Download Thoracic Spine and Rib Cage Algorithm

Thoracic Spine and Rib Cage Algorithms
Pain with
Respiration,
Coughing, or
Sneezing?
No
Mid/Lower Thoracic Single
Plane Active Mobility Exam
Yes
Transverse Plane
Mobility Loss
Sagittal Plane
Mobility Loss
Coronal Plane
Mobility Loss
Go To Rib
Cage Clinical
Pathways
Contralateral Pain
End of Range
Ipsilateral Pain
End of Range
Contralateral Pain
End of Range
Contralateral Pain
End of Range
Ipsilateral Pain
End of Range
Ipsilateral Pain
End of Range
Mid/Lower Thoracic
Spine Segmental /Soft
Tissue Mobility Exam
Mid/Lower Thoracic
Spine Segmental/Soft
Tissue Mobility Exam
Mid/Lower Thoracic
Spine Segmental /Soft
Tissue Mobility Exam
Transverse
Plane Flexion
Dysfunction
Pattern
Transverse
Plane
Extension
Dysfunction
Pattern
Skulpan Asavasopon MPT, OCS
Sagittal
Plane
Extension
Dysfunction
Pattern
Coronal
Plane
Flexion
Dysfunction
Pattern
Coronal
Plane
Extension
Dysfunction
Pattern
Sagittal
Plane
Flexion
Dysfunction
Pattern
KP So Cal Ortho PT Residency
Thoracic Spine Examination Algorithm
End of Range Pain
Contralateral Side
Thoracic Spine Active Mobility Exam
(with over pressure if indicated)
Pain Limited
Positive Asymmetry in
Flexion on Painful Side
End of Range Pain
Ipsilateral side
Active Mobility
Transverse Process Symmetry Palpation
Positive Asymmetry in
Extension on Painful Side
Structural Asymmetry
Soft Tissue Mobility
Restriction/Provocation
on Painful Side
Soft Tissue
Mobility/Provocation Exam
Soft Tissue Mobility
Restriction/Provocation
on Painful Side
Pain Limited Soft Tissue Mobility
Resistance Limited
Accessory Motions with
Symptom Provocation
Mobility Examination of Thoracic Spine
Accessory Motions
Resistance Limited
Accessory Motions with
Symptom Provocation
Pain Limited Accessory Motions
Flexion
Mobilization
Pattern
Skulpan Asavasopon MPT, OCS
Stabilization
Or
Modalities
Pattern
Extension
Mobilization
Pattern
KP So Cal Ortho PT Residency
Rib Cage Algorithm
Palpation/Provocation of:
• Costovertebral Joints
• Costochondral Junction
Suspect Underlying
Stress Fracture?
Consult With Referring
Healthcare Practitioner
Costovertebral
Joint Pain
Costrochondral
Junction Pain
Observe Rib Cage:
• Excursion with
Inhalation/Exhalation
Palpation for
Symmetry
Costovertebral Joint
Mobilization Pattern
Skulpan Asavasopon MPT, OCS
Anterior Rib
Mobilization Pattern
Posterior Rib
Mobilization Pattern
KP So Cal Ortho PT Residency
Rib Cage Clinical Pathways
Inhalation
Breathing
Exercises
Pain with Inhalation
Respiratory Pattern Recognition
Pain with Exhalation
Anterior with
Internal Rotation
Anterior with
External Rotation
Rib Positional Testing
Exhalation
Breathing
Exercises
Posterior Rib
Mobilization
with STM to
facilitate
Internal or
External Rib
Posterior with
Internal Rotation
Posterior with
External Rotation
Anterior Rib
Mobilization
with STM to
facilitate
Internal or
External Rib
Costovertebral Joint
Provocation Testing
Sternocostal Joint
Intercostal Muscle
Skulpan Asavasopon MPT, OCS
Mobilization of
Costovertebral,
Sternocostal
Joint, or STM
Intercostal
Muscles
KP So Cal Ortho PT Residency