Thoracic Anatomy & Pathology

Question 1

Typical Vertebrae

Answer 1

T2-T9

Question 2

Atypical Vertebrae

Answer 2

T1, T10-T12

Question 3

Rule of “Threes”

Answer 3

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

Question 4

Costovertebral Joint

Answer 4

Ribs 2-10 articulate with a vertebral body

Rib head attaches to concavity of vertebral body margins and IVD

Question 5

Costotransverse Joint

Answer 5

T1-T10 articulation with a rib and transverse process

Question 6

Most Common MOI for T Spine

Answer 6

Fall or collision

Question 7

T Spine Pain Referral

Answer 7

In and around chest wall

Question 8

T Spine Disc Lesions

Answer 8

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

Question 9

T Spine Disc Lesion Referral Patterns

Answer 9

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

Question 10

Costochondritis

Answer 10

Rib inflammation @ sternum - MOI MVA, pneumonia

T spine disc lesion mimicer

Question 11

Facet Joint Dysfunction

Answer 11

Common MOI - MVA (seat belt)

Localized sharp pain unilaterally

Dull ache in chronic stages

Most likely closing dysfunction

Acute - pn coughing, sneezing, breathing

Question 12

Facet Joint Dysfunction Referred Pain

Answer 12

Referred pain possible but no neuro sx - more likely proximally (back) than distally (sternum)

Question 13

T Spine Ligamentous Injuries

Answer 13

Vague, ill defined sx; no distal sx or neuro sx

Question 14

Rib Cage Injuries

Answer 14

Rib fx very pnful

Breathing may increase pn

Tender to palpation

Possible hematoma

Exam: tap with reflex hammer or use tuning fork

Question 15

T Spine Muscle Injuries

Answer 15

Uncommon in T Spine

Muscle spasms and trigger points common in upper T spine - possible compression of posterior primary rami

Question 16

T4 Syndrome Etiology

Answer 16

Unknown

May be autonomic or mechanical involving ZPJ

Question 17

T4 Syndrome

Answer 17

Dull aching, sx covering whole hand, +/- neuro sx, non-dermatomal referral pattern

Sx typically unilateral

Sx with springing

AKA “Glove Syndrome”

Question 18

Thoracic Hypomobility

Answer 18

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

Question 19

Scheuermann’s Disease

Answer 19

Adolescents

End plate failure - IVD merges with bone (?) and disc height decreases

Spontaneously resolving, postural deformity remains

Question 20

Pain Referral to T Spine from C Spine

Answer 20

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

Question 21

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)

Answer 21

False! With a nerve root lesion, distal pain (anterior, next to sternum) is greater than proximal pain (in the back)

Question 22

Will hard neurological signs be present with a thoracic nerve root lesion?

Answer 22

Not typically, with compression of the nerve root numbness and tingling will commonly be felt in a belt- like distribution

Question 23

What is commonly the least mobile vertebra in the thoracic spine?

Answer 23

T6

Question 24

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

Answer 24

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

Question 25

Where is pain typically referred in the thoracic spine when it originates in the cervical spine?

Answer 25

Typically referred to the medial borders of the scapula in “Clowards” areas

Question 26

Identify each of the 4 clowards areas and the nerve root that refers to that area.

Answer 26

1. C3- refers midline at the CT junction
2. C4- refers midline at the level of the spine of the scapula
3. C5- refers midline at the middle of the scapula
4. C6 - refers midline at the level of the inferior angle of the scapula

Question 27

T Spine Injury Classifications

Answer 27

• Gradual arthritic disorders
• Postural
• Acute, traumatic (most common)
• C spine referral
• Visceral

Question 28

T Spine Facet Joints

Answer 28

• Upper segments 45-60 degree incline (like C spine)

- Middle segments 90 degrees

Question 29

Costotransverse Ligament

Answer 29

Neck of rib to transverse process at same level

Question 30

Superior costotransverse ligament

Answer 30

Lower border of superior transverse process to upper rib and neck

Question 31

Lateral costotransverse ligament

Answer 31

Tip of transverse process to adjacent rib

Question 32

T4 syndrome etiology

Answer 32

Unknown! Possible autonomic syndrome or ZPJ issue

Question 33

T spine fracture

Answer 33

Compression fx most common in T spine

Question 34

Vertebroplasty vs. kyhoplasty

Answer 34

Vertebro: injection of cement mixture to strengthen weakened vertebrae (no correction of deformity)

Kypho: Uses a balloon to push bone back to normal height before cement mixture injection (correction of deformity)