Thoracic Anatomy & Pathology Flashcards
Typical Vertebrae
T2-T9
Atypical Vertebrae
T1, T10-T12
Rule of “Threes”
T1-T3 - Same level T4-T6 - Half level below T7-T9 - One whole level below T10 - One whole level below T11 - Half level below T12 - Same level
Costovertebral Joint
Ribs 2-10 articulate with a vertebral body
Rib head attaches to concavity of vertebral body margins and IVD
Costotransverse Joint
T1-T10 articulation with a rib and transverse process
Most Common MOI for T Spine
Fall or collision
T Spine Pain Referral
In and around chest wall
T Spine Disc Lesions
More common than previously thought but less common than in lumbar spine
Blow to rib may disrupt Thoracic IVD
More commonly in lower T spine (WB, posteriorly directred force)
Most common at T/L junction
T Spine Disc Lesion Referral Patterns
Lower T Spine - pn referral to abdomen and iliac crest
Upper T Spine - into upper extremeties
Spinal dura (most likely at T6) - vague referral pattern up and down T spine
Costochondritis
Rib inflammation @ sternum - MOI MVA, pneumonia
T spine disc lesion mimicer
Facet Joint Dysfunction
Common MOI - MVA (seat belt)
Localized sharp pain unilaterally
Dull ache in chronic stages
Most likely closing dysfunction
Acute - pn coughing, sneezing, breathing
Facet Joint Dysfunction Referred Pain
Referred pain possible but no neuro sx - more likely proximally (back) than distally (sternum)
T Spine Ligamentous Injuries
Vague, ill defined sx; no distal sx or neuro sx
Rib Cage Injuries
Rib fx very pnful
Breathing may increase pn
Tender to palpation
Possible hematoma
Exam: tap with reflex hammer or use tuning fork
T Spine Muscle Injuries
Uncommon in T Spine
Muscle spasms and trigger points common in upper T spine - possible compression of posterior primary rami
T4 Syndrome Etiology
Unknown
May be autonomic or mechanical involving ZPJ
T4 Syndrome
Dull aching, sx covering whole hand, +/- neuro sx, non-dermatomal referral pattern
Sx typically unilateral
Sx with springing
AKA “Glove Syndrome”
Thoracic Hypomobility
Common
Sudden onset (also sedentary -> active lifestyle)
Aggravated by movement breathing, coughing, sneezing
Often unilateral pn at CT joint (slightly off midline) that radiates
Chest wall pn
Manual therapy and therex to prevent recurrence
Scheuermann’s Disease
Adolescents
End plate failure - IVD merges with bone (?) and disc height decreases
Spontaneously resolving, postural deformity remains
Pain Referral to T Spine from C Spine
Cervical disc lesions - pn to T spine and medial borders of scapula (cloward areas); common after whiplash
Facet joints - sx locally and unilaterally; suprascapular and thoracic areas
T/F - With a thoracic nerve root lesion, true nerve root pain will be felt more proximally (in the back) than distally ( in the front near the sternum)
False! With a nerve root lesion, distal pain (anterior, next to sternum) is greater than proximal pain (in the back)
Will hard neurological signs be present with a thoracic nerve root lesion?
Not typically, with compression of the nerve root numbness and tingling will commonly be felt in a belt- like distribution
What is commonly the least mobile vertebra in the thoracic spine?
T6
T/F in facet joint dysfunction the pain is referred in the nerve root distribution and the pain is typically more intense distally- in the front near the sternum rather than proximally - in the back
FALSE- pain may be referred in the nerve root distribution, however, pain will be more intense at the site of dysfunction (proximally in the back) than distally near the sternum
