IV. Biomechanics Of The Thoracic Spine And Rib Cage

Question 1

Function of Ribs?

Answer 1

Stabilizers to the spine Decrease the general mobility of thoracic Protect thoracic viscera Function in respiration

Question 2

Quiet Respiration is mostly:

Answer 2

Diaphragmatic

Question 3

Forced Respiration is

Answer 3

External intercostals become very active to elevate ribs, as well as activationg of many other secondary muscles

Question 4

What are some common clinical pain syndromes or traumatic injuries associated with the thoracic spine and ribs?

Answer 4

scoliosis postural myofascial pain syndrome kyphosis compression fractures

Question 5

Describe the vertebral body in the thoracics

Answer 5

AP and transverse diameters are equal wedge shaped vertically with from 1-2 mm shorter

Question 6

TPs in the thoracic region point in which direction?

Answer 6

lateral and posterior

Question 7

TPs are stronger in the lumbar or thoracic region?

Answer 7

thoracic

Question 8

Describe the SPs in the thoracics

Answer 8

long vertically, less in the upper and lower thoracics common site of spinal anomaly

Question 9

For T1-T4, where are the TPs in relation to the SPs?

Answer 9

up 1 interspinous space and lateral

Question 10

For T5-T7, where are the TPs in relation to the SPs?

Answer 10

up 2 interspinous space and lateral

Question 11

For T8-12, where are the TPs in relation to the SPs?

Answer 11

up 1 interspinous space and lateral

Question 12

What is the average IVD height in the thoracics?

Answer 12

5mm

Question 13

What is the ratio of IVD to disc in the thoracics?

Answer 13

1:5

Question 14

What is the ratio of IVD to disc in the cervicals?

Answer 14

2:5

Question 15

What is the ratio of IVD to disc in the lumbars?

Answer 15

1:3

Question 16

Articular facets in the thoracics form what angle with the horizontal plane and vertical plane?

Answer 16

60º with horizontal

30º with vertical

Question 17

In the thoracics, what is the general orientation of the articular facets and how do they change superiorly and to inferiorly?

Answer 17

Overall they are in the coronal plane but they become more sagittal inferiorly

Question 18

In the cervical region, what plane are the articular facets in?

Answer 18

Oblique and transition to coronal inferiorly

Question 19

In the lumbar region, what plane are the articular facets in?

Answer 19

Sagittal and transition to coronal inferiorly

Question 20

Is there any concavity/convexity to the articular facet surfaces in the thoracics and if so what?

Answer 20

No, they are flat unlike the cervical and lumbars

Question 21

What direction do the superior articular facets face in the lumbars?

Answer 21

posterolateral, superior

Question 22

What direction do the inferior articular facets face in the lumbars?

Answer 22

anteriomedial, inferior

Question 23

How do ribs articulate to the vertebral bodies?

Answer 23

Costovertebral joint: via demi facets on vertebral body above and below

Question 24

Describe the articulation of a constotransverse joint

Answer 24

the rib articulates the the TP of the corresponding vertebrae

Question 25

Which ribs terminate anteriorly with costal cartilage?

Answer 25

1-10

Question 26

Which ribs are free floating (no costal cartilage)?

Answer 26

11-12

Question 27

Which ribs attahc via their costal cartilage to the seternum through true synovial joints?

Answer 27

1-7

Question 28

Which ribs attach to the sternum via common costal cartilage?

Answer 28

8-10

Question 29

What is the range the thoracic kyphosis?

Answer 29

25-45º

Question 30

What is happening to the articulation?

Answer 30

distraction

Question 31

What is happening to the articulation?

Answer 31

approximation

Question 32

Which rib is the stiffest?

Answer 32

2

Question 33

Which rib is the most flexible?

Answer 33

10

Question 34

The stiffness of the rib cage is how many times more than that of any single rib?

Answer 34

10-20

Question 35

Resection of the costovertebral joints lead to what?

Answer 35

instability of the involved motion segment

Question 36

Stiffness of the thoracic spine is ________ times greater with the rib cage?

Answer 36

2.5

Question 37

The thoracic spine is ______ times more resistant to compression with the rib cage

Answer 37

4

Question 38

Tensile properties of the thoracic spine are increased ____ % with the rib cage

Answer 38

40

Question 39

What is the global range of motion for flexion of the thoracic spine?

Answer 39

50º

Question 40

What is the global range of motion for extension of the thoracic spine?

Answer 40

not included in AMA guidelines

Question 41

How does the segmental range of motion for combined flexion/extension change in the thoracic spine?

Answer 41

it increases caudally, especially below T9

Question 42

What is the average segmental range of combined (flexion/extension) motion in the upper thoracics?

Answer 42

4º

Question 43

What is the average segmental range of combined (flexion/extension) motion in the mid thoracics?

Answer 43

6º

Question 44

What is the average segmental range of combined (flexion/extension) motion in the lower thoracics?

Answer 44

12º

Question 45

What is the IAR for flexion in the thoracics?

Answer 45

central superior portion of the subadjacent vertebral body

Question 46

What is the IAR for extension in the thoracics?

Answer 46

central inferior portion of the vertebral body

Question 47

What is the kinematic pattern of motion for flexion and extension in the thoracics?

Answer 47

sagittal rotation (+/- θ x) coupled with sagittal plane translation (+/- z)

Question 48

What happens to the IVF during flexion?

Answer 48

it opens

Question 49

What happens to the IVF during extension?

Answer 49

it closes

Question 50

What is the global range of motion for lateral flexion in the thoracics?

Answer 50

38º to each side

Question 51

What is the pattern of segmental range of motion in the thoracics?

Answer 51

generally uniform, increasing in the lower thoracics

Question 52

What is the average segmental range of motion for lateral flexion for T1-T9?

Answer 52

6º to each side

Question 53

What is the average segmental range of motion for lateral flexion for T10-T12?

Answer 53

8-9º to each side

Question 54

What is the IAR for lateral flexion in the thoracics?

Answer 54

contralateral subadjacent vertebral body

Question 55

What is the kinematic pattern of motion for lateral flexion in the upper thoracics?

Answer 55

lateral flexion with ipsilateral coupled rotation SPs rotate to the convexity

Question 56

What is the kinematic pattern of motion for lateral flexion in the mid thoracics?

Answer 56

minimal couple movement slight coupled rotation in either direction

Question 57

What is the kinematic pattern of motion for lateral flexion in the lower thoracics?

Answer 57

coupled rotation may go in either direction

Question 58

What happens to the IVFs with lateral flexion of the thoracics?

Answer 58

IVF opens on contralateral side and closes on ipsilateral side

Question 59

What happens to the IVDs with lateral flexion of the thoracics?

Answer 59

disc bulges on the concave side and retracts on the convex side

Question 60

The nucleus pulposus shifts with lateral flexion of the thoracic spine. True or False?

Answer 60

False, there is no significant shift in the nucleus

Question 61

What happens to the articular facets with lateral flexion of the thoracics?

Answer 61

they glide apart on the contralateral side and approximate on the ipsilateral side

Question 62

In the upper thoracics, the ipsilateral coupled rotation with lateral flexion affects the glide of articular facets how?

Answer 62

causes additional lateral glide of the inferior facet on the contralateral side and medical glide on the ipsilateral side

Question 63

What is the global range of motion for rotation of the thoracic spine?

Answer 63

37º to each side

Question 64

What is the segmental range of motion for rotation of T1-T9?

Answer 64

7-9º

Question 65

What is the segmental range of motion for rotation for T10-T12?

Answer 65

2º

Question 66

What is the pattern of segmental range of motion for rotation in the thoracics?

Answer 66

generally uniform until the lower 3-4 segments, which have less rotation (motion resembles lumbars)

Question 67

What is the IAR for rotation in the thoracics?

Answer 67

contralateral center of the corresponding vertebral body

Question 68

Waht is the kinematic pattern of motion for rotation of the thoracics?

Answer 68

upper thoracic rotation is coupled with minimal ipsilateral lateral flexion the coupling dminishes in the mid thoracics and below

Question 69

What happens to the articular facets with rotation of the thoracics?

Answer 69

on the side of rotation, they open and the inferior facet glides medially and inferiorly on the opposite side of rotation, they approximate and the inferior facet glides laterally and superiorly

Question 70

Non-segmental muscles can act \_\_\_\_\_\_

Answer 70

segmentally ex: erector spinae, rectus abdominus

Question 71

What type of contraction always initiates a motion?

Answer 71

concentric

Question 72

What type of contraction controls a motion?

Answer 72

eccentric

Question 73

Concentric contraction of _______ inititates flexion of the thoracic spine

Answer 73

rectus abdominis

Question 74

Eccentric contraction of _______ controls flexion of the thoracic spine

Answer 74

erector spinae

Question 75

What limits flexion of the thoracic spine?

Answer 75

- elastic limits of erector spinae and segmental muscles of the spine - PLL, flaval, interspinous, supraspinous & capsular ligaments - posterior IVD - bony impact of the vertebral bodies

Question 76

Concentric contraction of _______ inititates extension of the thoracic spine

Answer 76

erector spinae

Question 77

Eccentric contraction of _______ controls extension of the thoracic spine

Answer 77

rectus abdominis

Question 78

What limits extension of the thoracic spine?

Answer 78

- ALL - bony impact of spinous and articular processes - anterior IVD - elastic limits of anterior abdominals

Question 79

Concentric contraction of _______ inititates lateral flexion of the thoracic spine

Answer 79

ipsilateral erector spinae and quadratus lumborum

Question 80

Eccentric contraction of _______ controls lateral flexion of the thoracic spine

Answer 80

contralateral erector spinae and quadratus lumborum

Question 81

What limits lateral flexion in the thoracic spine?

Answer 81

- impact of articular facets - intertransverse and flaval ligaments - elastic limits of the contralateral segmental and non-segmental muscles

Question 82

Rotation of the thoracic spine is initiated and controlled by the concentric and eccentric contraction of what muscles?

Answer 82

abdominal obliques erector spinae multifidi rotatores

Question 83

What are the respiratory movements of the rib cage?

Answer 83

bucket handle pump handle

Question 84

In respiratory movement of the rib cage, bucket handle movement increases _______ diameter of the rib cage by elevating the lateral aspects of the ribs.

Answer 84

transverse (M-L)

Question 85

In respiratory movement of the rib cage, pump handle movement increases _______ diameter of the rib cage by elevating the anterior aspect of the rib cage with the upward and forward movement of the sternum

Answer 85

A-P

Question 86

Other than rib movement, normal respiratory movement is also dependent on what?

Answer 86

healthy costochondral and sternochondral joints costal cartilage sternum diaphragm

Question 87

How do the ribs move with lateral flexion?

Answer 87

open on the convex side close on the concave side

Question 88

What happens to the rib angle during rotation?

Answer 88

accentuated on the side of rotation flattened on the opposite side of rotation

Question 89

During rotation, at what joints does movement of the ribs occur?

Answer 89

both posterior and anterior joints

Question 90

The posterior intercostal spaces _____ with flexion and _____ with extension

Answer 90

open : close

Question 91

During flexion the superior and inferior aspects of the rib cage _______ and during extension the superior and inferior aspects of the rib cage \_\_\_\_\_\_\_\_?

Answer 91

- flatten, becoming more horizontal - become more angulated, less horizontal

Question 92

During flexion the A-P diameter of the rib cage ______ and during extension the A-P diameter ______ (increases or decreases)

Answer 92

increases : decreases

Question 93

During flexion, the sternal angle ______ and during extension the sternal angle ______ (increases or decreases)

Answer 93

decreases : increases

Question 94

What happens to the 12th rib during quiet respiration?

Answer 94

quadratus lumborum fixes it to provide stability

Question 95

Vertebra vs. rib dysfuction can be difficult to differentiate. True or False?

Answer 95

True, they often occur together

Question 96

Other than P-A and lateral, what postural evaluation should be done of the thoracic spine?

Answer 96

Adam's test (scoliosis)

Question 97

What is "broken stick" when referring to observational evaluation of the global ROM of the thoracic spine?

Answer 97

when lateral flexion does not have the normal C-shaped curve but rather a more dramatic curve in one area

Question 98

The majority of trunk rotation occurs in the _____ spine

Answer 98

thoracic