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MSK III > 4 Thoracic Biomechanics > Flashcards

4 Thoracic Biomechanics Flashcards

1
Q

What are the standard ranges for thoracic flexion, extension, rotation, and lateral flexion?

A
  • Flexion 30-40
  • Ext 20-25
  • rotation 30-35
  • Lateral flexion 25-30
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2
Q

Explain the movement of thoracic flexion

A
  • Forward bending and exhalation
  • anterior rotation and translation of superior vertebra on inferior vertebra
    • inferior facet slide up and forward on superior facets
      *
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3
Q

Describe couple rib motin of thoracic flexion

A
  • Superior vertebral body motion causes anterior rotation of rib head (inferior demifacet attachment)
  • Anterior portion of ribs moves inferiorly

Superior vertebral body moves forward

  • Transferse process push forward, force ribs into rotation, upper ribs move inferiorly

Lower Ribs

  • Ribs ELEVATE, bottom ribs come up, upper ribs go down
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4
Q

Describe the biomechanics of thoracic extension

A
  • Backbending and inhalation
  • Posterior rotation and translation of superior vertebra on inferior vertebra
    • Inferior facets slide down and backward on superior facets
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5
Q

Describe the coupled rib motion with thoracic extension

A
  • Superior vertbral body motion causes posterior rotation of rib head (inferior demifacet attachment)
  • Anterior portion of rib moves superiorly

Superior vert moves posterior -> rotates and translates posteriorly -> transverse process moves backwards -> pulls ribs and rotates posteiorly -> anterior ribs move superiorly

Upper ribs move up and loewr ribs go down

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6
Q

Describe the biomechanics for lateral flexion of the thoracic spine

A
  • Lateral flexion in frontal plane/saggital axis
  • Type 1 Mechcanics (rot - SB opposite)

Ipsilaetal compression

Downward glide

Opposite glide (opening)

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7
Q

Describe the biomechanics of thoracic rotation

A
  • Roation occurs in transverse plane around vertical axis
  • Type 2 mechanics (rot - sb SAME)

Rotation causes same side sidebending

Shift of vertebral body on L as rotates on R

Ribs on left rotate anterior to and get into FLEXION

Ribs on Right will posterior roate (elevate) and get into extension

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8
Q

What are the rib mechanics of respiration (motions, muscles)

A
  • Rib motions: move as described in thoracic extension/flexion
  • Primary muscles
    • Diaphragm
    • scalenes
    • Intercostals
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9
Q

Whata re the muscels used for forced inspiration

A

Serratus posterior superior/inferior, levator costarum, SCM, latissimis dorsi, iliocostalis cervicis and thoacis, pec minor and major, quadratus lumborum

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10
Q

What are the muscles of forced expiration?

A
  • Abdominals, transversus thoracic, internal intercostals
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11
Q

Describe the motion in the upper, middle, and lower ribs in respiration

A
  • Upper
    • Pump handle movement
    • Changes A-P Diamter
  • Middle
    • Bucket handle movement
    • Changes A-P and transverse diameter
  • Lower
    • Caliper like movement
    • Changes transverse diameter
    • (same as bucket handle elevation/depression) due to costotransverse formation)
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12
Q

What is considered the upper T spine?

A
  • T1-3
  • functions are part of the loewr C spine
  • more flexion and ext (not a lot of sidebeing)

Treatment: use rotation and lateral flexion techniques

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13
Q

What is considered the lower T spine?

A
  • T10-12
  • Funtions are part of the upper L spine

treatment: use rotation and sidebending

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14
Q

What is considered the functional T spine?

A
  • T4-9
  • “true” T spine
  • Greatest amount of movement is rotation = use flexion and extension techniqies
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15
Q

What are 2 common patterns of clinical presentation?

A
  • Pain from loading - Load attenuation
    • ex - sitting in awkward position
    • Symptoms related to movement/motion restrictions (too stiff)
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16
Q

Where is most load on the T spine? How does the T spine handle load?

A

Increases caudally - significant load on T12 compared to T1

  • Progressive increase caudally
    • Vertebral body height
    • End plate cross sectional area (thicker)
    • Higher Bone content (esp last 6 segments)
17
Q

How is load transfereed in the upper and lower T spine?

A
  • Upper: load transferred thorugh vertebral body/disc complex
  • Lower T spine: greater load transferred through posterior column via interlocking lamina and facet joints
18
Q

Describe the IVD in load attenuation of the T spine

A
  • Thinner than C spine and L spine disk
  • Stronger annulus fibrosis (resistn rotational stress)
  • More disc lesions
19
Q

Which part of the T spine would undergo greater deformation and crep?

A
  • Upper and mid thoracic discs
    • more malleable
20
Q

What is the difference between loading in the L and T spine

A
  • L spine: compressive loading is equally distributed across surface of end plate independent of postion of motion segment
  • T spine: loading distribution becomes asymmetric when loaded outside the neutral position
    • may explain common findings of mid thoracic pain with sustained loading postures (driving, sitting, etc)
      • being flexed for too long
21
Q

How can an “habitually” flexed T spine affect other areas of the body?

A
  • Normal mechanics/motion of the C spine and shoulder dependant upon normal mobility of upper T spine
  • Habitually flexed
    • reduced capacity of muscles to provide cervicothoracic retraction to work in the functional range
    • Anteriorly rotated upper ribs will restrict range of C spine extension and rotation motions due to requrement of movement out of the neutral spinal alignment
    • Therefore, greater demand on more mobil lower C spine segments and potential for symptoms/early degeneration
22
Q

What is the importance of upper T spine extension

A
  • required for bilateral shoulder flexion
    • restricted motion can lead to subacromial pathology (altered scap/GH mechanics)
    • Restricted upper rib mobility - sogns and symtpms consistent with subacromial impingement or thoracic outlet
23
Q

What is the importance of mid T spine and motion restrictions

A
  • Anterior elemts suvject to high comrpessive loads because of apex of kyphosis
  • Excessive kyphosis from excesive loading = hypomobility of ribs
24
Q

How does a PA mobilization on the spinous process move a segment?

A
  • indueces anterior translation and posterior rotation (extension) of the related vertebral segment
25
Q

Describe anteriorly applied PA to the thoracic spine?

A
  • Upper T spine: T3 downward vector and superior vector
    • Extension moement and anterior glide
  • Lumbar/T9 - Vector produces extension moment
26
Q

Describe spinal curvature PA in the thoracic spine?

A
  • Straight PA glide (Translation)
27
Q

Describe PA towards the center of vertebral body

A
  • Extension moment in upper
  • Flexion moement in lower

MSK III (13 decks)

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