T-Spine and Rib Cage

Question 1

Referred Pain Patterns (systemic origin - pain location)

Answer 1

pleural - upper back/scapula
ulcers - T6-T10
pancreas - midback/ R upper scapula
gallbladder - midback/ R upper scapula
esophagus - midback
MI - mid T-spine and L UE

Question 2

Orientation of Facets and Transverse Processes

Answer 2

upper t-spine segments 30-60 deg to horizontal plane (C7-T2)
mid approach vertical position (T3-9)
lower approach sagittal plane (T10-L1)
transverse processes ABOVE spinous process except T11 and T12

Question 3

Intercostals

Answer 3

stabilize, maintain shape, and integrity of rib cage

stability especially with speech and singing

Question 4

External Intercostals

Answer 4

contract to achieve inhalation (quiet and forcess)

responsible for elevation of ribs in transverse plane

Question 5

Internal Intercostals

Answer 5

contract to achieve forced exhalation as in coughing

quiet exhalation usually passive

Question 6

Rib Motion

Answer 6

1st rib - anterolateral motion (1/2 pump handle, 1/2 bucket handle)
Ribs 2-4 - ant pump handle
Ribs 5-10 - lat bucket handle
Ribs 11-12 - post caliper motion

Question 7

Neural Dysfunction

Answer 7

Herpes Zoster - painful viral infection, follows line of intercostal nerve along rib
- h/o of chicken pox, immunocompromised individuals
Post Herpetic Neuralgia - severe pain after infection has cleared

Question 8

Idiopathic Scoliosis

Answer 8

rot always to convexity, rib compression on concave side
30 deg or less - watch for progression
30-60 deg - consider bracing
> 60 deg - surgery (potential pulmonary compromise)
therex helpful for postural stabilization but questionable for preventing progression of curve

Question 9

Ankylosing Spondylitis

Answer 9

forward flexed posture
restricts spine and rib motion as vertebral segments fuses together
usually starts with sacroilitis
rheumatic disease

Question 10

T-Spine Disc Signs and Symptoms

Answer 10

chest wall pain in dermatomal distribution
myelopathy with LE symptoms
occasionally - shoulder, abdominal, pelvic, cardiothoracic type symptoms

Question 11

Acquired Thoracic Segmental Dysfunction

Answer 11

rotational faults
facet joint capsule strains, subluxation
similar etiologies to l-spine

Question 12

Acquired Rib Restrictions

Answer 12

inhalation restriction - depressed rib(s) that does not move up with inhalation
exhalation restriction - rib(s) that is “stuck up” and does not descend with exhalation (may be secondary to rib fxs, poor posture, pregnancy)
subluxation at costotransverse joint - due to trauma, rib issues

Question 13

Costochondritis

Answer 13

inflammation of sternocostal or CC joints due to trauma or arthritis
occurs to side of sternum (affects more than one rib, worsens when taking deep breaths or coughing)
treatment - NSAIDs, breathing and gentle stretching exercises, pain relieving modalities