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Facet Hypermobility Syndrome
Facet Hypomobility Syndrome

Characteristics: Restricted joint motion usually due to trauma,

                            degenerative changes, or poor posture.

Signs and Symptoms:

  • Localized pain with motion and sometimes with inhalation

  • Normal kyphosis is altered (Increase or decrease)

  • Tenderness

  • Positional faults

  • Decreased segmental mobility

  • May have decreased ROM

Special Tests: Positive passive intervertebral motion testing

                         Positive spring test

Intervention: Heat, joint mobilization, postural education,

                        stretching, strengthening, breathing exercises

                                                                                                (Gann, 2001)

 

Characteristics: Increased mobility usually due to trauma or from

                            muscle imbalances or compensations above or

                            below a restricted segment. Can occur from

                            excessive joint "popping".

Signs and Symptoms:

  • Pain usually after increased activity

  • Increased muscle tone

  • Tenderness on associated ligaments

  • Positional faults

  • Increased segmental mobility

  • Clicking, urge to "pop"

Special Tests: Positive PIVM, Positive Spring Test

Intervention: Restore neighboring hypomobility, strengthening,

                        postural education, bracing if more involved,

                        stabilization exercises                                (Gann, 2001)

Characteristics: Very rare, more frequent in men older than 50 at

                            T11 and 12, usually due to axial compression, can 

                            cause cord compression

Signs and Symptoms:

  • May have radicular pain

  • Pain is usually constant, dull, and burning

  • Increased kyphosis

  • Pain with breathing

Special Tests: Imaging

Intervention: Modalities, bracing, rest, postural exercises, extension and stabilization exercises.                         

                                                                                                (Gann, 2001)

 

Characteristics: Dowager's hump: upper T-spine kyphosis seen in

                            osteoporotic and/or post-menopausal women

                            Kyphosis and scoliosis: spinal curve alterations,

                            usually nonpainful if mild

Signs and Symptoms:

  • Dowager's hump: hypomobility in upper T-spine with a hump and mild tenderness

  • Curve alterations may have hypo- and hypermobility

  • Postural deficits may be visible

Special Tests: Observation, x-ray

Intervention: Postural exercises, strengthening and strengthening

                        exercises, patient education, bracing, surgery for

                        scoliosis if severe                                         (Gann, 2001)

Thoracic HNP
Postural Syndromes

Musculoskeletal System Dysfunctions

T4 Syndrome
Compression Fracture

Characteristics: Associated with hypomobility at T4 but can occur

                            at other levels, ANS may be involved, predisposing

                            factors incluse trauma or unaccustomed activities,

                            not very common

Signs and Symptoms:

  • Pain and paresthesias down the arm that does not follow a dermatomal distribution, with the hand always involved

  • Tenderness

  • Head and neck pain

  • Hyper- or hypo- mobility

Special Tests: Positive ULTT, Positive Slump test in some patients

Intervention: Mobilizations, postural correction, gentle neural

                        stretching, strengthening as symptoms decrease,

                        traction and modalities for pain may help

                                                                                               (Gann, 2001)

Characteristics: Due to minor trauma in the elderly, usually from

                            osteoporosis, more common in women older than

                            60, common at T11-12, L1-2, May occur

                            spontaneously.

Signs and Symptoms:

  • Acute pain after trauma, especially with motion

  • Very limited extension and rotation

Special Tests: X-ray

Intervention: acute: bed rest and pain modalities, walking

                        program, extension and stabilization exercises,

                        bracing, patient education, vertebroplasty to restore  

                        the vertebral height

                                                                                               (Gann, 2001)

 

 

Scheuermann's Disease
Costochondritis

Characteristics:

  • Disorder of the epiphyseal growth plate of the vertebral body

  • Results in anterior wedging of the vertebra

  • Etiology is unknown but is associated with increased activity and poor posture

  • Common in 12-18 year old boys

  • Common at T9 and may involve 5 vertebra

  • Can lead to DDD, cord compression, spondylolysis and stenosis

Signs and Symptoms:

  • Mild, localized pain

  • Kyphosis

  • Hypomobility

Special Tests: X-ray shows wedging and narrow intervertebral

                        space, decreased bone mineral density

Intervention: Postural exercises, spretching hamstrings and

                        pectorals, strengthening scapular adductors and

                        paraspinals, bracing, biofeedback             (Gann, 2001)

Characteristics:

  • Also known as Tietze's syndrome

  • Irritation of costochondral junction

  • Can be due to trauma, infection, surgical complication. arthritis, bronchitis, or unknown

  • Common at 4th rib and in teens

Signs and Symptoms:

  • Localized anterior chest wall pain, especially with palpation and after a persistent cough

  • Pain may radiate to the shoulder and arm

Special Tests: palpation and history, imaging

Intervention: Iontophoresis, phonophoresis, mobilizations, medication, surgical resection

                                                                                              (Gann, 2001)

 

 

 

Rib Dysfunction
Diffuse Idiopathic Skeletal Hyperostosis

Characteristics:

  • Usually associated with costovertebral, costotransverse, and/or costochondral joint problems

  • Usualy hypomobile but can be hypermobile

  • Can be due to trauma, DJD, ankylosis, or postural deficits

  • Common at T8-T10

  • Gradual or sudden onset

Signs and Symptoms:

  • Localized pain anywhere along the riba dn its attachments

  • Pain may refer laterally and be felt with breathing and sneezing

  • Tenderness

  • Altered rib position

  • Restricted motion: inhalation or exhalation restriction

Special Tests: Palpation, positive spring test, hypomobility

Intervention: Mobilization, Intercostal muscle stretching, breathing

                        exercises, muscle energy techniques, postural

                        exercises                                                        (Gann, 2001)

Characteristics:

  • Calcification of ligaments, especially the anterior longitudinal ligament

  • Spurs fuse forming bony bridges

  • Affects more men

  • Etiology is unknown, possibly linked to diabetes

  • can present in peripheral joints

Signs and Symptoms:

  • Decreased mobility

  • Decreased lordosis in the lumbar spine

  • Dysphagia from the cervical spine due to spurs

  • Can cause stenosis

  • Can cause paraplegia and fractures in severe cases

  • Aches, stiffness, and radicular pain

Special Tests: X-ray reveals bony bridges

Intervention: Heat, maintain AROM, restore function, pain modalities if severe, no traction, no mobilization if bridging is present, surgery                                                                  (Gann, 2001)

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