Study Guide for the Thoracic Spine Technique and Management

> FINAL Exam

> Written by Dr. Lew, DC

>
> Okay. It's not all essay.

> The test will have 15 fill in the blanks, 5 short answer, and 1
> essay (total 50 points). I am giving you examples of the short answer and
> essay questions ahead of time to allow you to prepare a very organized and complete
> presentation of the material. Stick figure drawings are welcome of course if
> they include the appropriate explanation.
>
>
> So, here is your chance to prepare! Don't put this off. My
> suggestion is toprep early (this week) and then practice (over and over) writing (or
> speaking) the answers (without looking) in less than 40 minutes.
> The goal is that the test should be only one hour.
>
>
> Short Answer (5 points)
>
> 1) Describe the three dimensional approach of rotational
> breathing as given
> in Schroth Physiotherapy Treatment.
>
> 2) What is the desired outcome and purpose of this treatment?
>
>
> Short Answer (5 points)
>
> 1) Describe the Schroth Physiotherapy approach to stretches and
> exercises for Scoliosis.
>
> 2) Explain why this approach is different than regular exercises and
> stretching programs.
>
> Short Answer (5 points)
>
> A patient has been given the diagnosis of T4 Syndrome
>
> 1) Describe the movements that can cause the onset of T4 Syndrome.
>
> 2) What is the typical complaint of a person with T4 Syndrome?
>
> 3) What areas do you expect you need to adjust?
> 4) What muscles do you expect to see involved?
>
>
> Short Answer (5 points)
>
> Describe the key points of the Woggon approach to treating scoliosis
>

> Short Answer (5 points)

>
> Describe at least 3 varieties of modified adjustment techniques
> to use to treat a 20 degree Right Thoracic Scoliosis.
>
>
>
> Essay Question (10 points): Please write out an extensive
> and complete treatment plan for a patient to do at home over the next month
> to help with Upper to Mid-thoracic discomfort. Include exercises, stretches,
> ice/heat,ergonomic tips, etc. Give instructions on how to do the
> various procedures and if appropriate discuss the intent of the procedures.
> Drawings are welcomed. *Go for it MORE is better.* (Of course in your
> office you will do adjusting, this is just for the patient's home care.)
>
>
>
> Essay Question (10 points)
>
> Please write out a treatment plan for a 14 year old asthenic
> female patient who has come to your office with a 20 right thoracic idiopathic
> scoliosis. Her Risser sign is 4. The scoliosis was diagnosed when she was 12 years old
at 15 and the treatment has been to monitor the progression. She has a 35 thoracic
kyphosis and anterior head carriage- her EAM is 1 inch anterior to her AC joint. Her
shoulders are rolled forward. The plumb line falls anterior to her knees by 1 inch. She has
some aches and pains in her back and neck and decreased mobility on motion palpation
in various areas of her spine.
>
> Part 1: Describe to
> the patient what it means to have scoliosis. Tell her what things seem to work, what
risk of progression there is, etc.
>
Part 2: Describe
> what exercises and stretches, and any other things she should do at home to help her
control her scoliosis.
>
Part 3: Describe at least 3 varieties of modified adjustment techniques to fix her
scoliosis. Include any other procedures you would like to do to treat her in your office.
>
> Essay Question: (10 points)
>
> A 30 year old mesomorphic female patient presents with classic symptoms of Postural
Syndrome.
>
> 1) Describe Postural Syndrome in detail.
>
> 2) Create an Incremental Home Treatment Plan. This means give a
> week by week plan of what exercises, stretches, any modifications in
> activities of daily living that you would give. You may assume that she will be in
> your office weekly for her adjustments.
>
> THESE ARE NEW POSSIBLE QUESTIONS ADDED TO THE ONES GIVEN AT
THE TIME OF THE MIDTERM
>
>
> Short Answer (5 points)
>
> Describe Scheuermann's Disease, the possible prognosis, and a treatment plan
> including home stretches and exercises and types of adjustments.
- Scheuremanns Disease:
- Juvenile Kyphosis
- 13-15
- 75% pain at mid T spine
- Midback with fatigue at the END OF active day
- No in Kyphosis on prone extension
- X-ray:
- 3 ant wedging of vertebraes of at least 5 degrees
- Smorls node
- Limbus bone
- Kyphosis > 45
- Tx:
- Stretch hamstrings and pecs
- Chiropractic manipulation
- 60 degrees with muilwaukee brace
- greater than 80 degrees do surgery.

- Adjustments:
- A-P or P-A
- Adjust compensatory cervical and lumbar structures.
>
> Short Answer (5 points)
>
 > In terms of the Scapulo-thoracic junction

> 1) Describe signs and symptoms of a restricted Scapula in then scapulo-thoracic

junction.
-Scapular excursion is
- Cant raise arms
- Rigid motions

> 2) What muscles do you expect to see involved?

- Rhomboids
- Teres minor and major
- Subscap

> 3) What other areas do you expect you need to adjust?

- Upper t-spines
- Upper Ribs
- Shoulder
> 4) Describe at least three ways to mobilize the scapula.
- Sideline
- Arms between legs
- Pull medial to lateral
- Pull scapula and pull slowly

> Short Answer (5 points)

>
> A patient has pain down her right arm into the thumb and index
> finger. She has pain in her Scalene muscles.
a> zxf
> 1) What other areas do you expect you need to adjust?
- Adjust 1st and 2nd rib
- Adjust clavicle and scapula

> 2) Describe an adjustment (or two) for each area?

- Rib adjustment, single thumb move supine
- Scapula move we just did

> 3) What other muscles do you expect to see involved?

- Accessory breathing muscles
- Pec minor
- Serratus anterior posterior
- Abs for expiration

> Short Answer (5 points)

>
> A patient has pain at the base of her neck and along her shoulder in the first rib area.
>
> 1) What areas do you expect you need to adjust?
- Clavicle
- SC joint
> 2) Describe an adjustment (or two) for the first rib.
- Head of table
- P-A
- S-I
- Or prone single hand drop move

> 3) What muscles do you expect to see involved?

- Scalenes
- SCM
- Traps
- Pec minor and major
- Levator scapula

>
> Short Answer (5 points)
>
> When a person has a first rib subluxation, they often get other symptoms. Explain in
detail and in a sequential event how the first rib can affect the shoulder girdle and spine.
Drawings with explanations are welcome.