Exam 2 Flashcards
What is the most rigid part of the vertebral column?
*Thoracic spine Facet joints
How is the thoracic spine aligned?
*In a mild kyphosis
What is the resting position of the thoracic spine/facets?
*Midway between flexion and extension (upright posture)
What is the closed pack position of the Thoracic spine?
Extension
What is the capsular pattern of the Thoracic spine?
*side flexion and rotation equally limited, extension
What is the mobile platform for thoracic movement?
- Thoracic Spine Facet Joints
- Upper extremities via ST and SC joints
- Cervical Spine
What does the sternum (breast bone) made up of?
- Manubrium, body, Sternum
* Sternal Notch of the Manubrium
What does the manubriosternal joint (sternal angle) align with?
*2nd rib
What does the xiphosternal joint align with?
- T9 vertebrae
* T7 ribs
What does the xiphoid process align with?
- T9 vertebra
* T6 dermatome
What is the norm for the infrasternal angle and what is the cause of a large or small one?
- Norm: 90 dg
- > 90 dg: tightness in internal obliques
- < 90 dg: tightness in external obliques
Would an upper chest breather have a larger or smaller angle?
*Less than 90 dg because they don’t expand the lower ribs
What can be palpated in the anterior ribs?
*Costochondral Junctions
How do you palpate the first rib?
*Posterior while sitting and/or prone
What are the characteristics of ribs 2-12?
- Most rounded inferior rib felt anterolaterally is the 10th rib and it’s costochondral junction
- Inferior and posterolateral to that is the tip of rib 11, ending just anterior to mid-axillary line
- Rib 12, inferior and medial to rib 11, it is about an inch or so below rib 11 about 2-4 inches from the spinous process
Which ribs have angles and where are they found?
- Ribs 2-10 have them
- 1st rib doesn’t possess an angle and 11th and 12th are slight if present
- 3-4 cm lateral to the tips of the transverse process
What are the rib articulations with the costovertebral joints?
- Ribs 1, 10, 11, 12 have one vertebral body articulation
* Ribs 2-9 articulate with two adjacent vertebrae
What are the rib articulations with the costotransverse joints?
- *Ribs and transverse processes of the same level
- Ribs 1-10
- Ribs 11 and 12 do not have these joints
What are the rib articulations with the costochondral joints?
- Ribs and costal cartilage
- Ribs 1-7 = True Ribs
- Ribs 8-10 = False Ribs
- Ribs 11 and 12 = Floating
What is the Thoracic Rule of Three?
- T1-3: SP at level with TP
- T4-6: SP are 1/2 level down than TP
- T7-9: SP are one full level down from TP
- T10-12: Starts to come back up
- T10: SP is one full level below TP
- T11: SP is one 1/2 level below TP
- T12: SP is even with TP
What is the OIAN of the External Obliques?
- O: Ribs 5-12
- I: Iliac crest, pubis, linea alba
- A: Bilaterally compresses abdomen and flexes the spine, Unilaterally it does ipsilateral side bending and contralateral rotation
What is the OIAN of the internal obliques?
- O: Lateral inguinal ligament, middle lip of iliac crest, thoracolumbar fascia
- I: Pubis, inferior border of ribs 9-12, linea alba
- A: Bilaterally compress abdomen and flexes the spine
- N: Lower 5 thoracic nerves, 1st lumbar nerve, iliohypogastric and ilioinguinal n.
What is the OIAN of the rectus abdominis?
- O: Crest of Pubis and pubic tubercle, pubic symphysis
- I: Cartilages of the 5-7 ribs and xiphoid process
- A: Flexes vertebral column, compresses abdomen
- N: Spinal nerves T7-12
What forms the washboard effect in the abdominals?
*The transverse fibrous intersections of the rectus abdominis
What are the OIAN of the Transverse Abdominis?
- O: Lateral 3rd of inguinal ligament, inner lip of iliac crest, inner cartilage of the lower six ribs, thoracolumbar fascia, and interdigitating with diaphragm
- I: Ends in aponeruosis, front and back of rectus sheath to linea alba and pubis
- N: Lower sic thoracic n, first lumbar n, iliohypgastic and ilioinguinal n.
- A: Compresses abdominal viserca dn tenses abdominal wall
What are the erector spinae divided between?
*Cervicis, thoracic, and lumborum
How does the pump handle action work and what does it effect?
*Move by rotating around their long axis. Rotates up with accompaniment of the manubrium and is done at T1-6
How does the bucket handle action work and what does is effect?
- Move upward, backward, and medially
- Effects T7-10
- Effects T2-6 at a much lesser degree
How does the Caliper action work and what does it effect?
- Moves laterally
* Effects T11 and T12
When measuring chest expansion, What is normal and what is problematic?
- Normal: > or equal to 5 cm
* Problem: < 2.5 cm, severe emphysema is 1 cm
What is the Sahrmann Core Stability Test?
- Ability of a patient to perform specific levels of stability testing while maintaining a neutral/flat spine (test is stopped if patient cannot maintain flat spine)
- Test is graded by the level the patient can perform
What is Level 1A- Fair of the SCS Test?
- Initial position to be used for rest of levels
- Hooklying, tighten your core keeping back flat and slowly lift 1 leg to 90 dg keeping your knee bent
- Keeping 1st leg up, slowly bring 2nd leg up to same position
- “Up up position”
What is level 1B- Poor (motor training) of the SCS Test?
- For the patient that cannot perform level 1A
* Hooklying, keeping back flat, slide one heel along floor out to straight leg and return to starting position
What is the level 2- fair+ of the SCS test?
- Starting in position 1A both legs up
- Slowly lower 1 leg down until heel touches table
- Slide heel along table out until leg is straight
- Slide it back until knee is bent
- Return to position 1A
- “One heel slide”
What is the level 3 (good) of SCS Test?
- Starting in position 1A (both legs up)
- Slowly lower 1 leg until it is a few inches above table
- Glide heel above table out until leg is straight
- Glide it back until knee is bent
- Return to position 1A
- “one heel glide”
What is the level 4 (sport level) of the SCS test?
- Starting in position 1A (both legs up)
- Slowly lower both legs until heels touch the table
- Slide both heels out until both legs are straight
- Slide them back until knees bent
- Return to position 1A
- “Double heel slide”
What is the level 5 (sport level- elite athlete) of the SCS test?
- Starting in position 1A (both legs up)
- Slowly lower both legs until heels are a few inches above table
- Glide both legs out until legs are straight
- Glide back until knees are bent
- Return to position 1A
- “Double heel glide”
What are the lower extremity myotomes?
- L2: hip flexion
- L3: Knee extension
- L4: Ankle dorsiflexion
- L5: Great toe extension
- S1: Ankle eversion, hip extension, plantar flexion
- S2: Knee flexion
What are the LE DTRs?
- L3/4: quads
- S1/2: Achilles
- L5/S1: Hamstrings
What is the pelvis made up of?
- 2 innominates and sacrum
- 3 joints
- 2 posterior (left and right SI joint)
- 1 anterior (pubic symphysis)
What occurs in the 2 posterior SI joints?
- Synovial articulations with irregular surfaces
- Strong ligamentous support and strong support from bony contour
- Movement- some and can have an effect on pain, stretch guarding
- Nutation and Counternutation, shearing
