Patient Complaints
What are the common patient complaints for Thoracic Facet Syndrome/Stiffness?
Unilateral stiffness/ache
Symptoms are ISOLATED to thoracic region
Pain may also present in surrounding areas
What are some tests you would do for Thoracic Facet Syndrome/Stiffness? What would these tests show us? (what would a + test look like?)
Thoracic Quadrant Test: + reproduction of symptoms (closing motion)
Joint mobility assessment: unilateral stiffness, hypomobility and +RS with UPA
Thoracic ROM: decreased ROM or movement in closing motions
What is the ICF category? What kind of treatment should we give a patient with Thoracic Facet syndrome/stiffness? What are some examples?
ICF: Thoracic pain with Mobility deficits
Treatment: Mobilization/manual therapy, stretching, passive/active movement
Examples: Thoracic SNAG, Chair thoracic extension, CPAs, STM of paraspinals,
What is Costochondritis? What are common patient complaints for Costochondritis?
Chest pain from inflammatory process of costochondral costosternal joints
Patient complaints:
Localized chest pain/tenderness at involved joint
Can be sharp, nagging, aching, or pressure-like
Can radiate and pain is often during deep inspiration/exertion
Injury to muscle in thoracic spine- too much too soon
Minor to moderate trauma
Prolonged positioning
What are some common patient complaints for Thoracic Muscle Strain?
"Stiffness" "tightness" "Spasms"
Intolerance to prolonged positions
Frequent need to stretch or self manipulation
Possible ergonomic insufficiency with repetitive activities
What are some tests you would perform for a Thoracic Muscle Strain? What would the tests tell you? (What would a + test look like?)
Thoracic/trunk muscles MMT: weakness or pain
Palpation of superficial neck muscles: tenderness to palpation
Deficits in muscle strength, endurance and coordination in trunk muscles
What is the ICF category for Thoracic Muscle Strain? What are some treatments we can give a patient with Thoracic Muscle Strain? What are some examples?
ICF: Thoracic pain with muscle power deficits
Treatments: patient education, mobilization/manipulation- for pain, restore deficits in muscle strength, length and coordination
Examples: Mid trap strengthening exercises (progressions)
What would you find during an exam for Costochondritis? What could you do for treatment?
Pain with trunk movement, palpation to costochondral joints, tenderness along with swelling and heat
Treatment: Mobilizations directed at posterior spine and ribs, SNAGs, motor control exercises for scapular regions
What are common MOIs for rib sprain?
Can be Trauma/acute, long bouts of coughing
What are some common complaints for a Rib Sprain?
Aching or sharp pain in the rib cage section
Sharp pains with deep breathing, coughing, sneezing or laughing
Pain and restriction with turning motions
Hx of trauma/acute injury related to ribs
What kind of tests would we perform for Rib Sprain? What would the tests tell us? (what would a + test look like?)
Joint assessment to ribs: hypomobility and pain
Palpation to sternocostal and vertebrocostal joints: tenderness
End range positions that put ribs on stretch are painful
What are some treatments for Rib Sprain? What is the ICF category?
ICF: Thoracic pain with coordination deficits
Treatment: mobilizations, patient education (low severity), endurance/coordination exercises
Examples: isometric mobilization for anterior rib and posterior rib
What is T4 syndrome? What are common patient complaints?
UE paresthesia and pain with or without symptoms into head/neck region. Entrapment of segmental spinal nerves
Patient complaints: Paresthesia of all 5 fingers in whole hand or forearm, hand feels hot or cold, aches and pains - non dermatomal pattern, pain may be bursting or a tight band, HA that presents in a "cap" on top of the head
What is the MOI for Thoracic Outlet Syndrome?
Entrapment syndrome from pressure in the thoracic outlet
Can be from trauma to shoulder girdle
What are some common patient complaints for Thoracic Outlet Syndrome?
Paresthesias, pain, tingling in arm
Temperature changes, possible edema
UE weakness
What are some tests you would perform for Thoracic Outlet Syndrome? What would these tests tell us if they are (+)?
First rib spring test: + (difference in side-side or stiffness)
Adson's test: + (pulse goes away)
Roos test: + (reproduces symptoms- heaviness or tingling)
Cervical rotation lateral flexion test + (firm or hard end feel, lack of ROM, indicates 1st rib elevation/hypomobility)
ULNTT: +RS with neurodynamic testing
UE paresthesias, numbness or weakness may be present
What are some treatments for Thoracic Outlet Syndrome? What are some examples? What is the ICF category?
ICF: Thoracic pain with radiating pain
Treatments: mobilization for pain, unloading/desensitization, exercise and strengthening to improve ROM
Examples: Cervicoscapular unloading, CPAs/UPAs
What would you find in an exam for T4 syndrome? What are some treatments?
PA at T4: +RS, Palpation of rib angles may cause symptoms, changes in color or temperature, ULNTT - (+)RS
Treatments: manual therapy, movement reeducation, desensitization
REFER OUT if s/s indicat: cardiac dysfunction, neurological disease, spinal tumor, kidney disease
What are the progressions for the middle trapezius muscle strengthening exercise?
Level 1: In the starting position (shoulders 90 degrees, elbows 90 degrees, forearms on table) have patient bring scapulas together
Level 2: then have them lift hands and wrists off the table
Level 3: then have them lift wrists, hands and elbows off the table
Level 4: Have them lift arms off table
Level 5: add band
What are some common complaints for 1st Rib dysfunction?
Stiffness, pain in region and with turning head or abducting arm on involved side, may result in local OR radicular symptoms
Heavy breathing or use of accessory muscles may provoke symptoms
What are some tests you would do for 1st rib dysfunction? What would the tests tell us if they were +?
Cervical Rotation Lateral Flexion Test: + (firm/hard end feel, lack of ROM- indicates hypomobile/elevated 1st rib)
Cervical spine ROM- flexion: limited
Restricted or painful abduction on involved side
What is the ICF category? What are some treatments we could provide?
ICF: Thoracic pain with mobility deficits
Treatment: manual therapy, passive and active movements
Examples: 1st rib mobilizations, self mobilizations for at home with towel, Isometric mobilizations for ribs