Thoracic Spine Lab Session DX 612 James J
Thoracic Spine Lab Session DX 612 James J. Lehman, DC, MBA, DABCO University of Bridgeport College of Chiropractic
Case Study n Actual case study from a Chiropractic College Clinic…
Clinical Presentation Chief Complaints 1. Numbness both thighs 2. Mild LBP 3. Mild hand & foot pain 4. Headaches 5. Hypothyroidism 6. Diabetes 7. Left-sided chest pain
Secondary Symptoms n n n Dizziness while getting out of bed Age-related fatigue Daily shoulder stiffness High blood pressure Gas and heartburn
Additional History n n Recent EKG normal Past Hx of MI Under financial stress Thigh numbness with standing & relieved with sitting (past 6 months)
High Risk Patient n n Is this guy a “walking time bomb? ” Why?
Additional History n n Chronic thoracic and lumbar back pain for years Pain relief with mm relaxants & back support while sitting up straight
History n Pain with use of arms in forward elevation
Additional History n Infrequent headaches resembled those that he experienced as a child.
Additional History n Reduced trunk ROM with back tenderness
Past Medical History n n n Heart attack 1996, angioplasty? Fractured C-spine 3 y/o Controlled diabetes Hypertension Hypothyroidism & Synthroid Rx
Past Medical History n Numerous meds for heart, high blood pressure, seizures, and acid reflux.
Past Medical History n n n 20 year Hx of chiropractic care 2 years since chiro care Some manipulations helped but not the drop table treatments.
Physical Examination n n 59 y/o male 72” height 301# Hypesthesia anterior right leg and thigh Decreased LE DTR
Physical Examination n n Left shoulder pain with abduction with reduced arterial return Mild neck pain in all ROM and with lifting Can you name the test?
Additional Examination n Would you prefer any other testing prior to assessment and treatment of this patient?
Intern/Clinician Assessment Working Diagnosis n Myofascial thoracic and lumbar pain associated with subluxation.
Assessment n n Do you agree with this assessment? Why?
Your Opinion n Are you ready to treat the patient?
Treatment Provided at Chiropractic College Clinic n n Prone T 4 Carver Bridge adjustment Drop to the sacral base
Outcome of Thoracic Adjustment n Immediate groaning and lifting up of torso off table with grasping and clutching of patient’s chest.
Post Manipulation Treatment Cryotherapy n Supine posture with ice reduced patient’s pain.
Clinical Question n What happened?
Patient Comments n “I felt and heard several popping sounds from inside my chest. I know my ribs are broken”
Evaluation n Positive finger pointing to anterior costal margins and exhibited signs of dyspnea
New Revelation… n n Patient fell off a building several years prior. He fractured several ribs at his sternum. He never went to a doctor for treatment… He forgot to mention this injury when asked in history x 3.
Anatomy of Rib Cage n n n Check margins Costal-cartilaginous junctures Sternal location
Working Diagnosis n What are your differential diagnoses?
Differential Diagnoses n n Sprain/Separation Costochondritis Fracture Coronary pain
Evaluation n n Would you perform orthopedic testing? If yes, which tests?
Orthopedic Evaluation n Positive finger point Palpation with positive jump sign Thoracic ROM testing
Orthopedic Evaluation n n Sternal compression Rib cage compression
Imaging Study n Radiographic examination of the ribs is indicated…
Sternal Compression Test n n n Contact sternum Apply AP force Compress rib cage gradually
Sternal Compression Test n What is the value of the sternal compression test?
Sternal Compression Test n n Pronounces rib fractures Produces pain with costochondritis
Scheplemann's Test n What is the value of Scheplemann’s test?
Vital Signs n Corroborate historical information with physical examination findings.
Subjective and Objective Findings Are the Hoof Beats… n Look for horses when you hear hoof beats,
Awareness Enhances Decision Making… n not zebras, unless you are in Africa…
Two years later… Complaint Served with Allegations n n n Medical negligence Failure to obtain informed consent Loss of consortium pled by spouse
Cardiac Emergencies n Notice that cardiac pain is not only on the left side…
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