describe how to perform a supine mid-thoracic manipulation

Answer 18

• Ask patient to cross both arms over a thole roll & roll toward you
• Position your hand on the T-spine region & take up the skin slack, may need to begin above the area
• Have the patient roll back onto your hand keeping the skin lock
• Use your body to apply a pre-thrust force through the patient’s elbows
• Fine tune by flexing the pt’s head/neck to max load the hand on the spine
• Use a body drop to deliver the thrust directed just above your hand on the spine

Question 19

Describe how to perform a prone thoracic manipulation

Answer 19

• Ask the patient to lay prone
• Assess spine with PA mobility test
• Operator place hands on the transverse processes, contact point is the bilateral pisiforms
• Take up the slack: twist and slide in opposite directions
• Mini manips to fid the pre-thrust crispness
• Deliver a HVLA (high velocity low amplitude) thrust with equal pressure bilaterally