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MSK > T-Spine Jawn part 1 > Flashcards

T-Spine Jawn part 1 Flashcards

1
Q

Arthrokinematics of T-Spine in flexion

A

• Bilateral upslides of the facets
• Bilateral ribs rotate anteriorly at
costovertebral joint

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2
Q

Arthrokinematics of T-Spine in extension

A

• Bilateral facets downslide
• Bilateral ribs rotate posteriorly
at costovertebral joint

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3
Q

Arthrokinematics of T-Spine in sidebending / lateral flexion

A
  • Ipsilateral facet downslides
  • Contralateral feet upslides
  • Ipsilateral ribs approximate
  • Contralateral ribs separate
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4
Q

Arthrokinematics of T-Spine in rotation

A 
• Ipsilateral facet distracts
(opens)
• Contralateral facet compresses
(closes)
• Ipsilateral rib rotates posteriorly
• Contralateral rib rotates anteriorly
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5
Q

Coupled motions of T-spine when in flexion

A

◦ Occur to same side

◦ I.e. right SB coupled with right rotation

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6
Q

Coupled motions of T-spine when in extension

A

◦ Occur to opposite sides

◦ I.e. right SB coupled with left rotation

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7
Q

Non-MS Causes of Thoracic Pain

A 
• Metastases: breast, lung, or colon CA
• Primary Thoracic Spine Tumors
• Infection
◦ Osteomyelitis, diskitis, epidural infections
• Inflammatory disorders
◦ Ankylosing Spondylitis
• Fracture
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8
Q

Visceral Sources or Thoracic Pain

A

◦ Dissecting aortic aneurysm- MEDICAL EMERGENCY ◦ Myocardial ischemia
‣ Stable angina- related to exertion
‣ Unstable angina ◦ Peptic ulcer
◦ Pyelonephritis

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9
Q

Quadrant Testing

A

Combines motion in multiple planes to assess for symptomatic response

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10
Q

Where can facets refer pain to in the T-Spine?

A

Facets can refer unilateral pain to 2 segments lower, along border of scapula, and inter scapular
area

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11
Q

Ribs pain can refer to what?

A

around the thorax

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12
Q

The Rule of 3’s T1-T3:

A

SP same level as TPs

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13
Q

The Rule of 3’s T4-T6:

A

SP 1/2 level inferior to TPs

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14
Q

The Rule of 3’s T7-T9:

A

SP 1 level inferior to TPs

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15
Q

The Rule of 3’s T10:

A

SP 1 level inferior to TPs

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16
Q

The Rule of 3’s T11:

A

SP 1/2 level inferior to TPs

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17
Q

The Rule of 3’s T12:

A

SP same level as TPs

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18
Q

What is a positive sign for Cervical Rotation Lateral Flexion Test

A

Restricted or blocked motion (+) for elevated 1st rib

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19
Q

Thoracic Manipulation: Contraindications and Precautions

A
  • 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
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20
Q

What is the primary function of the T-Spine?

A

protection of viscera, provides stability, limited mobility

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21
Q

Muscles of inspiration accessory

A

SCM (elevates sternum)
Scalenes (elevates upper ribs)
Pec minor

22
Q

Muscles of inspiration Principles

A

External intercostals Internchondral part of internal intercostals,

Diaphgram

23
Q

Muscles of expiration (quiet breathing)

A

Expiration from passive, elastic recoil of lungs and dib cage

24
Q

Muscles of expiration (active breathing)

A

internal intercostals pull ribs down

abs pull ribs down and push diaphragm up

QL pull ribs down

25
Q

Pump handle

A

upper ribs

26
Q

Bucket handle

A

Lower ribs

27
Q

Dual Energy X-Ray Absorptiometry is gold standard for

A

Osteoprosis

28
Q

For osteoporotic compression fractures what would you use

A

Radiographs, CT, MRI

29
Q

What is the clinical presentation of someone with traumatic vertebral fractures?

A

Severe pain, onset associated with traumatic incident (MVA, fall on butt or from height), muscle guarding around spine

30
Q

What happens during a chance fracture?

A

Seatbeat in flexion/distraction injury, can be unstable, 2-3 colmns involved, anterior compressed and middle/posterior under tension

31
Q

What happens during a Burst fracture?

A

High energy compression axial loading, associated with hindfoot fractures

32
Q

Burst fracture are most common where?

A

T9-L5

33
Q

TLSO bracing does what?

A

restrict motion and unload anterior vertebral bodies

34
Q

Jewett Brace what does it do and indications?

A

Prevents flexion, permits extension

 Stable Compression Fracture
 Post-op surgery of anterior vertebral
bodies
 Kyphotic posture

35
Q

What is scheuermann’s kyphosis?

A

wedged shaped vertebra, deficient growth anteriorly and normal posture, mimics wedge fx,

36
Q

Proper brace for scheuermann’s kyphosis?

A

Any TLSO to limit spinal flexion

37
Q

What is structural scoliosis?

A

inflexible curvature, unchanged with lat flex to convex side, 85% idiopathic

38
Q

What is functional scoliosis ?

A

flexible curve, curve reveres or straightens with lat flex toward convexity

39
Q

What is a Cobb Angle?

A

> 10 degree is considered for scoliosis

40
Q

what are possible Scoliosis intervention?

A

 Curves 25-40 ̊ and progressing
 Bracing
 Physical therapy

 Curves 40-50 ̊
 Surgical intervention

41
Q

In scoliosis what would you do to the convex side?

A

Strengthening of muscles

42
Q

In scoliosis what would you do to the concave side?

A

Stretching, joint mobilizations

43
Q

Who would you prescribe a milwaukee brace?

A 
Indications:
Thoracic scoliosis
Scheuermann’s disease
 Control curve
 Prevent progression
44
Q

Who would you prescribe a Boston brace?

A

Indications:

 Moderate curves in thoracic & lumbar spine

45
Q

Who would you prescribe a rigo system cheneau brace?

A

utilized in conjunction with schroth method of therapy

46
Q

What are is a barrel chest?

A

lungs remain inflated, thorax expanded

47
Q

Ankylosing Spondylitis

A

Effect costotransverse and costovertebral joint, limit chest expansion

48
Q

What happens to the thoracic outlet syndrome to the specific structures?

A

 Brachial Plexus: compression
 Subclavian Vein: engorgement
 Subclavian Artery: insufficiency

49
Q

What are neurologic symptoms for someone with TOS?

A

pain in neck, shoulder, arm, hand.

Parasthesias along C8 and T1 dermatomes

weakness and atrophy for gripping muscles, thenar muscles

Decreased hand dexterity

50
Q

What are vascular symptoms for someone with TOS?

A

 Heaviness/fatigue
 Especially with overhead activity (i.e. blow drying hair)
 Cramping with activity
 Cold intolerance
 Arterial: pallor, decreased pulses, ischemia
 Venous: engorgement, edema

MSK (5 decks)

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