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Msk Spine > (7) Functional anatomy, clinical exam, and pathologies of T-spine > Flashcards

(7) Functional anatomy, clinical exam, and pathologies of T-spine Flashcards

1
Q

Why do the thoracic vertebra have extra facets?

A

Articulations with the ribs

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2
Q

Where do the superior and inferior costal facets articulate with?

A

The head of the rib

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3
Q

Where do the transverse costal facets articulate with?

A

The tubercle of the ribs

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4
Q

What joint lies at the superior and inferior costal facet?

A

costovertebral joint

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5
Q

What joint lies at the transverse costal facet?

A

costotransverse joint

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6
Q

What is the bony anatomy of the thoracic spine?

A
  • progressively inferiorly angled (most prominent mid-thoracic)
  • Generally sp.pro may be as low as facet joint one spinal level below
  • Upper/lower T-spine project more horizontally
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7
Q

What are some general guides on the surface anatomy of certain T-spine vertebra?

A
  • T1: 2nd below last moving cervical sp.pro
  • T3: in line spine scapula
  • T7: in line inferior angle scapula
  • T12: in line 12th rib
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8
Q

What is the function of the muscles in the thoracic spine?

A
  • Mobility
  • Stability
  • Proprioception
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9
Q

Where does the erector spinae travel from?

A

3 bilateral columns extending from the skull to the sacrum

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10
Q

What are the 3 muscles of the erector spinae?

A
  • spinalis thoracis
  • longissimus thoracis
  • iliocostalis thoracis
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11
Q

What is the function of the erector spinae?

A
  • extension (bilaterally & concentrically)
  • lateral flexion (ipsilaterally & concentrically)
  • counter balancing postural disturbances
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12
Q

What joints connect the ribs and the vertebrae?

A
  • costovertebral
  • costotransverse
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13
Q

What part of the rib connects to the costovertebral joint?

A

convex facet on head of rib

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14
Q

What part of the rib connects to the costotransverse joint?

A

the tubercle of the rib

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15
Q

What is the normative amount of T-spine flexion?

A

~30-40 degrees in sagittal plane

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16
Q

How does the T-spine move during flexion?

A

Inf articular facet vertebra slides sup & ant. relative to superior facet below

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17
Q

What is the normative amount of T-spine extension?

A

~ 20-25 degrees in sagittal plane

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18
Q

How does the T-spine move during extension?

A

inf. articular facet of vertebra slides inf post. relative to superior facet of vertebra below

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19
Q

What is the normative value for T-spine lateral flexion?

A

~ 25 degrees in the frontal plane

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20
Q

How does the T-spine move during lateral flexion?

A

inf articular facet of vertebra slides sup (contralaterally) & inf (ipsilaterally) relative to superior facet of vertebra below

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21
Q

What is the normative value for rotation in the T-spine?

A

~ 30 degrees in the axial plane

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22
Q

How does the T-spine move during rotation?

A

inf articular facet of vertebra above slides against sup articular facet of vertebra below

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23
Q

What is included in the clinical interview for T-spine?

A
  • PC
  • HPC
  • DH
  • PMH
  • SH
24
Q

What are some red flags to look out for during a clinical interview of the T-spine?

A
  • Thoracic myelopathy
  • Malignancy
  • Infection
  • Fracture
  • Inflammatory
  • Deformity
25
Q

What do you have to be extra cautious of when carrying out a clinical interview with a T-spine patient?

A
  • chest pain
  • flank pain
  • abdominal pain
  • diffuse pain
26
Q

What does a clinical examination for T-spine normally look like?

A
  • observation
  • AROM
  • Muscle tests
  • palpation
  • if upper or lower T-spine pain, may have to clear cervical & lumbar spine
27
Q

What is looked for during AROM?

A
  • range
  • symptom response
  • quality
28
Q

How is a Slump Test carried out?

A
  • patient is asked to sit on edge of bed and slump their back
  • flex hip ~90 degrees & extend knee
  • chin to chest
  • plantar/dorsiflex foot
29
Q

What does the plantarflexion & dorsiflexion do during the Slump Test?

A

Dorsiflexing the foot loads the dura, whereas plantarflexing the foot will unload it

30
Q

What is non-specific thoracic back pain?

A
  • anything that is not serious or radicular
  • postural
  • mechanical (disc, soft tissue, facet)
31
Q

How does non-specific thoracic pain present?

A
  • pain
  • motion loss
  • posture
  • muscle involvement
  • disability
  • impact QOL
32
Q

What is scoliosis?

A
  • abnormal lateral curvature (+ rotation)
  • ‘S’ or ‘C’ shaped
33
Q

How does scoliosis develop?

A
  • 65% idiopathic (unknown)
  • 15% congenital
  • 10% neuromuscular disease
34
Q

How does scoliosis present on examination?

A
  • variable spine pain
  • movement restriction
  • uneven musculature
  • prominent ribs/scapula
  • loss of motion
35
Q

What is the Rx for scoliosis?

A
  • None
  • Exercise Rx (Schroth approach)
  • bracing
  • surgery
36
Q

What is Scheuermann’s disease?

A
  • Juvenile (hyper-) Kyphosis
  • altered vertebral body growth
  • anterior wedging (>5 degrees) in 3/more adjacent vertebral bodies
37
Q

How does Scheuermann’s Disease present?

A
  • prominent curvature (with trunk flexion)
  • pain
  • rigid kyphosis
38
Q

What is Hyper kyphosis?

A

When the Cobb angle is >40 degrees (norm 20-40 degrees)

39
Q

What is the Rx for Scheuermann’s Disease?

A
  • <60: stretching, mods, NSAIDs
  • 60-80: extension bracing
  • > 80: surgical opinion
40
Q

What is the Cobb angle?

A
  • line drawn along superior endplate of most tilted vertebrae on cephalad portion
  • line drawn along inferior endplate on most tiled vertebrae on caudal portion
  • angle when perpendicular lines cross
41
Q

How is osteoporosis diagnosed?

A

DXA scan

42
Q

How do osteoporotic fractures of the thoracic spine occur?

A
  • spontaneously (cough or twist)
  • traumatic (fall)
  • single / multiple levels
43
Q

How does an osteoporotic fracture present?

A
  • variable pain/disability
  • older age
  • localised tenderness
  • kyphotic
44
Q

What is the Rx for osteoporotic fractures of the thoracic spine?

A
  • analgesia
  • rest
  • bracing
  • +/- physio
  • meds to optimize bone health
45
Q

What is Ankylosing Spondylitis?

A
  • inflammatory back pain
  • systemic rheumatic disease
  • inflammation on sites where tendons/ligaments insert into bone
46
Q

How is ankylosing spondylitis diagnosed?

A

4 out of 5
- onset <40 yoa
- gradual onset
- improved exercise
- not improved with rest
- night pain/waking

47
Q

What are symptoms of ankylosing spondylitis in the thoracic spine?

A
  • inflammation of whiteness in eyes
  • morning stiffness
  • imaging
  • improved with NSAIDs
48
Q

How does thoracic disc syndrome occur?

A
  • less common (less mobile)
  • lower thoracic
  • ~70% asymptomatic
  • localised
  • +/- radicular
49
Q

What causes thoracic radiculopathy?

A
  • root impingement/compression
  • disc herniation
  • metastatic tumour
  • scoliosis
  • diabetes
50
Q

What are the symptoms of thoracic radiculopathy?

A

pain, paraesthesia dermatomal distribution

51
Q

What is Multiple Myeloma?

A

cancer of plasma cells in the vertebrae

52
Q

What are the symptoms of multiple myeloma?

A
  • vague & variable (easy to miss)
  • bone pain (lytic bone lesions)
  • fatigue
  • night sweats
  • decrease in appetite
  • weight loss
53
Q

What is spinal tuberculosis?

A
  • ultra rare bacterial infection in intervertebral disc and endplates
54
Q

What are the risks for developing spinal tuberculosis?

A
  • Exposure (SE asia, India)
  • Immunosuppression
55
Q

What are some symptoms of spinal tuberculosis?

A
  • generally unwell
  • weight loss
  • loss appetite
  • developing kyphosis
  • developing spinal cord involvement

Msk Spine (9 decks)

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