Intro Thoracic Spine Flashcards
The average thoracic kyphosis ranges from what to what degrees?
20 - 40 degrees
The apex of thoracic kyphosis is usually at what level
T7 - T8
What thoracic spine level is there a significant decrease in movement of the spinal cord leading to a tension point
T6
What are the thoracic rule of threes
T1 - T3: SPs level with their own body
T4 - T6: SPs level with inferior disc
T7 - T9: SPs one segment below TPs
T10 - T12: SPs and TPs on same horiz plane
What kind of joint is the costovertebral joint
Compound synovial joint
The costovertebral joint is strengthened by what ligament
Radiate ligament
The costotransverse joint is a joint between the what and what
Facets of TPs and rib tubercle
The sternocostal joint between sternum and cartilage of first rib is what kind of joint
Synchondrosis
If you get L sided chest pain in OSCE, what do you need to rule out first or automatic fail?
Cardiac involvement
T spine coupling
Mid and lower can go either way but tend to follow lumbar spine (opp)
Inspiration muscles
Diaphragm, external intercostals
Accessory: scalenes, SCM, UT, pec major/minor
Expiration muscles
Abdominals and internal intercostals
Accessory: lats, QL
Idiopathic scoliosis cause
Obscure
What percentage of idiopathic scoliosis is genetic?
90%
Idiopathic scoliosiis more common in male or female
Female
3 types of idiopathic scolisos
Infant
Adolescent
Jeuvenille
Scoliosis can continue after maturity due to
- strong genetic dose
- curve throws off balance of body
- poor muscle tone
Lateral shift in thoracic spine is sign of
Serious pathology
5 causes of kyphosis
Genetic, osteoporosis, spondylosis, pathologic fractures, Scheuermann’s
Scheuermanns is what
Osteoporosis of the vertebrae
Age for scheuermanns
10-20
Problem occurs where for scheumernnsn
Where disc and vertebrae connect
Schuermanns affects end plate?
Yes
Scheumernns end plate dysfunction causes
Collapse of vertebrae anteriorly
Scheumeranns pain sx
Pain slowly increasing as day goes on by heavy labor, never severe
Scheumanns diagnosis
X ray
3 adj vertebrae showing minimum 5 degrees wedging and kyphosis angle >45
Clinical sx AS
Mid low back pain/stiff > 3 mos
Worse in AM lasting more than 1 hr
Chest expansion < 2cm on full inhalation
Pain better with activity, not rest
Psoriasis, uveitis, iritis, chrons, colitis
AS diagnosis
HLA-B27 positive
X ray and MRI with fused spine
LBP>3mos
Limited chest expansion
T spine disc issues
Age
Area of disc
Worse than L/C spine?
Chest pain
PT t/x
40-60
Posterior or posterolateral
Better because IV foramen bigger
Anterior chest pain (rule out cardio)
Extension based
Costochondral conditions
Caused by
Pain and swelling where
Acute costochondrosis aka
Trauma
Bone/cartilage junction, 1in lat sternum
Tietz’s syndrome
Thoracic facet dysfunction
Sx
Unilateral limitation and pain in rotation
Asymmetrical segmental mobility and palpatory findings
Costovertebral joint dysfunctions
Main sx
Restricted mainly in
Pain with
Intense sharp pain unilaterally
Side bend
Deep breathing, sneezing, cough
Diff diagnosis costovertebral jt dysfunction
Cardiac
Pneumonia
Pleuritis
Rib fracture
Herpes zooster
Long thoracic nerve ANNT
1st rib dysfunction
Due to
Need to rule out
How to confirm
Neuro sx
Trauma
Presence of cervical rib
X ray
None
How to confirm presence of cervical rib
If 1st rib higher up to 1cm = joint dysfunction
1st rib higher up to 2+cm = cervical rib
C6-T3 (cervicothoracic region) coupling
Same
Cervicothoracic region dysfunction
Sx and motion
Pain and limitation with flx,ext, SB/rot to same side
