CHIR12007

Clinical Assessment and Diagnosis

Portfolio Exercises Week 3

Exercise 1

Complete the following chart of the Thoracic Spine and Rib Cage Red Flags

Condition Red Flags

- Chest Pain
Myocardial - Pallor, sweating, dyspnoea, nausea or palpations
Infarct - Presence of risk factors: previous history of coronary heart disease,
hypertension, smoking, diabetes, and elevated blood serum
cholesterol (>240 mg/dL)
- Men aged over 40 years, Women over 50 years
- Symptoms lasting longer than 30min and not relieved with sublingual
nitroglycerin
- Chest pain or pressure that occurs with predictable levels of exertion
Angina - Symptoms predictably alleviated by rest or sublingual nitroglycerin
- Severe, sharp knife-like pain with inspiration
Pleurisy - History of recent coexisting respiratory disorder (e.g. infection,
pneumonia, tumor, or tuberculosis)
- Chest pain that is intensified with inspiration, ventilation, or expanding
Pneumothorax rib cage
- Recent bout of coughing or strenuous exercise or trauma
- Hyperresonance upon percussion
- Decreased breath sounds
- Pleuritic pain that may be referred to shoulder
Pneumonia - Fever, chills, headache, malaise, or nausea
- Productive cough
- Colicky pain in the right upper abdominal quadrant with accompanying
Cholecystitis right scapula pain
- Symptoms may worsen with ingestion of fatty foods
- Symptoms unaffected by activity of rest
- Dull, gnawing pain, or burning sensation in the epigastrium, mid-back,
Peptic Ulcer or supraclavicular regions
- Symptoms relieved with food
- Localized tenderness at right epigastrium
- Constipation, bleeding, vomiting, tarry coloured stools, and coffee
ground emeses
- Sudden, severe back or flank pain
Renal Disease - Chills and fever
- Nausea and vomiting
- Renal colic
- Symptoms or urinary tract infection
- Reside in hot and humid environment
- Past episode(s) of kidney stone(s)
p.512; Magee; Orthopaedic Physical Assessment may be helpful
Exercise 2

List 7 mechanical conditions of the thoracic spine and thoracic cage that can be managed well with
Chiropractic Care

- Mechanical pain from Thoracic spine

- Costochondritis
- Scapulocostal Bursitis
- Scapulocostal Tendinitis
- Thoracic disc protrusion
- Maigne’s syndrome/LDRS
- Muscular injuries of the Thoracic spine
- Postural syndrome/dysfunction

Exercise 3

Explain the 3 typical pain patterns of an Osteoporotic compression fracture in an elderly patient

- Non-radiating
- Wrap around chest or abdomen
- Referred to top of sacrum/SI joints – esp at T/L junction; can be misdiagnosed

Exercise 4
List 5 reasons why Osteoporosis is very important to Chiropractors

- Increased risk of fracture

- Management needs to be altered
- May indicate other underlying disease processes
- To initiate proper early care modalities and help reduce the rate of progression
- To educate the patient appropriately

Exercise 5
Master Mark, 23yo, fit and well, presents to your office with mid back pain and pain under his arm
pit to the front. He explains he was ‘tackled’ from behind during a soccer match 2 weeks ago. The
pain and stiffness started the next day. Pain is rated 4/10. The pain has not affected his breathing
but does hurt just at the end when he takes in a really big breath. There is tenderness when you
palpate to the right of the spine at T7. Vital signs are normal and Mark appears and is otherwise fit
and healthy.

List the structures that could be causing the pain

- Ribs
- Nerve trunks
 - Muscles
- Tendons
- ligaments

List your differential diagnosis

- Rib Fracture?
- Serratus Posterior Inferior strain
- Paraspinal Muscles – Iliocostalis Thoracis strain/spasm