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NMT: Thoracics


ASSESSMENT
SP is 1-2 fingers lower than body of vertebra
sp's are longest in midsection of thorax
wiggle sp's and correlate with tvp movement to be sure you're on the right one
initiating the exam, pt is supine
use thenar eminences to broadly assess mvt
assess for rotation
by pushing with thumbs on opp sides of adjacent sps
stabilize bottom one, assess top one
assess for lateral flexion
by pushing down on the top of one tvp and bottom of corresponding
to see if vert twists
assess for flexion and extension
push under tvp's to see if they glide superiorly for flexion
using thumbs or pisiform
push down on tops of tvp's for extension

ROTATION MANIPULATION
push down on tvp's that stick up
stand on same side as posterior tvp
sternum is directly above, adjustment straight down with hypothenar
blocking hand thenar goes to vertebra(e) above
hand placement has fingers in opp directions, arms int rotated
feet square to side of table, knees bent, elbows bent
thrust is tightening of pecs and straightening of elbows
thrust at bottom of breath

BEDSIDE MANEUVER
for T1-3, maybe 4
for rotation of upper 3 vert or for ribs
set up on same side as posterior tvp
hypothenar on tvp with fingers resting on shoulder, soften hand for max friction
medial to lateral tissue pull
push is down and somewhat lateral
put head on opposite cheek but avoid over-rotating neck
traction head superiorly using hand to occiput
push head up until tvp pushes up into hypothenar of first hand
it's a lot of tension
once head is in position, stabilize it, no thrust on head
body weight translates down arm to tvp or rib

RIBS
posterior ribs
may or may not move with vertebra
does rib move down, up, forward? yes is normal
if rib not moving, vertebra mb stuck
adjust vertebra first, then recheck rib
palpate ribs 1 finger lateral to jct with tvp

adjust by digging hypothenar into space to drive rib either up or down
must use correct hand to match angle of ribs
reinforce hand with other hand on wrist
thrust at bottom of breath

ANOTHER WAY TO ADJUST rot rstrx or posterior rib
pt supine
stand on side opposite where tvp or rib is back
pt cross arms
pt outside knee bent and leaned toward me
reach over pt and find sticky outy tvp
thenar on tvp, med to lat tissue pull
sternum above hand on pts elbows
body drop onto pts elbows
roll pt more lateral to adjust posterior rib

SOURCES
lecture by Agresta 11/18/10

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