August Question(S) of the Month- Thoracic Spine

Test your knowledge on thoracic spine and ribs for OCS and SCS.

The inferior vena cava, esophagus, and aorta all enter through openings in the diaphragm. These openings are at approximate levels in the thoracic spine. The inferior vena cava enters the diaphragm at the ____ thoracic vertebrae. The esophagus enters the diaphragm at the ___ thoracic vertebrae. The aorta enters the diaphragm at the ___ thoracic vertebrae.

A. 2nd, 4th, 6th

B. 4th, 6th, 8th

C. 6th, 8th, 10th

D. 8th, 10th, 12th

2. A patient presents to you as a direct access patient with acute shoulder pain at the tip of their shoulder. The patient is a 30 year old male and denies any mechanism of injury, and yet the shoulder pain is excruciating. What is the most likely diagnosis?

A. Left rotator cuff tear

B. Ruptured Spleen

C. Cervical radiculopathy

D. Myocardial infarction

3. Which of the following thoracic outlet syndrome tests should be utilized to confirm compression of brachial plexus by the scalenes?

A. Adam’s Test

B. Adson’s Test

C. Wright Test

D. Costoclavicular Test

SCROLL DOWN FOR ANSWERS

The inferior vena cava, esophagus, and aorta all enter through openings in the diaphragm. These openings are at approximate levels in the thoracic spine. The inferior vena cava enters the diaphragm at the ____ thoracic vertebrae. The esophagus enters the diaphragm at the ___ thoracic vertebrae. The aorta enters the diaphragm at the ___ thoracic vertebrae.

~~A. 2nd, 4th, 6th~~

~~B. 4th, 6th, 8th~~

~~C. 6th, 8th, 10th~~

D. 8th, 10th, 12th

Answer choice D is the correct choice. These structures enter the diaphragm at these respective thoracic vertebrae levels.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1287418/

~~A. Left rotator cuff tear~~

B. Ruptured Spleen

This is a classic presentation of Kehr’s sign. A patient with a ruptured spleen may present with a primary complaint of acute left shoulder pain.

~~C. Cervical radiculopathy~~

~~D. Myocardial infarction~~

https://www.ncbi.nlm.nih.gov/pubmed/22290058

3. Which of the following thoracic outlet syndrome tests should be utilized to confirm compression of brachial plexus by the scalenes?

~~A. Adam’s Test~~

B. Adson’s Test

Adson’s test is used to identify thoracic outlet syndrome caused by the scalenes. While assessing the radial pulse the PT has the patient turn their head toward the affected arm. The PT then extends & externally rotates the arm. Patient is then asked to inhale and hold breath for 10 seconds. Any reduction of pulse is a positive test. Adam’s test is used to identify scoliosis. The costoclavicular test is similar to the Adson’s test except the patient’s head is looking straight forward. The Wright test is also a thoracic outlet syndrome test but does not confirm compression of brachial plexus by scalenes.

~~C. Wright Test~~

~~D. Costoclavicular Test~~