Thoracic Common Conditions
Pain from zygapophyseal joint dysfunction can radiate how many levels above and below?
- Above = 1/2 level - Below = 2-3 levels
What are risk factors for Intercostal Neuritis?
- Adults over 70 - Immunocompromised - Underlying malignancy - Organ transplant - AIDS
What is the most common fx in the thoracic spine?
- Anterior wedge compression fx - Burst fx *between 9th and 10th vertebral bodies*
What are some intervention ideas for intercostal muscle injury?
- Anti-inflammatories - Avoid motions that hurt
Zyapophyseal joint dysfunction causing a facet impingement has what clinical manifestation?
- Blocking feeling - Pain/guarding from trapped facet capsule
What is the clinical presentation of TOS?
- Diffuse arm and shoulder pain (especially when elevated above 90 degrees) - Pain localized in neck, head, face, UE - UE paresthesia - Arm feels heavy and fatigued - Swelling - Discoloration/ulceration - Neural sx's > Vascular sx's
What is the clinical presentation of intercostal neuritis?
- Fever - Chills - Headache and malaise - 1-2 days of pain, itching and hyperesthesia - Skin eruption appear 4-5 days after other symptoms
Zygapophyseal joint dysfunction causing a facet sprain has what clinical manifestation?
- Hx of trauma - Limited ROM - Swelling may cause foraminal stenosis or DDD
Thoracic vertebral fx occur from what two motions?
- Hyperflexion - Axial loading
Dorsal Nerve Root irritation may be caused by what two processes?
- Infection (shingles) - Mechanical (bone spur, etc)
Muscle strains produce localized pain and tenderness exacerbated with what 2 things?
- Isometric testing - Passive stretching
Why are rib fractures scary?
- Lacerate lungs - Lacerate brachial plexus - Injure liver, spleen
What is the clinical presentation of a dorsal nerve root irritation?
- Lateral/Anterior chest wall pain - Hx of back pain - Pain aggravated by UE exertion - Numbness/tingling - Atrophy
How does RA clinically manifest itself in the thoracic region?
- Pain and deep swelling - Possible sublux - Xray important to rule out instability * People w/ RA have delicate joints *
What are clinical findings of intercostal muscle injury?
- Pain b/w ribs that is WORSE with movement, inspiration or cough - Tender to palpation
What are clinical features of rib dysfunction?
- Pain with deep breathing, sneezing or coughing - Pain with trunk rotation - Localized pain approx 3-4 cm from midline
PT intervention for precordial catch syndrome includes what?
- Postural re-education - muscle imbalance exercise - mobilize hypomobile segments
If a PT suspects steroid abuse, what should they do?
- Report it to a coach or physician
What are the clinical characteristics for costochondritis?
- Sharp, stabbing pain along front edges of sternum - May radiate down left arm and upper back *Resembles a heart attack*
How does precordial manifest itself?
- Sharp, stabbing pain in precordial and L parasternal region - Does NOT radiate - Usually last a few seconds
What are the clinical characterisitcs of Tietze's Syndrome?
- Sudden or gradual onset of upper anterior chest pain - Inc. HR, BP - Pain radiating down left arm - Pain aggrevated by sneezing, coughing, deep inhale, twisting
What are RF for costochondritis?
- Trauma - Repetitive motion
What are the clinical findings for T4 syndrome?
- local tenderness - + slump, ULTT - Depression or prominent spinous process - local stiffness of one segment
Which costochondral joints does costochondritis typically effect?
2-5
If TOS sx's fail to respond to PT treatment within _____ months, surgery should be considered
4 months
Precoridal catch syndrome typically occurs in what age group?
Adolescents
What imaging is helpful in identifying rib dysfunction?
CT scan
A potential muscle impairment of scoliosis would be mobility impaired on the (concave/convex) side of the curves?
Concave
A potential source of symptoms with scoliosis occurs from muscle fatigue on )convex/concave) side?
Convex
In early stages of OA, DJD, and spondylosis, the thoracic spine is ______mobile
Hyper
In the late stages of OA, DJD, and spondylosis, the thoracic spine is _________mobile
Hypo
In the middle stages of OA, DJD, and spondylosis what begins to form within the thoracic spine?
Osteophytes -- need to be careful because osteophytes can impinge on SC
What age group does costochondritis most often effect?
Over 40 y/o
Initial interventions for thoracic muscle strains include strength and passive stretch into which direction?
PAINLESS
What is a clinical finding of Scheuermann's Disease?
Pain with thoracic ext and rotation
Intercostal muscle injuries typically occur from direct trauma, but can also result from sports such as ?
Rowing
What disease involves a defect to the ring apophysis of vertebral body and anterior wedging of affected vertebrae?
Scheuermann's Disease
With scheuermann's, end plates can crack allowing disc to protrude into the vertebral body, this is called what?
Schmori's node
Most ribs can sublux ant/post, but 1st rib can sublux in which direction?
Superior
What is a difference between Tietze's and costochondritis?
Tietze's = under 40 y/o Costochondritis = 40 or older
What other condition is very similar to costochondritis?
Tietze's Syndrome
Does T4 syndrome typically occur in men or women more?
Women
Where there is _______________ there will be compensatory ______________
hypomobility, hypermobility
In precordial catch syndrome, where does pain originate?
pleura