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thoracic spine > Part 1 > Flashcards

Part 1 Flashcards

1
Q

Why is there a slight kyphosis it the thoracic spine?

A

there is a normal slight wedge shape to the vertebral bodies of the T-spine

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2
Q

How does the size of the vertebral bodies change in the T-spine

A
  1. they progressively decrease in size form T1-T3

2. they increase in size from T3-T12

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3
Q

How are the spinous process of the T-spine angulated?

A
  1. 1-3 project slightly inferiorly but at the same segment
  2. 4-6 project half a segment down
  3. 7-9 project one segment below
  4. 11 same as 4-6
  5. 12 same as T3
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4
Q

Which t spine segment is the transition segment?

A

T7- it is the point at which lower limb axial rotation transition to upper limb axial rotation

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5
Q

How many ribs are true ribs?

A

1-7 because they attach directly to the strenum

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6
Q

How are T11 and T12 different than the other ribs?

A
  1. they are floating ribs and do not articulate with the transverse process
  2. they are held to the TP by a ligament
  3. they articulate with only a single vertebrae
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7
Q

How do the ligaments of the T spine change compared to the L spine?

A

1.They don’t except for the addition of the costovertebral capsular and radiate and intra-articular ligaments

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8
Q

which ribs only articular with a single segment?

A

1, 11, 12

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9
Q

Which ribs are false ribs?

A

8-10 because they join with the costocartilage of the rib above

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10
Q

What are the different parts of the rib head capsule?

A
  1. radiate ligament to re-enforce the capsule with anterior, superior, and middle sections
  2. intraarticular ligament connecting to the disc
  3. posterior fibers connect to the costotransverse ligament
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11
Q

What does the T-spine disc look like?

A

nearly uniform in shape with the upper segments slightly more thin

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12
Q

What are the articulations of the thoraic spine vertebrae?

A
  1. 4 costovertebral
  2. 2 costotransverse
  3. 2 superior articular facets
  4. 2 inferior articular facets
  5. 2 disc articulations
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13
Q

What is the pathway of the nerve roots in the T spine?

A
  1. they exit at the vertebrae below

2. they drop off the spinal cord about midway down the body

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14
Q

What is the shape of the costotransverse joint?

A
  1. the tubercle of the rib articulates with the reciprocal facet of teh TP of the vertebral level
  2. the upper 6 are curve while the lower 4 are more flat
  3. they are diarthordial synovial joints
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15
Q

What is the superior costotransverse ligament continuous with?

A
  1. posterior continuous with external inner costals

2. anterior internal inner costals

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16
Q

What is the superior costotransverse ligament?

A
  1. a strong fibrous band that arises from the neck of a rib to the transverse process of the vertebra above.
  2. It comprises two sets of fibers.
    - anterior set passes obliquely superiorly and laterally from the sharp crest on the superior border of the neck of each rib to the anterior surface of the transverse process of the vertebra immediately superior to it
    - posterior set passes superiorly and medially from the crest on the superior border of the neck of the rib to the inferior border of the transverse process of the vertebra immediately superior to it.
    - The ligament may be absent for the first rib
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17
Q

What is the lateral costotransverse ligament?

A

it occupies the interval between the neck of the rib and the transverse process

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18
Q

How does the first costosternal joint differ from the other six?

A

cartilage of the first rib units directly to the sternum and forms a synchondrosis

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19
Q

What are the properties of the sternocostal joints?

A
  1. 1st rib is a synchondrosis
  2. 2-7
    - synovial joint with convex rib and concave sternum
    - articular surfaces are covered with fibrocartilage
    - supported by capsular, radiate, intra-articular, costoxiphoid ligaments
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20
Q

What is the radiate sternocostal ligament?

A
  1. transverses the sternocostal joint anteriorly and posteriorly
  2. it is thin and broad
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21
Q

What is the sternocostal intraarticular ligament?

A
  1. intra articular ligament that is consistent only at the 2nd costosternal ligament
22
Q

What are the intrachondral joints?

A

borders of the distal ends of ribs 6-9 articulate with each other

23
Q

What is the costochondral joint?

A

the joint between the costal cartilage and the boney sternal end of the rib

24
Q

What muscle of the thorax are involved in respiration?

A
  1. all of them

2. it they move the ribs then they are involved respiration

25
Q

How does the diaphragm effect rib movement?

A
  1. it pulls the ribs and sternum up to increase thorax A/P diameter causing….
    - elevated and depressed ribs 1-6
    - elevated sternum up and forward
    - pulls ribs 7-10 laterally moving them up and back
    - 8-12 are pulled back in a “caliper” action
26
Q

What do the ventral rami of the T spine innervate?

A
  1. 1-2 upper limb
  2. 3-6 thoracic wall
  3. 7-12 thoracic and abdominal wall
  4. subcostal nerve abdominal wall and gluteal skin
27
Q

What are the similarities and differences of the intercostal and subcostal nerves?

A
  1. both are thoracic ventral rami

2. subcostal comes out under the 12 rib versus between two ribs

28
Q

How does the sympathetic nervous system relate to the spinal nerve of the T spine?

A

sympathetic trunk ties into the ventral rami of the mixed spinal nerves via white and gray rami communicans.
-the white comes out with the spinal nerve and then travel to the sympathetic chain

29
Q

What are the different pathways of the sympathetic nerves rami?

A

There are THREE ways the white rami connect to the cell body of the gray from the mixed spinal nerve
1.at the same level of the sympathetic trunk
2.pass up or down the sympathetic trunk
3.passes through the trunk to directly into the target organ
Once synapsed to the gray in the sympathetic chain one of TWO paths are taken
1.leaves the chain to travel to the target organ via a sympathetic nerve
2.travels back into the spinal nerve to join the ventral or dorsal rami to reach the target organ

30
Q

What disease is caused by ensinophic granuloma?

A

cavle’s vertebral osteochondritis

31
Q

What is the cervicothoracic ganglion?

A

fusion of the inferior cervical and superior thoracic ganglion

32
Q

What structures create anterior stability of the T spine and ribs?

A
  1. thoracic kyphosis
  2. ALL
  3. annulus
  4. PLL
  5. costovertebal uoints
  6. radiate ligaments and costotransverse ligaments of ribs
33
Q

What creates posterior stability of the thoracic spine?

A
  1. ligamentum flavum
  2. capsular liegaments
  3. interspinus ligaments
  4. supraspinous ligaments
  5. facet joints and capsules (decreased influence T9 down)
34
Q

How much rotation is available in the thoracic spine?

A
  1. 4 degrees upper
  2. 6 degrees middle
  3. 12 degree TL junction
35
Q

How are the motions of the t spine coupled?

A
  1. upper spine (1-4 follows the cervical
  2. mid spine is not distinct or constant
  3. lower thoracic coupled with the lumbar
36
Q

What is the axis of motion of the LOWER ribs?

A
  1. costo-vertebral and costotransverse are inseparable so you can only get rotation
  2. axis is close to the frontal plane so you get an increase in transverse diameter with movement
37
Q

What is the axis of motion of the MIDDLE ribs?

A
  1. it is a transition between the upper and lower so the axis is at a 45 degree from the sagital plane
  2. you get both sagital and frontal plane motion
38
Q

How does the costal cartilage behave with breathing?

A
  1. during inspiration the ribs are lowered relative to the sterum
  2. this twists the costal cartilage storing energy for expiration or returning to neutral
39
Q

What direction do the ribs move relative to the sternum with inspiration?

A

the ribs lower

40
Q

How do Panjabi and White describe the IAR of the T-spine?

A
  1. extesnion- anterior and below center of superior vertebral body
  2. flexion- joint anterior and about the center of the inferior vertebral body
  3. SB (R)- passing centrally through the (L) half of the inferior vertebral body
  4. SB (L)- passing centrally through (R) half inferior vertebral body
  5. axial rotation- variable from nucleus propulsus to anterior canal
41
Q

How does Bogduk describe the T spine IAR

A

rotation axis shift to the closed back facet from the inferior vertebral body

42
Q

How does Grimsby describe the IAR for t spine rotation

A

same as Bogduk in that the axis shifts to the closed pain contralateral facet

43
Q

What variables effect the IAR?

A
  1. disc height
  2. condition of facets
  3. a/p translation
  4. sacral angle
  5. hypomobile segment
44
Q

What are the anterior static stabilizers of the t spine (superficial to deep)

A
  1. ALL
  2. anterior 1/2 of AF
  3. radiate ligament and costovertebral lig
  4. posterior 1/2 AF
  5. PLL
45
Q

What are the posterior static stabilizers deep to superficial?

A
  1. costotransverse
  2. capsular ligaments
  3. facet articulations
  4. ligament flavum
  5. supra- and infra- spinous ligaments
46
Q

How does the axis of motion changes between the upper and lower ribs?

A
  1. upper-axis is in the front plane creating sagittal plane motion
  2. lower- axis is in the sagittal plane creating frontal plane motion
47
Q

In what way is the disc of the T spine different than the L spine?

A
  1. ratio of diameter to height is 2-3x higher in the t spine
  2. nucleus propulsis is smaller in the T spine
  3. rib attachements limit disc mobility in the T spine
  4. ALL, PLL and LF are very well developed increasing stability
48
Q

How do Panjabi and White describe the T spine ROM?

A 
FLEX/EXT          lat flex         rot
1-5  4 degrees   1-9, 6          1-5, 9
7-9 6 degrees     10, 7           6-8, 7
10 9 degrees      11-12, 9      9, 4 
11-12 12 degrees                  10-12, 2
49
Q

How does Robert describe the ROM of the T spine?

A
  1. least flex/ext, SB, rot in the mid thoracic

2. 11-12 most mobile, almost 2x upper t spine

50
Q

What are the limiting factors for t spine extension?

A
  1. approximation of the posterior aspect of the vertebrae

- impact of the articular processes, spinous processes and tension of ALL

thoracic spine (2 decks)

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