T-Spine Jawn part 1 Flashcards
Arthrokinematics of T-Spine in flexion
• Bilateral upslides of the facets
• Bilateral ribs rotate anteriorly at
costovertebral joint
Arthrokinematics of T-Spine in extension
• Bilateral facets downslide
• Bilateral ribs rotate posteriorly
at costovertebral joint
Arthrokinematics of T-Spine in sidebending / lateral flexion
- Ipsilateral facet downslides
- Contralateral feet upslides
- Ipsilateral ribs approximate
- Contralateral ribs separate
Arthrokinematics of T-Spine in rotation
• Ipsilateral facet distracts (opens) • Contralateral facet compresses (closes) • Ipsilateral rib rotates posteriorly • Contralateral rib rotates anteriorly
Coupled motions of T-spine when in flexion
◦ Occur to same side
◦ I.e. right SB coupled with right rotation
Coupled motions of T-spine when in extension
◦ Occur to opposite sides
◦ I.e. right SB coupled with left rotation
Non-MS Causes of Thoracic Pain
• Metastases: breast, lung, or colon CA • Primary Thoracic Spine Tumors • Infection ◦ Osteomyelitis, diskitis, epidural infections • Inflammatory disorders ◦ Ankylosing Spondylitis • Fracture
Visceral Sources or Thoracic Pain
◦ Dissecting aortic aneurysm- MEDICAL EMERGENCY ◦ Myocardial ischemia
‣ Stable angina- related to exertion
‣ Unstable angina ◦ Peptic ulcer
◦ Pyelonephritis
Quadrant Testing
Combines motion in multiple planes to assess for symptomatic response
Where can facets refer pain to in the T-Spine?
Facets can refer unilateral pain to 2 segments lower, along border of scapula, and inter scapular
area
Ribs pain can refer to what?
around the thorax
The Rule of 3’s T1-T3:
SP same level as TPs
The Rule of 3’s T4-T6:
SP 1/2 level inferior to TPs
The Rule of 3’s T7-T9:
SP 1 level inferior to TPs
The Rule of 3’s T10:
SP 1 level inferior to TPs
The Rule of 3’s T11:
SP 1/2 level inferior to TPs
The Rule of 3’s T12:
SP same level as TPs
What is a positive sign for Cervical Rotation Lateral Flexion Test
Restricted or blocked motion (+) for elevated 1st rib
Thoracic Manipulation: Contraindications and Precautions
- Osteoporosis
- Joint ankylosis- ankylosing spondylitis
- Possibility of metastasis
- Suspected fx
- Suspected infection
- Instability and spondylolisthesis
- Severe scoliosis
- Long-term use of corticosteroids
- Neurological signs
- Suspected cord compression
- Pt unable to relax/tolerate
- Lack of informed consent
What is the primary function of the T-Spine?
protection of viscera, provides stability, limited mobility
Muscles of inspiration accessory
SCM (elevates sternum)
Scalenes (elevates upper ribs)
Pec minor
Muscles of inspiration Principles
External intercostals Internchondral part of internal intercostals,
Diaphgram
Muscles of expiration (quiet breathing)
Expiration from passive, elastic recoil of lungs and dib cage
Muscles of expiration (active breathing)
internal intercostals pull ribs down
abs pull ribs down and push diaphragm up
QL pull ribs down
Pump handle
upper ribs
Bucket handle
Lower ribs
Dual Energy X-Ray Absorptiometry is gold standard for
Osteoprosis
For osteoporotic compression fractures what would you use
Radiographs, CT, MRI
What is the clinical presentation of someone with traumatic vertebral fractures?
Severe pain, onset associated with traumatic incident (MVA, fall on butt or from height), muscle guarding around spine
What happens during a chance fracture?
Seatbeat in flexion/distraction injury, can be unstable, 2-3 colmns involved, anterior compressed and middle/posterior under tension
What happens during a Burst fracture?
High energy compression axial loading, associated with hindfoot fractures
Burst fracture are most common where?
T9-L5
TLSO bracing does what?
restrict motion and unload anterior vertebral bodies
Jewett Brace what does it do and indications?
Prevents flexion, permits extension
Stable Compression Fracture
Post-op surgery of anterior vertebral
bodies
Kyphotic posture
What is scheuermann’s kyphosis?
wedged shaped vertebra, deficient growth anteriorly and normal posture, mimics wedge fx,
Proper brace for scheuermann’s kyphosis?
Any TLSO to limit spinal flexion
What is structural scoliosis?
inflexible curvature, unchanged with lat flex to convex side, 85% idiopathic
What is functional scoliosis ?
flexible curve, curve reveres or straightens with lat flex toward convexity
What is a Cobb Angle?
> 10 degree is considered for scoliosis
what are possible Scoliosis intervention?
Curves 25-40 ̊ and progressing
Bracing
Physical therapy
Curves 40-50 ̊
Surgical intervention
In scoliosis what would you do to the convex side?
Strengthening of muscles
In scoliosis what would you do to the concave side?
Stretching, joint mobilizations
Who would you prescribe a milwaukee brace?
Indications: Thoracic scoliosis Scheuermann’s disease Control curve Prevent progression
Who would you prescribe a Boston brace?
Indications:
Moderate curves in thoracic & lumbar spine
Who would you prescribe a rigo system cheneau brace?
utilized in conjunction with schroth method of therapy
What are is a barrel chest?
lungs remain inflated, thorax expanded
Ankylosing Spondylitis
Effect costotransverse and costovertebral joint, limit chest expansion
What happens to the thoracic outlet syndrome to the specific structures?
Brachial Plexus: compression
Subclavian Vein: engorgement
Subclavian Artery: insufficiency
What are neurologic symptoms for someone with TOS?
pain in neck, shoulder, arm, hand.
Parasthesias along C8 and T1 dermatomes
weakness and atrophy for gripping muscles, thenar muscles
Decreased hand dexterity
What are vascular symptoms for someone with TOS?
Heaviness/fatigue
Especially with overhead activity (i.e. blow drying hair)
Cramping with activity
Cold intolerance
Arterial: pallor, decreased pulses, ischemia
Venous: engorgement, edema
