PT3 - Linking The Upper Extremity And The Spine

Question 1

What are the anatomical links between the spine and the upper extremity?

Answer 1

• MSK
• neurological
• vascular (TOS)
• pain

Question 2

What is they bony link between the upper extremity and the thorax?

Answer 2

• clavicle

Question 3

How does the structure of the SC joint reflect the links between upper extremity and the thorax?

Answer 3

• lots of articular links e.g. ligaments, articular disc for shock absorption, subclavicular muscle
• breakdown in transfer of force = fracture of clavicle

Question 4

What is an open chain movement?

Answer 4

• hand moving in space e.g. lateral raise

Question 5

What is a closed chain movement

Answer 5

• distal end is anchored e.g. pull up

Question 6

How many planes of movement are available at the scapulothoracic joint?

Answer 6

• 3 planes => sagittal, frontal + transverse

Question 7

What is the impact of aging on the thorax?

Answer 7

• kyphosis
• reduced shoulder function
• not necessarily correlated to pain
• neurological link between axial spine + limbs = brachial plexus

Question 8

What happens to the function of the brachial plexus when compromised?

Answer 8

• affect neurological function in upper extremity e.g. sensory/motor
• might also be a mechanical difference + inhibit movement available e.g. thoracic outlet

Question 9

What is a common area of compromise of the brachial plexus?

Answer 9

• c-spine e.g. radiculopathy/radicular pain

Question 10

Which structures can cause referred pain?

Answer 10

• any structures with nociceptive capability

Question 11

What is referred pain?

Answer 11

• pain felt in a part of the body other than its source

Question 12

Why does referred pain occur?

Answer 12

• thought to be erroneous signalling from one body part being mis-read at the dorsal horn level (or above) coming from a shared body area

Question 13

What is referred pain also known as?

Answer 13

• convergence theory of referred pain

Question 14

What is sclerotome referral?

Answer 14

• all connective tissue of MSK origin stems from sclerotome
• embryological development => migration to final destination pulling sensory/nociceptive nerve supply
• wherever tissue are irritated => pain may be felt some distance from site

Question 15

What is angiotome referral?

Answer 15

• vascular tissue that has migrated e.g. capillary beds and arterioles during embryological development
• follows the path of connective tissue during migration, but diffuse in skin + subcutaneous tissue
• nociceptive supply to limbs => sympathetic fibres, T1-L2