Learning Scenarios: Thoracic Spine

 

CASE 1 (Spinal dysfunction):

A 50 year old kennel worker had a car accident two days ago sustaining a whiplash injury. Pain is mainly in the low cervical spine. A neurological examination is normal. Symptoms are mild and not irritable.

Tasks on the model:

  • Advise the patient on the management of their symptoms over the last 5 days.
  • Justify your choice of advice to the examiner.
  • Teach the patient 2 exercises for home.
  • Justify your choice to the examiner.
Hints and tips Hints and tips

Review your anatomy. Knowledge of surface anatomy and the structures that lie beneath will improve confidence of which structures are dysfunctional.

Learn the muscles and joint orientations (facets 45 degrees in the cervical spine) as these are often questions examiners ask.

NICE guidelines – Clinical guidelines for the physiotherapy management of Whiplash Associated disorder.

CASE 2 (Spinal dysfunction):

A 50 year old farmer is complaining of pain and stiffness in his mid thoracic spine. It is moderate pain and non-irritable.

Tasks on the model:

  • Examine the thoracic posture of the model.
  • Explain to the examiner what you are looking for.
  • Demonstrate an appropriate manual therapy technique for this patient.
  • Justify your choice of technique to the examiner.
Hints and tips Hints and tips

Review your anatomy.

Practice your assessment.

Check out the latest evidence. Muscle energy techniques and  maitland mobilisations are often used in the treatment of thoracic stiffness. Explain your clinical reasoning to the examiner. If you are looking for a stiff segment and then concentrating on this region make sure you explain this.

TASK: Using the keywords in bold above perform a medline search. We all hate evidence but the more familiar you become with it the easier it is to allow this to be the underpinning of your clinically reasoning and choices. If someone has already been successful using a treatment you are more likely to be!!

Thoracic Spine   Acquired Brain Injury    Upper Limb    Lower Limb

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