T4 Thoracic Spine Flashcards
What is the most common disease affecting the thoracic spine?
Osteoporosis
The upper thoracic spine refers to ____
The lower thoracic spine refers to ____
-T1-T2
- T3 - T12
T1 (cervicothoracic junction) and T12 (thoracolumbar junction) are considered…
Transitional vertebrae, therefore they can begin to move in unison w/ their articulating vertebrae
The ribs contribute to…
Spinal stability, restricting forward bending, side bending, and rotation, protect viscera
Which are the atypical ribs and what does this mean?
Ribs 1,11 & 12
This means they articulate with one vertebral body are not united to a disc and articulate with the numerically corresponding vertebral body only
Define typical ribs
Typical ribs, articulate with two vertebral bodies to the numerically corresponding vertebral body and the IVD and the vertebral body above. They have a head with two facets on either side of a tiny crest.
Ribs 11 & 12 are…
Floating ribs
Ribs 1 & 2 articulate with the ___
Ribs 3-7 articulate with the ___
- manubrium
- sternum
When the mid thoracic spine (T3 - T9)
Flexes the ribs roll…
Extends …
Laterally flexes…
Rotates…
- flexion: the ribs roll anteriorly and glide superiorly
-Extension: the ribs roll posterior and glide inferiorly - Lateral flexion: the ribs approximate ipsilaterally and separate contralateral
- rotation: the ipsilateral rib will posteriorly rotate. The contralateral rib will anteriorly rotate.
How many joints are there in the thorax?
136
How do we generate our core power?
With thoracopelvic rotation
What are the primary muscles of respiration during inspiration?
Diaphragm, levator costorum, external intercostals, internal intercostals
What are the secondary muscles of respiration during inspiration?
Scaleni
SCM
Trapezius
Serratus anterior and posterior
Pectoralis major and minor
Subclavius
Latissimus Dorsi
Serratus posterior superior
QL
Iliocostalis lumborum
What are the primary muscles of respiration during expiration?
Internal obliques
External obliques
Rectus abdominis
Transversus abdominis
Transverses Thoracis
Transverse intercostals
Internal intercostals
What is the primary muscle of respiration?
The diaphragm
The diaphragm is innervated by
C 3,4 and 5 phrenic nerve
During inspiration the volume is ____ and pressure is ____ in the abdominal cavity,
the volume is _____ and pressure is _____ in the thoracic cavity
- decreased, increased
- Increased, decreased
The “bucket handle” action of the ribs happens mainly at ribs ___
7 through 10
With the bucket handle action of the ribs, movement at the costovertebral jt happens around which axis?
AP axis
With the “pump handle” action, movement at the costovertebral jt happens around which axis?
ML axis
When we inhale the spine ____, the ribs _____ & rotate ______ and glide _____ where they meet the spine
- Extends
- Expands
- Posteriorly
- Inferiorly
When we exhale the spine ____, the ribs rotate ____ and glide ____ where they meet the spine
- flexes
- anteriorly
- superiorly
Where is veryebral compression fracture common?
- In the lower thoracic region
Vibra compression fracture occurs in older patients with the main cause being…
Osteoporosis
What is the presentation of vertebral compression fracture?
Sudden onset of acute pain after minor trauma in older people for example, stepping off a curb, sudden movement, sneezing
What are some signs and symptoms of scoliosis?
- typically asymptomatic
- Rib prominence, elevated shoulder and or prominent shoulder blade
- Uneven, hip arm or leg lengths
- Uneven musculature, impaired mobility, and muscle performance
- Back pain is not usually considered a scoliosis symptom
What are some complications of scoliosis?
- pulmonary/cardiac risks
- Neurological complications in severe and progressive curves
- Gastrointestinal disturbances
- Intermittent back ache may occur
True or false: radiating leg pain night pain or systemic complaints are normal symptoms of scoliosis
False: these are not normal symptoms of scoliosis, and require further investigation by medical doctor
The curve labeling of scoliosis is dictated by the ____ side
Convex
Scoliosis curve can have which shapes?
C curve or S curve
What are transitional vertebrae when it comes to scoliosis?
Vertebrae between the curves
What is the span of scoliosis?
The anatomical start, and end points of curve
What is the apex of scoliosis?
Vertebra furthest from midline
Scoliosis severity:
10° is…
10°-20° is …
20°-50° is…
50° is …
10° is normal
10°-20° is mild
20°-50° is moderate
50° is severe
What are the labelling components of scoliosis
Right or left curve
Curve shape
Major and minor curves
Transitional vertebra
Span
Apex
Cob method
Severity
With scoliosis, the vertebral bodies rotate to the ____ of the curve
Convexity
True or false: Functional scoliosis is reversible and can be altered with forward or side, bending, and positional changes
True. Proper and consistent treatment may include therapeutic exercise, positional changes, and correction of contributing causes.
To test for functional scoliosis we can use…
Adams forward Bend test
Which type of scoliosis is a fixed deformity
Structural scoliosis
What are the three types of structural scoliosis?
Idiopathic, congenital, neuromuscular
What is the most common type of scoliosis?
Idiopathic
What is congenital scoliosis caused by?
Disturbances in vertebral development, failures of formation or failures of segmentation of the vertebral bodies
When does congenital scoliosis usually occur?
During the first six weeks of embryonic formation
True or false: Neurological complications are common with congential scoliosis
False. Neurological complications may present but are not common.
Neuromuscular scoliosis often presents as…
a long c-shaped curve from cervical to sacral region
With children and adolescents what is a key component to the plan of care
Consistent monitoring of the curve progression
In adults scoliosis treatment is usually focused on…
Releiving Pain
True or false: Idiopathic scoliosis can be fixed or corrected.
False: This type of scoliosis is progressive and cannot be fixed or corrected
Congenital scoliosis may be a progressive disorder in which usually involves…
Surgical intervention
Forms of treatment and intervention are considered when the curve is between…
Bracing is considered when the curve is between…
Surgical interventions are considered when the curve is between…
- 20° - 30°
- 30° - 40°
- 40°- 45°
What will rib fractures present with…
will present with acute pain with all motions of the spine
Rib dysfunction may present as…
atypical interscapular, chest, sternum, or arm pain
What is the clinical presentation of rib dysfunction?
- sharp pain (sometimes described as stabbing)
- aggravated by specific movements
- upper ribs aggravated by reaching
- lower ribs aggravated with bending/twisting
- pain will increase w/ sneezing, coughing, deep breaths
- paraspinal tenderness/hyperalgesis
Describe exhalation dysfunction…
A rib that fails to move fully into its inhalation position. This can be described as being “locked in exhalation”, exhalation restriction, limited in inhalation, or depressed.
Describe inhalation dysfunction
A rib that fails to move fully into its exhalation position. This can be described as being locked in inhalation, an inhalation restriction, limited in exhalation or elevated.
What is the most common cause of intercostal neuralgia?
Herpes zoster virus (shingles)
What are the symptoms of intercostal neuralgia?
- unilateral neurogenic pain that radiates around towards the sternum in the associated dermatome
- sporadic episodes of acute pain or constant dull ache
- pain can be stabbing, sharp, spasm-like, gnawing
- pain increases with certain mevements, actions, activities (coughing, sneezing, laughing
Costochondritis is relatively common as a primary condition and in combination with…
Coronary heart disease
What does costochondritis (a.k.a tietze’s syndrome) present as?
- pain and tenderness of the costochondral junctions
- diffuse tenderness and multiple lesions
