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Osteopathic Skills--Lexie > TEST 3: Thoracic and Rib SD Dx > Flashcards

TEST 3: Thoracic and Rib SD Dx Flashcards

1
Q

what is important to remember about the thoracic spine?

A
  • it is interdependent on the cervical and lumbar spine, so you should tx accordingly
  • heart and lungs in thoracic cage, so problems with thoracic cage can be life threatening
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2
Q

SNS and thoracic spine

A
  • much of SNS outflow arises from the thoracic spine

- can mimic life threatening problems

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3
Q

thoracic anatomy

A
  • 12 vertebra
  • 12 ribs
  • clavicle and scapula often involved in thoracic injuries and pain syndromes, but are considered upper extremity
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4
Q

3 parts of the sternum

A
  • head/manubrium–articulates with clavicles
  • body/gladiolus–joined to manubrium at sternal angle
  • xiphoid–small portion at inferior aspect of sternum
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5
Q

Rule of 3’s

A
  • T1-3 has a SP at the same level as the TP of same numbered vertebra
  • T4-6 has a SP halfway b/w TP of same numbered vertebra and the TP of vertebra one segment inferior
  • T7-9 has a SP in the same plane as the TP of one segment inferior
  • T10 like 7-9
  • T11 like 4-6
  • T12 like 1-3
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6
Q

visceral afferent neurons and thoracic spine

A
  • usually these neurons are nociceptive and follow the same pathway as the sympathetics
    • visceral disturbances cause increased MSK tension in somatic structures innervated from the corresponding spinal level
    • OMT can reduce somatic afferent input which reduces somatosympathetic activity to the organ
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7
Q

inferior angle of scapula at…

A

T3

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8
Q

functional divisions of the thoracic vertebrae**

A
  • T1-4: sympathetics of head and neck
    • T1-6 innervates heart and lungs
  • T5-9 sympathetics to upper abdominal viscera
    • stomach, duodenum, liver, gall bladder, pancreas, spleen
  • T10-11 sympathetics to lower abdominal viscera
    • rest of small intestines, kidney, ureters, gonads, R colon
  • T12-L2 sympathetics to remainder of lower abdominal viscera
    • L colon and pelvic organs
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9
Q

thoracic biomechanics

A
  • motion capabilities in the thoracic spine is generally less than cervical and lumbar
    • follows Fryette’s principles
    • costal cage mechanics affect all planes of motion
  • general body shapes and movement also affected by growth, aging, and lifestyle factors
    • adaptations to work, athletics, postural decompensation
    • changes in one area affect motion in other areas
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10
Q

what kind of abnormalities affect motion?

A
  • kyphosis
  • costal cage asymmetries–pectus excavatum/carinatum
  • osteoarthritis or osteoporosis
  • cardiopulm conditions increasing chest wall diameter
  • postural problems
  • cervical and shoulder influences
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11
Q

Wolff’s Law

A
  • bones and soft tissues deform (are strained) according to the stresses (forces applied to an area) that are placed on them
    • scoliosis, kyphosis, arthritis, leg length inequalities
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12
Q

F/E and rotation and SB in thoracic spine

A
  • F is greater than E
    • due to normal kyphotic curvature and gravity
  • rotation is greater in upper and middle portions (second only to AA joint)
    • lower thoracic moves similar to lumbar
  • SB is limited by rib cage
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13
Q

what kinds of abnormalities affect motion in the thoracic spine?

A
  • scoliosis +/- kyphosis
  • upper and lower motor neuron lesions
  • repetitive motion activity effects
    • tethering affect of myofascial tissues
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14
Q

small muscles of the back

A
  • often involved in postural stress
    • often responsible for maintaining non neutral and neutral SD of vertebral units
  • includes rotatores (SP down 2 levels to TP), multifidus (from SP down 2-3 levels to TP), and intertransvereriae M (b/w each SP)
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15
Q

spinal SD can result from what?

A
  • neurological pathological conditions
  • trauma
  • visceral dz
  • intrinsic mechanical asymmetries
  • chronic asymmetric motions or activities
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16
Q

anatomy of the ribs

A
  • 12 sets of ribs correspond to thoracic vertebrae
  • bony rib connected to thoracic vertebrae at costovertebral articulations
  • 2-9 articulate with vertebrae above and below
  • 1, 10-12 have unifacets that articulate with corresponding vertebra only
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17
Q

rib one landmarks

A
  • anteriorly attaches inferior to clavicle

- posteriorly attaches cephalad to border of scapula

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18
Q

rib 2 landmarks

A

-anteriorly articulates with manubrium and body of sternum

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19
Q

rib 3 landmarks

A

-posteriorly at level of scapular spine

20
Q

rib 7 landmarks

A
  • anteriorly at xiphosternal joint

- posteriorly at level of inferior angle of scapula

21
Q

rib 10 landmarks

A

-cartilage at lowest part of thoracic cage at midclavicular line

22
Q

what are the typical ribs?

A

2-9

23
Q

describe typical ribs

A
  • head, neck, tubercle, body is thin and flat
  • head has 2 facets (for body of same numbered and for body of one above)
    • costovertebral articulation
  • tubercle articulates with TP
    • costotransverse articulation
24
Q

rib one anatomy

A
  • flattest, shortest, with greatest curvature
  • subclavian groove on superior surface
  • head articulates with T1 only
25
Q

rib 10 anatomy

A

-articulates T10 only

26
Q

rib 11 and 12 anatomy

A
  • no neck or tubercles
  • articulates with associated vertebrae
  • 12 has no costal groove
27
Q

costovertebral joint

A
  • vertebral body (same level and one above)
  • vertebral disc (annulus fibrosis)
  • facets
  • ligaments–radiate and interosseous
28
Q

costotransverse joint

A
  • tubercle and TP
  • ligaments:
    • superior, lateral, inter transverse, and costotransverse
    • superior ligament connects TP to next lower rib
29
Q

muscles of inhalation

A
  • intercostals (external mostly)
  • diaphragm
    • crura anchor at L1-3
    • attachments to lower ribs and sternum
30
Q

muscles of exhalation

A
  • rectus abdominus
  • internal and external obliques
  • transverse abdominus
31
Q

accessory muscles of inhalation

A
  • SCM

- scalenes

32
Q

accessory muscles of exhalation

A
  • passive recoil

- abdominal muscles contribute

33
Q

what are the effects of respiration?

A
  • elevation of sternum
  • elevation of ribs
  • inc of transverse, superior/inferior, and anterior/inferior diameter
  • ribs move in 3 motion patterns
34
Q

pump handle motion

A
  • analogous to F and E
  • ribs move anteriorly
  • inc AP diameter
  • rib 1 has 50% pump handle
  • ribs 2-6 is predominantly pump handle
35
Q

bucket handle motion

A
  • analogous to abduction and adduction
  • ribs move laterally
  • inc transverse diameter
  • rib is 50% bucket handle
  • rib 7-10 predominantly bucket handle
36
Q

caliper motion

A
  • analogous to internal and external rotation
  • pivoting motion–no anterior attachment
  • ribs 11-12
37
Q

AJ Murphy

A
  • looked at pulmonary fcns and OMM
  • found an increase in tidal volume and respiratory rate after tx
  • found an inc in lung perfusion after tx
    • increases gas exchange
38
Q

Doran

A
  • looked at respiratory fcn and lumbar lordosis
  • found tx dec lordosis and inc tidal volume
  • found inc of abdominal component to respiration after tx
39
Q

harmonics mechanics

A
  • respiration requires smooth fcn
  • dysfcn to any component
    • dec in chest wall expansion
    • dec in oxygenation
    • inc risk of atelectasis
  • visceral fcn of chest
    • refer to soma/body
40
Q

what causes chest wall contusions?

A

air bags and seat belts

41
Q

rib fractures

A
  • dec chest expansion due to pain
  • inc risk of infection
  • no rib belts
42
Q

costochondritis

A
  • inflammation of costochondral joint
  • unable to put area to rest
  • pin point tenderness at area involved
  • pain increased with large inhalation
  • tx: NSAIDS and OMM
43
Q

pneumonia

A
  • viscerosomatic reflex to T2-4
  • cough–productive or not
    • rib dysfcn
    • lumbar dysfcn (crura L1-3)
    • thoracic dysfcn
  • tx: lymphatics to area 1
44
Q

quadratus lumborum

A
  • extension of diaphragm
  • trigger points/spasm effects quality of diaphragm excursion
    • dec lymph pumping action
45
Q

Iatrogenic causes

A
  • thoracotomy–lobectomy
  • sternotomy–coronary bypass graft
  • effects are local and produce compensatory changes elsewhere
46
Q

osteoporosis

A
  • dec strength to matrix
  • fractures easily
  • use caution with some techniques–some contraindicated
47
Q

metastatic dz

A

common site for metastasis–breast, prostate, lung

Osteopathic Skills--Lexie (16 decks)

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