Exam 2 Flashcards
Which thoracic spine vertebrae are transitional?
T1 and T12
do thoracic or cervical vertebrae have larger bodies?
thoracic
Vertebral bodies have?
transverse and anterior-posterior diameters
Why dont thoracic vertebrae have transverse foramen?
There is no vertebral a. to protect
Transverse processes are more ____ than cervical?
posterior
Inferior facets of superior verebrae face?
inferior and anterior
Superior facets of the inferior vertebrae face?
superior and posterior
Decreased Weight bearing occurs on the facet joints compared to C-spine due to?
Facet articulations are 60* from horizontal place
what is responsible for resisting compression in verterbral body?
vertical, oblique and horizontal trabeculae in spongy bone
What is the zone of weakness?
Decreased trabeculae bone. Can lead to ant comp fractures,
with age kyphosis?
increases, more anterior pressure in thoracic spine
vertical trabeculae fibers resist?
compression
Horizontal trabeculae fibers resist?
tension/shear
Does the vertebral arch have a lot or less trabeculae?
multiple, making it more supported for weight bearing
Difference between spondylysis v.s spondylolythesis?
spondylolysis is just fracture
spondylolythesis
Ribs
restrict ROM
Upper thoracic ROM?
rotation and sidebending
Lower thoracic ROM?
flexion and extension
Middle thoracic ROM?
little bit of everything
Freyette’s law upper thoracic spine?
SB and rotation occur in the same direction in neutral and non-neutral biomechanics
Freyette’s law lower thoracic spine?
SB and rotation occur in opposite directions
Degrees of freedom in the thoracic spine?
3* (flexion/extension, Sb, rotation)
Why does upper thoracic have decreased flexion/extension?
facets lie in frontal plane
60* from horizontal plane
Why does lower thoracic have increased flexion/extension?
2* from sagittal plane
What does rule of 3s help to determine?
SP and TP orientation
Orientation of T1-T3 SPs?
Level with respective Tps
Orientation of T4-T6 SPs?
1/2 level below respective TPs
Orientation of T7-T9 SPs?
SP 1 full level below respective TPs
Orientation of T10 SPs?
SP 1 full level below
Orientation of T11 and T12?
Sp 1/2 level below, SP in line with TP
What structures provide check rein to flexion?
PLL, ligamentum flavum, erector spinae, Spinal cord
Anterior vertebral body + IV disc
What structures check rein to extension?
ALL, rectus abdominus,
Post vertebral body + disc, spinous process
What structures check rein to side bending?
Contralateral musculature Intratransverse compression
Ribs
What happens to facets and IV foramen with sidebending?
closing of facets and IV foramen
Posterior inferior motion
Distortion of rib pair?
this happens during rotation
One rib goes posterior the other goes anterior
magnitude dependent on CV and CT joint motion
Check rein for rotation?
winding of the disc
ribs
Scoliosis is named according to?
direction of convexity and region
what is a type I scoliotic dysfunction?
rib hump evident
Primary curve v.s secondary curve?
primary: congenital
secondary: compensatory
Describe normal Thoracic LOG?
LOG anterior to thoracic (flexion moment)
PLL counteracts
Describe LOG action due to a moderate kyphosis?
Increased anterior (increased flexion moment)
PLL and erector spinae
Describe Severe kyphosis affect on LOG?
Even greater anterior (larger flexion moment)
erector spina and PLL
Upper cervical spine will go into extension to counteract
Where do ribs 1-7 attach?
true ribs
attach directly to cartilage to sternum
Where do ribs 8-10 attach
false ribs
attach to costal cartilage above attaching to sternum
Where do ribs 11-12 attach?
floating ribs (no attachment to sternum)
what type of joint are the costovertebral joints?
planar synovial
head of rib is?
convex
T2-T8 facets are?
formed by 2 concave demifacets on inferior and superior body of vertebrae
T1, T11, T12 articulate with?
only 1 vertebrae
The vertebral facets of T9-T12 are?
posterior to the pedicles
Ribs 2-10 also articulate with?
intervertebral discs
Which costovertebral joints have more mobility?
those that articulate with only one vertebrae
How does rotation and gliding occur in CV joint?
Rib springing
Where does Functional internal rotation lie to spinous process?
T5
Where does Functional external rotation lie to spinous process?
T3
What is the total degrees of ROM for Horizontal Abduction
Horizontal Adduction
120-140’ AB
40-60’ ADD
What is the total degree of ROM for extension or hyperextension?
60-80’
What are the four joints that make up the shoulder complex?
Glenohumeral
scapulothoracic
acromioclavicular
sternoclavicular
What are the four joints that make up the shoulder complex?
Glenohumeral
scapulothoracic
acromioclavicular
sternoclavicular
Where does the superior angle of the scapular in respects to spinous process?
T2
Where does the inferior angle of the scapular in respects to spinous process?
T7
What angle of upward rotation does the scapula lie in?
3-5 degrees
Why does the scapular have upward rotation at rest?
Because it creates a shelf for humeral head to stop dislocation
When the scapula elevates it causes more anterior tilting which can lead to
AC impingement
upper cross syndrome
Upward rotation promotes ______stability. With what contribution?
inferior
Glenoid contribution
CH & SGH ligament contribution
What is scapular dumping?
When there is relaxation (adaptive stretch) of coracohumeral ligament and superior glenohumeral ligament
downward rotation means no shelf
inferior translation/ dislocation
What is the typical posture for scapular dumping?
Rounded Shoulder
inferior translation
increase kyphosis
What is the normal range for anterior tilting of the scapula?
9’-20’
What are you to likely see with anterior tilting greater than 20 degrees?
Subacromial impingement
w/ inc. kyphosis
osteoporosis
menopausal women
What is the scapulo-clavicular angle?
50 degrees
POS 30’ anterior to frontal plane
Clavicular retraction angle is 20’
What is the purpose of scapulothoracic motion?
appropriately position the glenoid to allow optimal motion
Scapulothroacic motion has _____translation and _____rotary motion? What are they?
Translation
-elevation/depression
-protraction/retraction
Rotary
-upward/downward rotation
-anterior/posterior tilting or tipping
-medial/lateral rotation
What motion is coupled with protraction of the scapula?
Medial rotation = protraction
What motion is coupled with retraction of the scapula?
Lateral rotation = retraction
What is the pathology that reveals the entire medial border of the scapula?
scapular winging
What causes scapular winging?
neuropathy of the long thoracic n.
adaptive shortening of serratus anterior
What is the pathology that reveals the inferior angle?
Excessive anterior tipping
What causes excessive anterior tipping?
adaptive shortening of pec minor
At neutral where is the instanenous center of rotation
at the spine of the scapula
What is the concavity of the AC joint?
Convex lateral clavical
concave acromion
What type of joint is the AC joint?
Synovial joint with an fibrocartilaginous disc
What ligaments stabilize the AC joint
Conoid, trapezoid and AC ligamentts
What ligament is responsible for posterior tilting of the scap
Conoid ligament
What type of joint is the costotransverse joint?
planar, synovial between ribs and TP
Which thoracic vertebrae have costotransverse jiont?
T-T10
Convexity of the costal facet? costal tubercle?
costal facet: concave
costal tubercle: convex
Some rotation is allowed at which costotransverse joint?
T1-T6
Which costotransverse joint is flat?
T7-T8
What type of joint is the costosternal joint?
Planar, synovial
except rib 1: cartilagenous
Where do costosternal joint ribs 1-7 articulate with?
sternum
what do costosternal joint ribs 8-10 articulate with?
costocartilage
what do costosternal joint ribs 11 and 12 articulate with?
nothing babe
Rib 1 kinematics?
Costosternal joint is stiff
Elevates with inspiration
costovertebral joint: superior and posterior
axis for Costovertebral and costosternal joint?
2* to CKC,
CS moves vertically but no rotation
around what axis does rib 1-6 motion occur?
M-L axis
Nearly in the fronal plane
around what axis does rib 7-10 motion occur?
A-P axis
Nearly sagittal plane
Ribs 1-6 motion can be described as ?
pump handle
increased A-P dimension
Rib 7- 10 motion can be described as?
Bucket handle
increased lateral dimention
Rib 7- 10 motion can be described as?
Bucket handle
increased lateral dimension
up and out
Rib 11-12 motion can be described as?
caliper
lateral dimension
Welcome to the shoulder :)
From base position how many degrees of UE ER do we have? what plane of motion is this happening in?
40-60*, transverse plane
At 90* abduction how many degrees of UE ER do we have? what plane of motion
90-100, sagittal plane
At 90* abduction how many degree of UE IR do we have?
45-60*
What is the ideal level of functional internal rotation and functional er?
FIR: spinous process of T5
FER: Spinous process of T3
Ideal degrees of horizontal abduction?
120-140
ideal degrees of horizontal adduction?
40-60*
Ideal degrees of extension?
60-80*
What are the 4 joints of the UE?
glenohumeral
scapulothoracic
acromioclavicular
sternoclavicular
What are the main movements in the scapulothoracic joint?
rotary: upward/downward rotation, tilt, medial-lateral rotation
translatory:protraction/retraction + elevation, depression
how much scapular upward rotation do we have at rest?
3-5*
Upward rotation of scapula promotes?
inferior stability
What contributes to upward rotation of scapula?
Glenoid
Coracohumeral ligament
SGH ligament (superior glenohumeral ligament)
What capsuloligamentous scapular dumping?
relaxation of Coracohumeral and SGH ligament
Will produce false sulcus test
Scapulathoracic joint is slightly anterior tilted in neutral. to what degree?
9-20*
A pathologically elevated scap will lead to more?
anterior tilting
potential for impingement
Anterior tilt of scap does what to muscles?
adaptively shortening elevators
Adaptively lengthens depressor
increases impingement of subacromial structures
What is the plane of the scapula?
30* anterior to frontal plane
What is the scapulo-clavicular angle?
50*
what is the clavicular retraction angle?
20*
Main function of the scapulothoracic joint?
appropriate position glenoid
Do scapulothoracic motions occur independently?
no
Elevation of scapula does what to the clavicule?
elevation
Elevation and depression is coupled with which two motions?
anterior and posterior tilt
What is protraction and retraction coupled with?
medial and lateral rotation
Anterior tilting involves what movement of the superior/inferior angles?
anterior displacement of superior angle
posterior displacement of inferior angle
Posterior tilting involves what movement of the superior/ inferior angles?
posterior displacement of superior angle
anterior displacement of inferior angle
Tilting is coupled with?
retraction/protraction
Upward/downward rotation
Rotary motions of the scapulothoracic joint occur around?
vertical axis of AC joint
medial rotation of the scapula does what to the glenoid fossa?
lateral rotation?
faces more anteriorly
Faces more posteriorly
What motion is affected with scapular winging?
medial/lateral rotation
medial rotation is excessive
upward rotation of scapula, does what to the glenoid? clavicle? inferior angle?
upward of glenoid
elevation of clavicle
superolateral displacement
What are the 3 rotary motions of the acromioclavicular joint?
anterior/posterior tipping
medial/lateral rotation
upward/downward rotation
What type of mechanism would injure AC joint?
Lateral FOOSH
Lateral force
Convexity of the acromial end of the clavicle?
convex
Convexity of the acromion?
Concave
What type of joint is the AC joint?
Fibrocartilagenouw
The AC joint is stabilized by?
Conoid, trapezoid, AC ligaments
What is the benefit of a fibrocartilagenous joint?
Healing properties
What type of joint is the sternoelavicular joint?
Synovial w/ articular disc
SC motions are linked with which snap motion?
Elevation depression, protraction, retraction, post/ant rotation
Convexity of sternal end of clavicle?
Convex
Convexity of sternum
Concave
Transverse plane convexities of clavicle and sternum?
Opposite of frontal plane. Concave clavicle, convex sternum
Post rotation of Sc joint is coupled with what scap motion
Upward rotation after 30° clavicle elevation
Max rotation at Sc joint?
30-55°
Anterior rotation at sc joint?
No ant. Rotation (from neutral)
The glenoid cavity has-more concavity in which direction?
Superior → inferior
What is angle of humeral head?
130°150°
Which directions does the humeral head face?
Medial, superior, posterior
Issue with glenoid + humerus orientation?
Humerus is superior, glenoid is inferior
ER at gh joint? At base? @ 90°?
40-60° 90-100°
IR at GH joint at 90°?
45-60°
Elevation @GH joint?
0-120°, informal!
Full elevation of the UE requires___ to prevent impingement and provide greater humeral articulation.
External rotation
Mechanical purpose of scapulohumeral rhythm?
Increase ROM of elevation
Increases inferior stability of GH
Maintains optimal length tension relationship
Describe phase 1A of UE elevation.
0-30* scaption/ 0-60* flexion
predominantly glenohumeral
scapula seeks a position of stability
Describe Phase 1B of UE elevation?
30-90* scaption/60-90* elevation
Consistent upward scapula motion
Acromion elevation, elevates clavicle
IC @ root of spine and SC joint
Describe phase 2A of UE elevation?
90-120 of elevation
claviclar elevation tension loads costoclavicular ligaments
Costoclavicular ligaments limit elevation
IC shifts to AC joint
Describe phase 2B of UE elevation?
120-end ROM elevation
ICR @ AC joint
Scapular upward rotation combined with corocoid depression
Depression of corocoid tension loads coraclavicular ligaments
What causes posterior clavicular rotation?
Coracoclavicular tension from phase 2B impacts downward force on posterior clavicle through conoid ligament
The “Crank” shape of the clavicle allows for what?
30* further clavicular elevation of outer clavicle during 2B
posterior clavicle able to aid scapular tilting
Describe phase 1B scapular rotation?
Upper trap creates upward rotation via superomedial force on acromion
Lower serratus creates upward force via inferolateral force
Rhomboid and mid trap provide stabilization
lower trap tries to do downward rotation but it cant do to MA
Describe phase 2B scapular rotation?
lower trap does upward rotation
Upper trap moment arm decreases
Lower serratus (large MA) upward rotation (inferolateral force)
Rhomboid and mid trap stabilizat
During abduction describe the roles of the serratus and trapezius?
trap is more important
trap paralysis ROM would only be 75*
serratus paralysis: full ROM possible
During flexion describe the roles of the serratus and trapezius?
serratus most important
Serratus paralysis: limited flexion
Trap paralysis: full flexion
If the trapezius was working alone how much flexion could it create?
20* upward rotation during flexion
Describe the synergist action between deltoid and supraspinatus?
deltoid only will produce superior humeral translation
Supraspinatusreduces this by compressing head into gloid
Factors involved in glenohumeral stability?
negative intra articular pressure
labral concavity compression
capsular constraint mechanism
Scapulohumeral muscles
Capsuloligamentous restraint
What is negative intra-articular pressure?
venting produces inferior subluxation
less force needed to translate humeral head in other directions
Stability ratio equation related to labrum concavity?
stability ratio= translation force/compressive load x100
With intact labrum the glenohumeral joint resists dislocation force up to____% of the compressive loads?
64%
Which muscles compress the humeral head into the glenoid allowing for stability?
deltoid, supraspinatus, infraspinatus, teres minor
Most increase in which translation (direction) with decreased muscle contractility?
anterior translation (46%increase)
Least increase in translation (direction) with decreased RC muscle contractility?
inferior translation (0% increase)
RC muscles act as a buttress by_____?
centering the humeral head in the glenoid
How do capsuloligamentous structures add to GH stability?
GH ligaments restrain motion
motion will take the “slack: out of the ligaments
What is the capsular constraint mechanism?
End ROM motion takes slack out of ligament
Contribute to obligate humeral head translation
Anterior humeral capsule check rein for?
ER
The pec minor muscle attaches to the coracoid at what clock position?
4 oclock
What muscles attach to the coracoid at 7 oclock?
coracobrachialis
biceps brachii
what attaches to the coracoid at 10 oclock?
coracoacromial ligament
What position on the clock do the coracoclavicular ligaments attach to the coracoid?
11 oclock + midnight
