OMM
According to the rule of 3s, where is the transverse process of T7 located relative to its spinous process?
A.One and a half vertebral levels above the tip of the spinous process
B. At the same level
C.One full vertebral level above the tip of the spinous process
D.One-half vertebral level above the tip of the spinous process
C. One full vertebral level above the tip of the spinous process
According to the rule of 3s, the transverse process of T7 is located one full vertebral level above the tip of its spinous process. This is also true for T8, T9, and T10.
An individual with a history of emphysema has a muscular impairment that limits their ability to depress their ribs. Which of the following muscles is most likely affected?
a.Rhomboid major
b.Serratus posterior superior
c.Levator scapulae
d.Serratus posterior inferior
e.Trapezius
Serratus posterior inferior
The serratus posterior inferior depresses the ribs, assisting with exhalation. A deficit in this muscle would limit the ability to depress the ribs.
A patient presents with a palpable posterior spinous process at the level of the inferior angle of the scapula. Which spinal segment are you palpating?
A.T5
B.T7
C.T8
D.T9
B.T7
The inferior angle of the scapula is a key landmark for the T7 spinous process.
A patient presents with weakness in retracting their scapula. Upon examination, you find a lesion affecting the nerve that originates from the anterior rami of C5. Which nerve is most likely injured?
a.Dorsal scapular nerve
b.Long thoracic nerve
c.Subscapular nerves
d.Spinal accessory nerve
e.Thoracodorsal nerve
Dorsal scapular nerve
The dorsal scapular nerve originates from the anterior ramus of C5. It innervates the rhomboid major and minor, whose primary actions include scapular retraction. This nerve would be the most likely injured.
A physician is performing passive testing on a patient in the prone position. The physician places their thumbs on the transverse processes and observes that the segment moves more easily with rotation to the right and sidebending to the left. What is the diagnosis?A.Not enough information to diagnose
B.Type II dysfunction
C.Type I dysfunction
D.Physiological barrier
C.Type I dysfunction
The dysfunction is described as having rotation to the right and sidebending to the left. These are coupled motions in opposite directions, which is a characteristic of a Type I dysfunction (neutral).
A patient's T4 segment translates easily to the right. What is the side of sidebending?
A.Neutral
B.Sidebent Left
C.Sidebent Right
D.Cannot be determined
B.Sidebent Left
The ease of translation is to the right, which indicates a left sidebending somatic dysfunction.
A patient suffers a traumatic injury to the dorsal scapular nerve. Which of the following muscles would most likely be paralyzed?
a.Levator scapulae and trapezius
b.Serratus posterior superior and serratus posterior inferior
c.Latissimus dorsi and trapezius
d.Trapezius and latissimus dorsi
e.Rhomboid major and levator scapulae
Rhomboid major and levator scapulae
The dorsal scapular nerve innervates the rhomboid major and the levator scapulae.
A physician is using passive testing to diagnose a segment. The patient is prone, and the physician's thumbs are on the transverse processes (TPs). They observe that the T3 segment springs well on the right and poorly on the left. The segment also translates easily to the right. What is the diagnosis?
a.T3 Flexed, Rotated Right, Sidebent Left (FRSL)
b.T3 Neutral, Rotated Right, Sidebent Left (NRRSL)
c.T3 Extended, Rotated Left, Sidebent Left (ERLSL)
d.T3 Neutral, Rotated Left, Sidebent Right (NLRSR)
e.T3 Flexed, Rotated Left, Sidebent Left (FLLSL)
T3 Neutral, Rotated Left, Sidebent Right (NLRSR)
A TP that springs poorly on the left is considered a posterior TP, which indicates rotation to the left. Easy translation to the right indicates a sidebending dysfunction to the left. The rotation and sidebending are in opposite directions, which is characteristic of a Type I (Neutral) dysfunction.
During surgery to remove a tumor in the posterior triangle of the neck, a surgeon accidentally ligates the superficial branch of the transverse cervical artery. Which part of the trapezius muscle would become ischemic?
a.Ascending part
b.Lateral part
c.Descending part
d.Middle part
e.Superior part
Middle part
The middle part of the trapezius is supplied by the transverse cervical artery or its superficial branch.
A patient's T12 segment is found to be rotated left and sidebent right. Which of Fryette's laws applies to this finding?
A.Fryette's Law III
B. Fryette's Law I
C. None of the above
D. Fryette's Law II
B. Fryette's Law I
Fryette's Law I states that in the neutral range, sidebending and rotation are coupled in opposite directions. The patient's T12 is rotated left and sidebent right, which follows this law.
On examination, the left transverse process of T11 is noted to be posterior in the seated neutral position. When the patient is asked to flex, the asymmetry becomes more prominent. What is the diagnosis?
A.T11 Extended, Rotated Left, Sidebent Left (ERLSL)
B.T11 Neutral, Rotated Left, Sidebent Right (NLRSR)
C.T11 Extended, Rotated Left, Sidebent Right (ERLSR)
D.T11 Flexed, Rotated Left, Sidebent Left (FLLSL)
A.T11 Extended, Rotated Left, Sidebent Left (ERLSL)
The left TP is posterior, so the segment is rotated left. Since the asymmetry becomes *more* prominent with flexion, it is considered an extended dysfunction. According to Fryette's Law II, the rotation and sidebending are coupled in the same direction, so the segment is sidebent left as well.
A patient presents with a deep stab wound to the posterior back, resulting in denervation of the serratus posterior superior muscle. What would be the most likely clinical finding?
Impaired elevation of the upper ribs
That's right!
The serratus posterior superior muscle originates from the spinous processes of C7-T3 and inserts on the 2nd-4th ribs. Its action is to elevate the ribs. An injury to this muscle would therefore impair the ability to elevate the upper ribs.
a.Limited medial rotation of the humerus
b.Limited scapular retraction
c.Inability to elevate the humerus
d.Inability to depress the humerus
e.Impaired elevation of the upper ribs
Impaired elevation of the upper ribs
The serratus posterior superior muscle originates from the spinous processes of C7-T3 and inserts on the 2nd-4th ribs. Its action is to elevate the ribs. An injury to this muscle would therefore impair the ability to elevate the upper ribs.
While evaluating a patient, you palpate a posterior transverse process (TP) at the level of the spine of the scapula and note that it becomes more symmetric when the patient sidebends to the left. What is the diagnosis?
A.T4 Flexed, Rotated Left, Sidebent Left (FLRSL)
B.T4 Neutral, Rotated Left, Sidebent Right (NLRSR)
C.T3 Extended, Rotated Right, Sidebent Right (ERRSR)
D.T3 Neutral, Rotated Right, Sidebent Left (NRRSL)
D. T3 Neutral, Rotated Right, Sidebent Left (NRRSL)
The spine of the scapula landmark is at the level of the T3 spinous process. T3 is in the T1-T3 range, where the TP and SP are at the same level. A posterior TP indicates rotation to that side. The patient is becoming more symmetric when sidebending left, indicating that the segment prefers left sidebending, which means it is sidebent left. The combination of rotated right and sidebent left, which are opposite directions, indicates a neutral dysfunction.
A patient presents with weakness in retracting their scapula. Upon examination, you find a lesion affecting the nerve that originates from the anterior rami of C5. Which nerve is most likely injured?
a.Dorsal scapular nerve
b.Long thoracic nerve
c.Subscapular nerves
d.Spinal accessory nerve
e.Thoracodorsal nerve
Dorsal scapular nerve
The dorsal scapular nerve originates from the anterior ramus of C5. It innervates the rhomboid major and minor, whose primary actions include scapular retraction. This nerve would be the most likely injured.
You palpate a posterior transverse process in a patient that springs poorly on the right at the level of the T8 spinous process. The dysfunction becomes less prominent when the patient is extended. What is the diagnosis?
A.T9 Neutral, Rotated Right, Sidebent Left (NRRSL)
B. T9 Extended, Rotated Right, Sidebent Right (ERRSR)
C. T8 Extended, Rotated Right, Sidebent Right (ERRSR)
D. T8 Flexed, Rotated Right, Sidebent Right (FRRSR)
B. T9 Extended, Rotated Right, Sidebent Right (ERRSR)
The spinous process of T8 corresponds to the transverse process of T9, as the TP is one full vertebral level above the SP in this region. The posterior TP on the right means it's rotated right. The segment becoming 'less prominent' (more symmetric) in extension indicates it's an extended dysfunction. According to Fryette's Law II, rotation and sidebending are coupled in the same direction, so it's also sidebent right.
A patient's T7 segment has a palpable posterior TP on the left. The segment resists translation to the left and springs well on the right. During a passive exam, the asymmetry becomes more prominent with flexion. What is the diagnosis?
a.T7 Flexed, Rotated Left, Sidebent Left (FLLSL)
b.T7 Neutral, Rotated Left, Sidebent Right (NLRSR)
c.T7 Extended, Rotated Left, Sidebent Left (ERLSL)
d.T7 Extended, Rotated Right, Sidebent Left (ERRSL)
e.T7 Extended, Rotated Left, Sidebent Right (ERLSR)
T7 Extended, Rotated Left, Sidebent Left (ERLSL)
A posterior TP on the left means the segment is rotated left. Resisting translation to the left also indicates a sidebending dysfunction to the left. The asymmetry becoming more prominent with flexion indicates an extended dysfunction. Since rotation and sidebending are in the same direction, this is a Type II dysfunction.
A 25-year-old male is admitted to the hospital after a serious motor vehicle accident. He presents with a complete transection of the thoracodorsal nerve. Which of the following actions would be most significantly affected?
a.Retraction of the scapula
b.Elevation of the scapula
c.Depression of the ribs
d.Adduction of the humerus
e.Extension of the neck
Adduction of the humerus
The thoracodorsal nerve innervates the latissimus dorsi muscle, which is responsible for the extension, adduction, and medial rotation of the humerus. An injury to this nerve would impair these actions.
On exam, you find that the right transverse process (TP) of T5 is posterior and becomes more symmetric with flexion, but more posterior with extension. What is the diagnosis?
A. T5 Extended, Rotated Right, Sidebent Right (ERRSR)
B. T5 Neutral, Rotated Left, Sidebent Right (NRLSR)
C. T5 Flexed, Rotated Right, Sidebent Right (FRRSR)
D. T5 Neutral, Rotated Right, Sidebent Left (NRRSL)
C. T5 Flexed, Rotated Right, Sidebent Right (FRRSR)
The posterior TP becoming more symmetric (moving anterior) with flexion indicates a flexed somatic dysfunction. The right TP is posterior, which means it is rotated right. According to Fryette's Law II, in a flexed or extended state, rotation and sidebending are coupled in the same direction, so it is also sidebent right
A surgeon is performing a procedure on a patient's back. To expose deeper muscles, they need to reflect the serratus posterior inferior. Which bony landmarks would you expect to find at its origin?
a.Spinous processes of C7-T3
b.Spinous processes of T11-L2
c.Transverse processes of C1-C4
d.Superior borders of the 2nd-4th ribs
e.Iliac crest and inferior 3 or 4 ribs
Spinous processes of T11-L2
The serratus posterior inferior originates from the spinous processes of T11-L2 and inserts on the inferior borders of ribs 8-12.
A physician is evaluating a patient's T4 segment. In the neutral position, a posterior TP is noted on the right. When the patient is asked to flex, the asymmetry becomes less prominent. When the patient is asked to extend, the asymmetry remains unchanged from the neutral position. What is the diagnosis?
a.T5 Flexed, Rotated Right, Sidebent Right (FRRSR)
b.T4 Flexed, Rotated Right, Sidebent Right (FRRSR)
c.T4 Flexed, Rotated Right, Sidebent Left (FRSBL)
d.T4 Neutral, Rotated Right, Sidebent Left (NRRSL)
e.T4 Extended, Rotated Right, Sidebent Right (ERRSR)
T4 Flexed, Rotated Right, Sidebent Right (FRRSR)
A posterior TP on the right indicates rotation to the right. The asymmetry becoming less prominent with flexion indicates a flexed dysfunction. According to Fryette's Law II, sidebending and rotation are coupled in the same direction, so it is also sidebent right.
During a prone exam, you find a posterior transverse process (TP) that springs poorly on the right at the level of the T8 spinous process. When you passively extend the patient, the TP becomes more prominent. What is the diagnosis?
T9 Extended, Rotated Right, Sidebent Right (ERRSR)
T9 Flexed, Rotated Right, Sidebent Right (FRRSR)
Right answer
The posterior TP at the level of the T8 spinous process is actually the TP of T9, because the TP of T7-T9 is one full vertebral level above its corresponding SP. The posterior TP is on the right, indicating rotation to the right. The segment becoming more prominent with extension means it is a flexed dysfunction. According to Fryette's Law II, in a flexed or extended state, rotation and sidebending are coupled in the same direction, so it's also sidebent right.
T9 Extended, Rotated Right, Sidebent Right (ERRSR)
T9 Flexed, Rotated Right, Sidebent Right (FRRSR)
T9 Flexed, Rotated Left, Sidebent Left (FLLSL)
T8 Flexed, Rotated Right, Sidebent Right (FRRSR)
T9 Neutral, Rotated Right, Sidebent Left (NRRSL)
T9 Extended, Rotated Right, Sidebent Right (ERRSR)
T9 Flexed, Rotated Right, Sidebent Right (FRRSR)
The posterior TP at the level of the T8 spinous process is actually the TP of T9, because the TP of T7-T9 is one full vertebral level above its corresponding SP. The posterior TP is on the right, indicating rotation to the right. The segment becoming more prominent with extension means it is a flexed dysfunction. According to Fryette's Law II, in a flexed or extended state, rotation and sidebending are coupled in the same direction, so it's also sidebent right.
A patient is unable to elevate their scapula due to a complete paralysis of the levator scapulae muscle. Which of the following is the most likely location of a nerve injury?
a.A lesion to the spinal accessory nerve (CN XI)
b.A lesion to the dorsal scapular artery
c.A lesion to the posterior intercostal arteries
d.A lesion to the dorsal scapular nerve
e.A lesion to the subcostal nerve
A lesion to the dorsal scapular nerve
The levator scapulae muscle is innervated by the dorsal scapular nerve. A lesion to this nerve would result in paralysis of the muscle.
A patient's T6 segment presents with a prominent right transverse process that resists posterior-to-anterior springing. When you passively sidebend the patient, the segment translates easily to the left. What is the diagnosis?
A.None of the above
B.T6 Neutral, Rotated Right, Sidebent Left (NRRSL)
C.T6 Neutral, Rotated Left, Sidebent Right (NLRSR)
D.T6 Flexed, Rotated Right, Sidebent Right (FRRSR)
A.
None of the above
A posterior TP that resists springing on the right indicates rotation to the right. Easy translation to the left indicates sidebending to the right. A neutral dysfunction is defined by rotation and sidebending in *opposite* directions. The patient has a posterior TP on the right (rotated right) and translates easily to the left (sidebent right). This is inconsistent with Fryette's Law I and may indicate a different type of dysfunction or an incomplete finding.
Which of the following muscles originates on the spinous processes of C7-T1 and inserts on the medial end of the scapular spine?
a.Serratus posterior superior
b.Trapezius
c.Levator scapulae
d.Rhomboid major
e.Rhomboid minor
Rhomboid minor
The rhomboid minor originates on the spinous processes of C7-T1 and inserts on the medial end of the scapular spine.
While palpating a patient's thoracic spine, you identify a posterior transverse process (TP) at the level of the spine of the scapula. When you sidebend the patient, you notice the asymmetry becomes more prominent with right sidebending and more symmetric with left sidebending. What is the diagnosis?
a.T3 Extended, Rotated Left, Sidebent Left (ELLSL)
b.T4 Neutral, Rotated Left, Sidebent Right (NLRSR)
c.T3 Neutral, Rotated Left, Sidebent Left (NLLSL)
d.T3 Flexed, Rotated Right, Sidebent Right (FRRSR)
e.T3 Neutral, Rotated Right, Sidebent Left (NRRSL)
T3 Neutral, Rotated Right, Sidebent Left (NRRSL)
The spine of the scapula corresponds to the T3 spinous process. A posterior TP on the right indicates rotation to the right. The patient's sidebending ease is to the left (the side where the asymmetry becomes more symmetric). When sidebending and rotation are in opposite directions, this indicates a neutral (Type I) dysfunction.