thoracic Flashcards
Rules of 3s
- T1-3 SP at same level
- T4-6 SP 1/2 level below
- T7-9 SP 1 full level below
- T10 1 full level below
- T11 1/2 level below
- T12 at same level
Ligamenta Flava
- Assists in resuming posture after flexion
- Can cause stenosis
Radiate Ligament
- Connect anterior head of each rib with bodies of 2 vert and intervertebral fibrocartilage
- Triradiate (above, at level, below) except 1, 10, 11, 12 (biradiate - above and at level)
Multifidi: Jull, Hodges, Hides
- Between TP and SP, sacrum to C2
- stabilize vertebral column
- pain inhibits
Critical Zone: artery of adamkiewicz
-T4-9 has 3mm of redundancy, watershead vascularization
Typical Ribs
- Ribs 3-10
- Attached above and below and to intervertebral disc
Atypical ribs
- Ribs 1, 2, 11, 12
- Ribs 1, 11, 12 to T1, 11, 12 with unifacet
- Rib 2 to T1 with 2 demifacets
Respiratory motion with thoracic flexion
Rib internal torsion
Respiratory motion with thoracic extension
Rib external torsion
Physiological motion of costal cage
- Pump handle: upper/mid
- Bucket handle: mid to inf ribs
- Calipers: ribs 11-12
- Torsional motion: internal/external, mid to lower ribs
Structural dysfunction: superior subluxation
First rib: exhalation dysfunction
Structural dysfunction: anterior/posterior subluxation
circumferential pain = sympathetic facilitation, traumatic force.
asymmetry of boney landmarks of UE
Structural dysfunction: internal or external torsion
rib stuck with dysfunctional vertebrae or chronic myofascial restrictions.
- circumferential tenderness, hypertonicity of ipsilat intercostals
- Inf edge post: internal torsion
- Sup edge post: external torsion
Structural dysfunction: inhalation and exhalation
Often asymptomatic, no asymmetries.
Less problematic
Thoracic Scan: Compression
seated, arms crossed. push down through shoulders
ID: fracture
Thoracic Scan: Traction
seated, arms crossed, lift up
ID: disc/ligament
Thoracic Scan: Breathing pattern
look at breathing, can put hands on ribs
Thoracic Scan: Manubrial compression
pain provication
Thoracic Scan: Upper sternal compression
pain provication
Thoracic Scan: Lower sternal compression
pain provication
Thoracic Scan: abdominal cutaneous relfex
pt in hooklying, drag sharp end of reflex hammer into belly button.
Look for asymmetry of inconsistency.
Upper: T6-10
Lower: T10-12
Thoracic Scan: Beevor’s Sign
hooklying, pt lift head off pillow, look for deviation (will deviate away from dysfunction)
Thoracic Scan: Aortic pulse
larger than 3 finger width, lack of normal lub-dub
Thoracic Scan: Abdominal quadrant palpation
looking for rebound or pain
Thoracic Scan: Sprin test
- PA of SP pt in prone
- Rib spring PA, pt in prone
Thoracic Scan: Soft tissue spring
due to segmental innervation soft tissue changes will be along same level of dysfunction. “idiot light”
Thoracic Tests: AROM
- Flexion, ext, rotation, SB
- in sitting, prone, prone pressup, arch/sag
Thoracic Tests: Positional/motion testing
-Hands on TPs, pt flex/ext
Thoracic tests: PIVM
-Flexion, extension, rot, SB
Thoracic Test: PAIVM
combined motions: quadrants
Thoracic Tests: Anterior translation
- Pt prone
- Stabilize inferior vert
- Cranial hand on TP give P>A force to superior vert.
- Positive = excessive translation, clunk, crepitus
Thoracic Tests: Rotational stability
- Pt prone
- Stabilize inf vert at TP
- Sprint opposite side of TP of superior vert to rotate the superior vert on inferior.
Thoracic Tests: Posterior translation
- Pt sitting
- P>A vert inferior to one being tested, block ribcage
- essentially an A>P of sup vert
Thoracic Tests: Lateral stress test
- pt sitting
- Palpate SP of inf vert, shear trunk toward PT
Costal Cage Assessment: Key Rib
- Rib within a group of ribs that is limiting respiration of others
- Will have both structural and respiratory rib dysfunction
- Inhalation: key rib above
- Exhalation: key rib below
Costal Cage Assessment: Bony landmarks
Look for asymmetries
Costal Cage Assessment: Passive overpressure
- Spring into internal torsion (flexion)
- Spring into external torsion (extension)
