PHT 123 Orthopedics, Lecture Preparation Spring 2013

Name: Jesus Roman __________________________

Diagnoses Review Thoracic and Cervical Spine

Diagnosis Thoracic muscle injuries Causes/contributing factors
Occurs because of some type of direct contact (contusion during athletic activities) or indirect overstretching or contraction.

Treatment ideas
Control pain with massage and swelling; Ice applied during acute stage; Ultrasound; Moist heat; estem; Strengthening exercises; postural awareness that focuses on scapular retraction & thoracic extension; Prone thoracic & lumbar extension; Pain decreases do isotonic strengthening exercises. Lateral disc can be treated with rest, analgesics, modalities to reduce pain and swelling, and epidural injections. Central disc herniations must be surgically treated to remove the neurological impingement; Following with bracing for bone and soft tissue healing to prevent from unwanted forces, AROM, strengthening and endurance activities.

Other concerns/considerations These muscle injuries occur mainly in younger active patients; Patient should do these exercises only if they can tolerate them.

Thoracic disk injury

Most common areas affected are between the 9th-12th thoracic vertebrae; Affects both men and women equally; Treatment depends on whether the disc is herniated laterally or centrally; Central disc prolapse may produce symptoms of spastic paraparesis and increase deep tendon reflexes; Lateral disc can show signs of nerve root compression.

Kyphosis

Poor posture; Osteoporosis causes anterior wedging.

Patient education in posture; Bracing of the thorax to minimize compression may be used if there is a significant amount of curvature; Stretching exercises for the anterior shoulder and pectorals; Strengthening for the thoracic extensors; Massage for pain; Thermal agents; Analgesics

Causes of pain because of kyphosis are due to stress in the posterior longitudinal ligaments, muscle fatigue due to weakened posterior muscle groups.

PHT 123 Orthopedics, Lecture Preparation Spring 2013 Scoliosis The cause is usually unknown (idiopathic) but can be a result from neuromuscular causes or related to osteoporosis, degenerative disease, trauma, and postsurgical factors.

Name: Jesus Roman __________________________ Strengthening and stretching exercise to increase muscle strength, reduce pain, and improve spinal motion; Bracing; Surgery for severe curves.

Whiplash

Cervical radiculopathy - disc

Cervical spondylosis

There are two types of scoliosis, structural and nonstructural. Structural scoliosis (irreversible) is not corrected by the patients position or during active voluntary activities. Nonstructural scoliosis (reversible) can be change by the patients position. Pain is the most presented feature of either or. Usually occurs because of Analgesics; muscles relaxants; ROM should be approached motor vehicle accidents. rest; agents to control pain and cautiously to avoid swelling (heat, cold, reproducing the motion that ultrasound, e-stem); AROM; caused the injury; Strengthening exercises; Protection of the affected Education on posture; area to prevent further Isometric stabilization injury; Avoid end range of exercises; work site changes. head & neck flexion. Most common causes are Reduce pain, swelling, and There may be neurological because of cervical disc muscle spasm, work on symptoms with this kind of herniations, spondylosis, and centralizing the symptoms; patients because of the nerve osteophytes. ROM exercises; Strengthening root compression or exercises; Education on inflammation. posture. Is a result of wear and tear on Thermal and electrical agents for Protection from the weight-bearing structures pain relief; Analgesics; Rest from inappropriate and unwanted aggravating positions; Traction to forces because spondylosis is of the cervical spine; Impact reduce joint compressive loads, loading and repetitive a chronic degenerative cord compression, and nerve root condition and requires from microtrauma. irritation; Isometric stabilization long term care; Affects men exercises; ROM exercises; more than women. Discectomy or laminectomy to
relieve cord or root compression if pain persists; Strengthening activities; Flexion exercises.

PHT 123 Orthopedics, Lecture Preparation Spring 2013 Cervical facet Degenerative changes to the cervical facet and surrounding soft tissue may cause it. Thoracic outlet syndrome Presence of a cervical rib, shortened or hypertrophied anterior scalene muscle, or malunion of the clavicle and subluxed first thoracic rib cause this syndrome.

Name: Jesus Roman __________________________ Pain control; ROM exercises; Posterior neck stiffness; Pain may occur with extension or rotation. In order for the treatment to be effective, it must focus on specific exercises for the affected muscles; Numbness, pain, tingling, weakness, skin and temperature changes may occur.

Stretching and strengthening exercises; Thoracic extension for muscle weakness; Education on cervical posture; Axial extension or cervical retraction exercises for the forward head posture;

Special Test Review Cervical spine

Diagnosis Vertebral Artery Test Indication/Diagnosis Vertebral artery occlusion Position Patient is supine while the examiner sits and supports the patients head with both hands. Action Extend, rotate, and laterally flex patients cervical spine to each side and hold each position for 30sec. Examiner observe for any dizziness, blurred vision, nystagmus, slurred speech, or loss of consciousness. Examiner puts downward pressure on the patients head as he/she laterally flexes head to opposite side. Positive Finding If any of those symptoms are seen, that indicates partial or complete occlusion of the vertebral artery.

Foraminal Compression Test (Spurling)

Nerve root pressure

Patient is seated as the examiner rests his both hands on top of patients head.

If there is pain, it indicates pressure on a nerve root, which can be correlated by the dermatomal distribution of the pain.