Thoracic Flashcards
Biomechanics - the thoracic vertebrae are wider in what direction
wider ant-post than med-lat
Biomechanics - facets
Complete facets T1, T10-T12
Demifacets T2-T9
Articular processes - facet/zygagpophyseal joints are what
pedicle to lamina junction
Articular processes - motion at thoracic spine because of capsule
Flex is limited
Minimal axial rotation and LF
TP - what happens to shape throughout
TP length dec from T1-T12
these are where ribs attach
SP - what happened to orientation throughout
Upper - aligned horizontally
Middle - post and inf
Lower - short and projects posterior
Sternum - landmarks
Sternal notch at T3 body
Body at T5-T9 levels
Supporting structures - anterior instability
PLL interspinous ligament supraspinous ligament post disc issue with those that limit flexion
Supporting structures - posterior instability
ALL
ant disc
issue with those that limit extension
Costovertebral and Costotransverse are what type of joinrs
Gliding
Ribs to sternum - attachments
1st to manubrium
2nd to junction
3-7 to body
8-10 to cartilage of 7th rib
Thoracic spine - sagittal, forntal, transverse plan ROM throughout
Sagittal (flex/ext) - inc from sup to inf
Frontal (lateral) - same
Transverse (rot) - decreases from sup to inf
Rib motion - sagittal plane
pump handle motion
Rib motion - frontal plane
bucket handle motion
With thoracic flex - what is rib motion
rib depression
With thoracic ext - what is rib motion
rib elevation
With thoracic rot what is rib motion
ipsilateral TP moves post pulling the rib and inc rib curvature
So if rot R, R closed, L is open
turning L, pushes ribs right (bone to bone) and pulls ribs left (ligaments)
With thoracic lateral flexion, what is rib motion
Ipsilateral will have rib approximation
Contralateral will have rib separation
Superincumbent weight exerts what type of moment on the thoracic spine
flexion
Moment inc from T1-T4 and then dec again
Greater kyphosis = greater flexion moment
Forward bending - what are the mechanics and muscles activated throughout
0 (standing straight) - less ES activity, Inc while bend forward
30 flex - ES stops firing, stretch will suspend body without contracting mm
90 flex - moment arm dec, ligaments not stretched as much, increase strain, dec stress, mm are silent
Thoracic - joints are designed for
compression, not shear! Kyphotic posture inc shear by 2.5x in standing!
S/S of facet dysfunction
Local sharp pain!
SP of thoracic spine - rules of
3s! T1-T3 = in line with VB of same level T4-T6 = in line with IVD of inf level T7-T9 = in line with VB of inf level T10 = inf body T11 = inf IVD T12 = same body
Articulations - Manubriosternal, Xiphisternal
Synchondrosis
Ossifies in older adults
Manubrial rotation occurs with shoulder flexion
Articulation - costovertebral
synovial joint
Articulation - costotransverse
synovial
Coupled movement
Upper = like cervical = LF and Rot SAME direction Lower = like lumbar = LF and Rot OPP direction
If rib dysfunction and thoracic what tx first
Tx thoracic first!
Pump handle action
during inspiration ribs 1-6 pull up and forward
manubrium elevation
Bucket handle action
ribs 7-10 move up, backward, and medial to increase lateral dimension
Caliper action
ribs 8-12 move laterally to increase lateral diameter
posterior and lateral during inhale
Bucket bail lesion is what
bucket handle position is displaced more than pump handle because of its lateral position
usually from trauma
Disc pathology in T spine
less common to be herniation
more commonly degeneration
Scheuermann’s disease is what
Common in lower thoracic - related to schmorles nodes
vertical disc herniation into vertebral body, causes achiness and stiffnes
excessive kyphisis, loss of flex/ext
Spinal tumors
MOST COMMON IN T SPINE!
Back pain will be primary sx with it being worst at night
Red flag if s/s cannot be reproduced with mvmnt
Benign spinal tumors include
Osteochrondroma Osteoid osteoma Osteoblastoma Giant cell tumor Hemangioma Eosinophilic granuloma
Malignant spinal tumors include
Plasmacytoma Ewings sarcoma Lymphoma Osteosarcoma Chondrosarcoma Chondroma
Ankylosing spondylitis is what
chronic inflammatory arthropathy, stiffening or fusion of spine and SI joints
More common and more severe in men
2nd most common in T SPINE
Scoliosis - non structural
poor posture
nerve root irritation
leg length discrepancy
Scoliosis - structural
genetic
idiopathic
wedge/hemi vertebrae contributes to rotation
Scoliosis - curve pattern is named according to
apex of the curve and direction of the convexity
vertebral body rotates toward the convexity, rib post which is why we see rib hump with forward flexion
Pectus carinatum
pigeon chest
sternum projects forward and downward
inc ant-post dimension of chest
Pectus excavatum
funnel chest
sternum pushed post by overgrowth of ribs
and-post chest dimension dec
Barrel chest
sternum projects forward and up
ant-post dimension inc
seen with emphysema
Normal motion with breathing assessment
abdomen rises, lateral expansion, upper chest/accessory mm
Rib motion with breathing assessment
supine
feel for ant/post motion during inhale/exhale
Depressed rib - breathing assessment
will stop moving relative to others on inhale
Elevated rib - breathing assessment
will stop moving relative to others on exhale
Diaphragm attaches to
internal part of xiphoid process (sternal portion)
inner surface of lower ribs (costal portion)
L1-L3 (lumbar portion)
Shoulder flexion can be used to assess
the upper 7 ribs
Shoulder abduction can be used to assess
the lower ribs
With right cervical rotation the R rib moves ____ and the L rib moves ___
R moves anteromedially
L moves posterolaterally
With unilateral shoulder flexion you will get
thoracic rotation
With bilateral shoulder flexion you will get
thoracic extension
