The Thoracic Spine Flashcards
(125 cards)
What is the thoracic spine “Rule of 3’s”?
- T1 through T12 vertebrae are divided into 4 groups of 3 & classified by the orientation of the spinous process relative to the transverse processes
- at T1 through T3, the processes are at the same level
- at T4 through T6, the spinous processes are lower (about 1/2 a level)
- at T7-T9, the spinous processes are much lower (about one level)
- at T10 through T12, they go back to being at the same level
Some manual therapy and osteopathic practitioners site rib angles as a landmark/site of rib cage dysfunction. Describe the theory and its validity
- the idea is that rib joint dysfunction causes muscular tension of the iliocostalis muscles & can cause pain / tenderness
- this type of rib cage dysfunction hasn’t been validated in clinical or laboratory research
- rib angle tenderness to palpation is found in healthy, pain-free subjects, so this sign needs to be carefully correlated with the patient’s chief complaints
Contrast the ratio of intervertebral disc height to vertebral body height in the cervical, thoracic, and lumbar spine.
- cervical: disc is 2/5ths (40%) of body height
- thoracic: disc is 1/5th (20%) of body height
- lumbar: disc is 1/3rd (33%) of body height
Which ribs attach to only one facet on their corresponding vertebra?
1st, 10th, 11th, and 12th ribs attach only to the vertebral body
Which ribs are considered “true” ribs & why?
ribs 1-7; they attach directly to the sternum
Which is the lowest rib that attaches directly onto the sternum
rib 7 is the last “true rib”
Which ribs are considered “false” ribs & why?
ribs 8-12; they don’t attach directly to the sternum
Which of the “false” ribs attach distally to the costochondral cartilage?
ribs 8-10 (11 & 12 are floating ribs)
What are the 2 attachment sites on the vertebral body for the “typical” ribs 3 through 9?
- superior rib facet (superior vertebral body)
2. inferior rib facet (forms costovertebral joint at the same numerical vertebra, e.g. 3rd rib attaches to T3)
Which ribs form costotransverse joints with the vertebrae?
ribs 1 through 10
What is the relationship between the orientation of the costotransverse joints and breathing motions in the ribcage?
In upper thoracic spine (down to T5-6), the orientation of the costotransverse joints allows for more rotation/torsion. In the lower thoracic (T7 and below), the joint allows more planar/gliding motion. So, during breathing, the upper rib cage rises (flexes in sagittal plane) while the lower ribs widen (abduct in frontal plane)
List the 8 key muscles / muscle groups that should be considered when assessing the thoracic spine.
- trapezius (upper, middle, & lower)
- iliocostalis thoracis
- iliocostalis lumborum (erector spinae muscles generally)
- serratus anterior
- pec major
- scalenes (anterior, middle, & posterior)
- pec minor
- the diaphragm (sternal, costal, & lumbar parts)
What is the relationship between breathing and thoracic spine disorders?
lack of relaxed, diaphragmatic breathing is an impairment that often accompanies both acute & chronic spinal disorders and could contribute to thoracic spinal mobility restrictions
How is it that the thoracolumbar junction can refer pain to the hip?
the Subcostal nerve supplies the skin of the abdominal wall, the lateral hip, and over the iliac crest, so nociceptive input at arising from T12 can result in hip pain
How are spinal nerves numbered with respect to their corresponding vertebrae?
in cervical spine, spinal nerve exits above its vertebrae; then after C8 exits between C7 & T1, the spinal nerve exit below its corresponding vertebrae
What area of the thoracic spine is known as the “critical zone” & why?
from T4 through T9, the spinal canal narrows & the local blood supply is reduced, so a large disc herniation can theoretically cause central spinal cord compression
What is T4 Syndrome & what interventions may be useful in addressing it?
- constellation of signs and symptoms such as upper or lower quarter neurologic & sympathetic signs (e.g. bilateral extremity paresthesia & sweating)
- origin unknown, but likely to be a result of amplified nociceptive input into the peripheral & central nervous systems
- interventions targeting mobility impairments at/around T4 level may result in a temporary reduction of symptoms
Which thoracic spine articulation(s) can refer pain to the anterior chest wall & sternum?
Facet (zygapophyseal) joints at T3/4 & T4/5
What are typical pain referral patterns from the facet joints?
at C7-T3 facets, superior angle of scapula, between scapulae toward inferior angle
- at T3-T11 facets, at or up to 2.5 segments below the joint (never above), slightly lateral to the joint
(data from subjects with only unilateral pain that does not radiate)
What are typical referral patterns from the costotransverse joints? What is the exception?
mostly at the joint, but T2 may refer up to C7 vertebral level & some may have pseudovisceral pain (osteophytes at the joint that encroach on the thoracic sympathetic chain)
What is the incidence of asymptomatic thoracic disc protrusions?
37%
Which cervical spinal levels have the potential to lead to referred upper and/or middle thoracic spine pain? Which structures?
facet joints and/or intervertebral discs of C5-6 and C6-7 segments can refer to upper thoracic and interscapular pain
What is the relationship between thoracic flexion/extension and rib rotation?
When the thoracic spine flexes, the corresponding rib rotates anteriorly. When it extends, the rib rotates posteriorly
What is the relationship between thoracic spine motion and shoulder elevation?
End-range active bilateral shoulder elevation is coupled with end-range thoracic extension (lower thoracic spine contributes the greatest degree)