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ORTHO 2 > t-spine intro > Flashcards

t-spine intro Flashcards

1
Q

physiologic motion of the t-spine is influenced by:

A

the stabilizing forces and movements of the ribs

*rib cage and sternum add strength and stability to the t-spine

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2
Q

normally, inter-rib motions stop BEFORE

A

intervertebral motion

endranges of osteokinematic motion involve motion of the TP on a “FIXED” rib

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3
Q

costotransverse joint

A

has a convex/concave relationship with ribs 1-7/8 and is flat for ribs 8-10

this relationship can guide both rib motion and segmental motion

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4
Q

flexion

A

0- (25-45) degrees

tape change= ~2.7cm

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5
Q

opening segmental motion limited by:

A

supraspinatus
infraspinatus
capsular ligaments
posterior longitudinal ligament

posterior force on the nucleus

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6
Q

motion of the rib cage during flexion/extension

A

costovertebral
sternocostal
costochondral

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7
Q

extension

A

0-(25-45) degrees

tape change= ~2.5 cm

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8
Q

closing segmental motion limited by:

A

approximation of spinous processes

anterior forcé on the nucleus

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9
Q

lateral flexion

A

0- (20-40) degrees

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10
Q

opening and closing lateral segmental motion is limited by:

A

lateral and rib cage structures

lateral forces on the nucleus

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11
Q

motion of the ribs during lateral flexion

A

motion on the convex side: intercostal spaces widen- enlarges cage

motion on the concave side: intercostal spaces narrow

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12
Q

rotation

A

0-(35-50) degrees

“twisting and rotation” of the disc (rather than shear like in the lumbar spine) leads to greater ROM (3 degrees per segment compared to 1 degree in lumbar spine)

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13
Q

opening and closing rotational segmental motions limited by:

A

rib cage deformations

axis through the body of the vertebra (lumbar spine axis posterior to SP)

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14
Q

motion of ribs in rotation

A

bends ribs and costal cartilages- these structures help limit motion

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15
Q

ribs

A

connected to the vertebrae by synovial joints

  • costovertebral joints
  • costotransverse joints
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16
Q

costovertebral joint

A

head of rib (convex) articulates with both vertebral bodies (concave) and annulus.

consider as 2 pairs of articular facets separated by an interosseous ligament enclosed by a single capsule reinforced by the radiate ligament running forward to both vertebral bodies and annulus.

stable d/t interlocking joint surfaces

17
Q

costotransverse joint

A

convex rib tubercle on concave transverse process for ribs 1-7 or 8; flat for 8-10 stabilized by 3 costotransverse ligaments:

  • interosseus
  • posterior costotransverse
  • superior costotransverse
18
Q

rib movement

A

occurs through an axis through both joints

UPPER RIBS: “Pump handle”
Axis lies closer to the frontal plane; raises sternum, expands A-P dimension of rib cage

MIDDLE RIBS:
Axis through roughly 45 degrees to frontal plane-transition, both types of motion present

LOWER RIBS: “Bucket handle”
Axis lies closer to the sagittal plane; expands medial/lateral dimension of rib cage and changes angle at sternocostal joint

INFERIOR RIBS: (11 &12)
“Caliper motion”

19
Q

superficial layer of posterior muscles

A

traps
rhomboids
latissimus dorsi

20
Q

2nd layer of posterior muscles

A

splenius

serratus posterior

21
Q

3rd layer of posterior muscles

A

iliocostalis
longissimus
semispinalis

22
Q

deepest layer of posterior muscles

A 
levator costorum
interspinalis
intertransversarii
multifidii
rotatores
23
Q

rib muscles

A

intercostals:

  • external for inhalation
  • internal for exhalation

levator costae: elevates ribs (inhalation)

sternocostalis (retrosternal location): exhalation

diaphragm: increases all 3 dimensions of the rib cage

24
Q

impairment based classification system for t-spine

A

*(see olsen page 204)

  • thoracic hypomobility
  • TS hypomobility w/ UE referred pain
  • TS hypomobility w/ neck pain
  • TS hypomobility w/ LBP
  • thoracic clinical instability
25
Q

thoracic hypomobility

A

*common TS condition

  • TS manipulation shows promise in the literature to increase movement and decrease pain complaints
  • differentiate from rib hypomobility by MOTION TESTING
  • rib and TS hypomobility can occur concurrently; treat the SPINE first, then address any lingering RIB hypo mobility
26
Q

differentiate rib vs TS hypomobility by…

A

motion testing

27
Q

TS hypomobility w/ UE referred pain

A

AKA “ T4 syndrome”

=UE paresthesia and pain w/ or w/out CS pain

  • findings include T4 region stiffness, +ULTT
  • ?sympathetic nervous system referral to CS, head and UEs
  • evidence shows good success with upper TS manipulation followed by movement (level 4/case study level of evidence)
28
Q

TS hypomobility w/ neck pain

A

Cleland CPR for TS manip for CS pain
-symptoms <30 degrees

if 3/6 present successful outcome increases from 54-86%

29
Q

TS hypomobility w/ shoulder impairments

A
  • decreased upper TS mobility may predispose RC impingement
  • check PIVM of the TS
  • observe TS during active elevation; re-checl with manual retraction of the scapula
  • include mob/manip and postural re-education
30
Q

TS hypomobility w/ LBP

A
  • lower TS stiffness may increase demand on the lumbar spine
  • remember the linkage of the thoraco-lumbar fascia
  • manipulation of the TS may help inhibit hyperactive T/L musculature
31
Q

thoracic clinical instability

A

Less common than hypomobility conditions

Look for ache w/ sustained upright posture, relief with recumbent positions, aberrant movement w/ AROM, and hypermobile PIVM

Associated with:

  • systemic hypermobility
  • severe postural deviations
  • S/P trauma
  • S/P TS surgery
32
Q

Red flags/risk factors

A
  • minor trauma (osteroporosis/cortisone use)
  • major trauma
  • fever, pm sweats, risk factor for infection
  • hx of malignancy, age >50, no improvement w/ treatment, unexplained weight loss, pain at multiple sites, pain at rest, pm pain
  • chest pain/heaviness, no mechanical link to pain, abdominal pain, SOB, cough
33
Q

patho-anatomical considerations

A

SPRAINS/STRAINS

  • overuse/posture: most common reason for TS pain
  • trauma

THORACIC PAIN D/T PROBLEMS EXTERNAL TO TS

  • referral from abdominal and thoracic organs
  • referral from CS

THORACIC DISC LESIONS

  • root pain can mimic fractured rib or chondral problems; r/o w/ AP pressure on sternum=no pain w/ disc lesion
  • also mimics visceral disease (angina, gall bladder, colitis, etc)
VERTEBRAL PROBLEMS 
Fractures: 3 columns:
-anterior= usually not big problems
-middle= usually BIG problems
-posterior= instability not uncommon
-Schmoral's nodes= usually no problems
Segmental Problems: instability/hypermobility
-surgical: rods, plates,, pedical screws
-conservative: stabilization exercises, orthoses, corsets, strapping
34
Q

rib dysfunction: fractures

A

fractures: ribs and costal cartilage

usually treated conservatively w/out immobilization-watch for pnuemothorax

35
Q

rib dysfunction: costochondritis

A

usually trauma or infection (diff dx from MI)

  • painful swelling of costochondral junction
  • localized, palpable swelling
  • pressure on sternum or lateral border elicits pain at junction
  • pain w/ deep breathing/coughing

conservative tx: NSAID, rest, occ injected

36
Q

posture

A

assess along w/ C-spine, shoulder girdle, lumbar spine and LE alignment

37
Q

proprioceptive cues for posture

A
  • corsets

- taping

ORTHO 2 (18 decks)

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