Thoracic Somatic Dysfunction

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Question

Answer

Chest pain can be influenced via this bone.

Rib

Paraspinal neck muscles can arise from the level of the _______.

Thoracic Spine

Learning about thoracic somatic dysfunction is useful for ________ pain.

Viceral Chest Back

What are the ways to think about the thoracic spine?

Side to side Back to front Top to bottom Inside to outside

Medical conditions that may correlate with thoracic somatic dysfunction:

sinusitis asthma COPD pneumonia coronary artery disease hypertension peptic ulcer disease depression stress

What are the different things to assess about thoracic spine? (5)

1) Skin Layer 2) Fascia 3) Muscle 4) Bony Layer 5) Movement

What are the unique features of the thoracic vertebrae?

Demifacet Transverse costal facet Coronal (more or less) orientation of the articular processes Long spinous process

What are the rules of 3?

the relationship of the spinous process tip to underlying bony structures

What is the relationship of the spinous prcesses of T1-T3 to underlying bony structures?

Same level as vertebral body

What is the relationship of the spinous processes of T4-T6 to the underlying bony structures?

1/2 vertebral level down

What is the relationship of the spinous processes of T7-T9 to the underlying bony structures?

1 vertebral level down

What is the relationship of the spinous processes of T10-T12 to the underlying bony structures?

Same level of as vertebral body

What are the 10 facet joints?

intervertebral (4) costovertebral (4) costotransverse (2)

What is the formula for success? (4)

1. Palpate for side of paraspinal fullness 2. Side of fullness= posterior transverse process= rotation to that side 3. Rotation increases with flexion = flexed vertebra 4. Rotation increases with extension = extended vertebra

For single segments you must do what to complete your diagnosis of somatic dysfunction?

Flex and extend

How do you know which side has paraspinal fullness?

Side of fullness = posterior transverse process = rotation to that side

Fullness on T2 left paraspinal region and disappears with flexion.

T2 FRS Left

Fullness on T8-T10 right paraspinal region

T8-10 NS(l)R(r)

Fullness on T4 right and T6-11 left paraspinal regions. T4 gets better with flexion.

T4 FRS(r) T6-T11 NS(r)R(l)

How can you treat thoracic somatic dysfunction?

Counterstrain Myofascial release Muscle energy High velocity low amplitude (HVLA or thrust) Articulatory

Priority of treatment

Type II before Type I Thoracic before Rib

What are the contraindications for direct manipulation of the thoracic spine?

Malignancy Spinal infection Fracture Dislocation Joint synostosis Severe osteoporosis

What should be treated with caution with direct manipulation of the thoracic spine?

Pain at barrier Hypermobility Rotator cuff sprain/tendonitis Osteoporosis

What are reasons to treat the thoracic spine?

Thoracic back pain Non-thoracic pain Spinal or rib stiffness Organic conditions Sympathetic normalization Postural abnormality (scoliosis, hyperkyphosis) Cardiovascular conditions Respiratory conditions Anxiety or stress

Fullness on T2 left paraspinal region and gets worse with flexion.

T2 ERS(l)