Thoracic Orthopedic Evaluation and Differential Diagnosis

Course Description

The ability to perform a competent examination and differential diagnosis of the patient with symptoms of thoracic origin is critical for the practice of physical therapy. While most entry level physical therapists possess a basic understanding of the anatomy of the region and can perform a basic examination including a subjective history, AROM and palpation, a more nuanced understanding of the source of thoracic symptoms is essential for the management of more complex cases. This understanding should derive from examination of combined movements, segmental assessment, stress testing and an expanded ability to integrate the concept of regional interdependence, and as such this course will be focused on those areas.

Course Objectives

At the end of this course, the participant will be able to:

• Define the anatomical boundaries of “thoracic pain” and clearly state an anatomical rationale for those boundaries
• Identify the current incidence and prevalence of thoracic pain, as well as recognize patient populations who have the highest incidence
• Recall the components of the thoracic motion segment and costal cage
• Summarize the essential components of a subjective examination for the patient with thoracic pain
• Recognize relevant mechanisms of injury involving the thoracic spine and costal cage that can be associated with serious medical pathologies
• Recognize red flags and non-mechanical sources of pain during a thoracic subjective examination that would necessitate medical referral. Particular attention will be paid – but not limited – to organ related pain referral, compression fractures, and cardiopulmonary conditions.
• Summarize subjective information associated with thoracic outlet syndrome (TOS) for the purpose of differential diagnosis.
• Summarize the outcome measures that are validated for use in patients complaining of thoracic pain
• State the key areas of observation and palpation including general postural findings.
• Describe a method to differentiate structural vs functional scoliosis in and determine the need for medical referral.
• Recall the sequence of palpation, AROM and combined movements of the thoracic spine, and explain how to interpret the results in order to help rule in the thoracic spine and rule out involvement from the cervical or lumbar spine.
• Describe passive physiological and passive accessory movement assessment in the thoracic spine in order to identify a segment of interest
• Recall the suggested methodology for strength assessment of the deep cervical flexors and relevant thoracic and scapulo-thoracic musculature
• Summarize and describe the performance of special tests relevant to the thoracic spine (including stress testing, neurological testing, TOS and neural mobility assessment)
• Recall evidence based test clusters and clinical prediction rules that can be applied to aid in the diagnosis and / or treatment planning of the patient with thoracic pain.
• Integrate subjective examination findings with biomechanical considerations for the thoracic spine and differentiate the objective examination data in order to form a treatment hypothesis.
• Distinguish which movements, special tests and confirmatory techniques can help support their theory
• Develop a treatment algorithm through the case presentation to prioritize treatment interventions in order to maximize chances for success.

• Prerequisites

  None

• Educational Level

  Intermediate

• Other

  Satisfactory completion of this course will require the participant to respond to polling questions asked throughout the webinar.