Chapter 4-- Thoracic Flashcards
What are the general functions of the Ribs
stabilizers of the spine
decrease general mobility of the thoracics
protect the thoracic viscera
function in respiration
Does the thoracic spine have more or less pain syndromes or traumatic injuries
no, exceptions to this: scoliosis postural myofacial pain syndrome kyphosis (scheurmanns disease) compression fractures
What shape are the the throracic vertebrae bodies
wedge shaped– leads to kyphotic curve
What site on the thoracic spine is the common site of anomaly
The SP
What are the location of the SPs to TPs from T1-4 and T8-12
up 1 interspinous and lateral
What is the location of the SPs to the TPs from T5-7
Up 2 interspinous and lateral
What is the disc:vertebral body height ratio in the thoracic spine
1:5
What does this low ratio lead to
Decreased flexibility in the thoracic spine
What angles are formed by the articular facets in the horizontal plane and the vertical plane
Horizontal: 60
Vertical: 30
What are the shapes of the articular facets
Flat
What direction do the superior facets face
Posterolateral and superior
What direction do the inferior facets face
anteromedial and inferior
Which ribs articulate in some kind of costochondral joint
R1-10
Which ribs articulate directly with the sternum
R1-7
What is the range of kyphotic curve of the thoracic spine
25-45 degrees
What provides extra stiffness to the thoracic spine
rib cage
What rib adds the most stiffness to the thoracic spine
rib 2
How many more times stiffer is the thoracic spine with the ribs
2.5 times more stiff
4 times more resistant to compression
What is the GROM of flexion in the thoracics
50 degrees
What is the GROM of extension in the thoracics
not included in the AMA guideline
Which direction does the SROM of the increase in thoracics with flexion
S->I
4 degree upper
6 degrees middle
12 degrees lower
What is the IAR for the flexion of thoracics
central superior portion of the subadjacent body
What is the IAR of extension in the thoracics
central inferior portion of the vertebral body
Which direction does the disc bulge and retract during movement
bulges on the concave side
retracts on the convex side
What is the GROM during lateral flexion of the thoracics
38 degrees to each side
What is the trend from SROM in the thoracics during lateral flexion
generally uniform with slight increase in lower thoracics
T1-9: 6 degrees
T10-12: 8-9 degrees
What is the IAR of lateral flexion in the thoracics for lateral flexion
contralateral subadjacent vertebral body
What are the patterns of movement in the upper thoracics for lateral flexion
Lateral flexion is coupled with rotation to the same side
SPs rotate to the convexity
What is the pattern of motion in the mid thoracics for lateral flexion
minimal coupled movement
slight coupled rotation may go in either direction
What is the pattern of motion in the lower thoracics for lateral flexion
coupled rotation may go in either direction
Is there a significant shift in the nucleus during lateral flexion of the thoracics
No
In the upper thoracics what does the coupled motion mean for arthrokinematics for lateral flexion
additional lateral glide of inferior facet on the contralateral side and medial glide on the ipsilateral side
What is the GROM for rotation in the thoracics
74 degrees total
What is the trend for SROM in rotation of the thoracics
uniform until the last 3-4 lower segments
T1-9: 7-9 degrees
T10-12: 2 degrees
What is the IAR for rotation of the thoracics
contralateral center of the corresponding vertebral body
What is the pattern of motion in the upper thoracics for rotation
rotation coupled with minimal lateral flexion to the same side
This coupling diminishes in the mid and lower thoracics
What occurs arthrokinematically on the side of rotation in the thoracics
facet opens and inferior facet glides medially and inferiorly
What occurs arthrokinematically on the opposite side of rotation in the thoracics
facets approximate and the inferior facet glides laterally and superiorly
What are the two movements of the rib cage during respiration
bucket handle
pump handle
What happens during the bucket handle phase of rib movement
increase the transverse diameter of the rib cage by elevating the rib and its costochondral arch
Which ribs is the bucket handle movement the greatest
lower ribs
What is occurring in the pump handle movement in the ribs
increase the A-P diameter of the rib cage by elevating the anterior aspect of the rib cage with the upward and forward movement of the sternum
Which ribs is the pump handle movement the greatest
the upper ribs
What happens to ribs during lateral flexion
ribs open on the convex side
ribs close on the concave side
What happens to the ribs during rotation
Movement occurs at both ant/post joints
angle accentuation on side of rotation
angle flattens on side opposite rotation
What happens to the rib cage during flexion
rib cage flattens superiorly and inferiorly decreasing the sternal angle
the A-P angle diameter increases
When watching GROM for lateral flexion in the rib cage what are we looking for
normal C shape curve
observe for broken stick appearance
Why is the cervical spine a common site of injury
flexible rod between the stable thoracic spine and head
What is the cervical spine rich in
proprio- and mechanoreceptors for righting reflexes
What is the normal lordotic curve of the cervical spine
30-40˚
What are the potential effects of a hyperlordotic curve
posterior disc compression
tensile strength anteriorly to the disc and myofascial structures
shortening of posterior musculature
possible predisposition to facet syndrome
What are common causes for a hypolordotic curve
Hyperplastic pillars (congenital)
Compensation for flat back posture
Result of CAD trauma (post traumatic)
Acute Facet Syndrome (antalgic)
What are the potential effects of a hypolordotic curve
Increased compression of the anterior disc
prolonged tensile strength on posterior ligaments
Increased workload on paravertebral mm
shortening of anterior cervical muscles
decreased shock absorption
protective muscle splinting
What is the GROM for flexion in the cervical spine
60˚
What is the GROM for extension in the cervical spine
75˚
What is the GROM for lateral flexion in the cervical spine
45˚ to each side
What is the GROM for rotation of the cervical spine
80˚
What do the cervical segmental muscles do
coordinate and integrate segmental motion acting as involuntary integrators of overall movement
What do cervical non-segmental muscles do
produce integrated global movement as a result of the heads moving in relation to the trunk
