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
2
Q
SNS and thoracic spine
A
- much of SNS outflow arises from the thoracic spine
- can mimic life threatening problems
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
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
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
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
7
Q
inferior angle of scapula at…
A
T3
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
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
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
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
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
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
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)
15
Q
spinal SD can result from what?
A
- neurological pathological conditions
- trauma
- visceral dz
- intrinsic mechanical asymmetries
- chronic asymmetric motions or activities
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
17
Q
rib one landmarks
A
- anteriorly attaches inferior to clavicle
- posteriorly attaches cephalad to border of scapula
18
Q
rib 2 landmarks
A
-anteriorly articulates with manubrium and body of sternum
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
rib 10 anatomy
-articulates T10 only
26
rib 11 and 12 anatomy
- no neck or tubercles
- articulates with associated vertebrae
- 12 has no costal groove
27
costovertebral joint
- vertebral body (same level and one above)
- vertebral disc (annulus fibrosis)
- facets
- ligaments--radiate and interosseous
28
costotransverse joint
- tubercle and TP
- ligaments:
- superior, lateral, inter transverse, and costotransverse
- superior ligament connects TP to next lower rib
29
muscles of inhalation
- intercostals (external mostly)
- diaphragm
- crura anchor at L1-3
- attachments to lower ribs and sternum
30
muscles of exhalation
- rectus abdominus
- internal and external obliques
- transverse abdominus
31
accessory muscles of inhalation
- SCM
| - scalenes
32
accessory muscles of exhalation
- passive recoil
| - abdominal muscles contribute
33
what are the effects of respiration?
- elevation of sternum
- elevation of ribs
- inc of transverse, superior/inferior, and anterior/inferior diameter
- ribs move in 3 motion patterns
34
pump handle motion
- 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
bucket handle motion
- analogous to abduction and adduction
- ribs move laterally
- inc transverse diameter
- rib is 50% bucket handle
- rib 7-10 predominantly bucket handle
36
caliper motion
- analogous to internal and external rotation
- pivoting motion--no anterior attachment
- ribs 11-12
37
AJ Murphy
- 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
Doran
- 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
harmonics mechanics
- 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
what causes chest wall contusions?
air bags and seat belts
41
rib fractures
- dec chest expansion due to pain
- inc risk of infection
- no rib belts
42
costochondritis
- 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
pneumonia
- viscerosomatic reflex to T2-4
- cough--productive or not
- rib dysfcn
- lumbar dysfcn (crura L1-3)
- thoracic dysfcn
- tx: lymphatics to area 1
44
quadratus lumborum
- extension of diaphragm
- trigger points/spasm effects quality of diaphragm excursion
- dec lymph pumping action
45
Iatrogenic causes
- thoracotomy--lobectomy
- sternotomy--coronary bypass graft
- effects are local and produce compensatory changes elsewhere
46
osteoporosis
- dec strength to matrix
- fractures easily
- use caution with some techniques--some contraindicated
47
metastatic dz
common site for metastasis--breast, prostate, lung
