Thoracic and Cervical Flashcards
1
Q
Normal kyphotic convexity in the sagittal plane is between
A
20-40 degrees
2
Q
Line of gravity falls anterior to
A
the vertebral bodies
3
Q
what percent of axial trunk rotation occurs in the thoracic segments
A
80%
4
Q
What forms the anterior wall of the thorax
A
sternum
5
Q
Joints of manubrium
A
manubriosternal joints
sternoclavicular joints
6
Q
Xiphoid process joint
A
sternoxiphoid joint
7
Q
Sternocostal joints
A
The sternocostal joints also known as sternochondral joints (or costosternal articulations), are synovial plane joints of the costal cartilages of the true ribs with the sternum.
8
Q
Ribs
A
1 to 7 increase in length
sternocostal joints
costochondral junction
chondrosternal junction
9
Q
Ribs 2 to 7 display what type of motion
A
gliding
10
Q
radiate ligaments
A
The radiate ligament connects the anterior part of the head of each rib with the side of the bodies of two vertebrae, and the intervertebral fibrocartilage between them.
11
Q
ribs 8 to 12 are longer or shorter
A
shorter
12
Q
ribs 11 and 12 have what attachment
A
no anterior attachment
13
Q
costovertberal joints
A
heads of ribs 1 to 12
articulate with thoracic vertebral bodies
14
Q
costotransverse joints
A
ribs 1 to 10
articulate with transverse processes
15
Q
external intercostals
A
oblique and medial fibers
inhalation
16
Q
internal intercostals
A
oblique and lateral fibers
forced expiration
17
Q
muscle of respiration
A
external and internal intercostals
stabilize rib cage
play role in axial rotation of thorax
18
Q
serratus posterior superior
A
elevates the upper ribs
19
Q
serratus posterior inferior
A
stabilizes the lower ribs during contraction of the diaphragm
20
Q
levatores costarum
A
elevates ribs
21
Q
thoracic motion
A
limited flexion and extension
22
Q
thoracolumbar flexion
A
70 to 85 degrees
23
Q
thoracolumbar extension
A
45 degrees
24
Q
lateral bending of thoracic
A
45 degrees
25
rotation of thoracic
30 to 40 degrees
26
lateral bending coupled with rotation in same direction
lateral bending and rotation
| may be opposite directions in lower T spine
27
Unlikely but possible conditions
spinal stenosis
spondylolisthesis and spondylolysis
facet joint sprain
disc hernation
28
Discogenic pain
disc degeneration rather than herniation
Involved: annulus fibrosis, nucleus pulposis, spinal nerve root
MOI: trauma
Complaints: typically asymptomatic and picked up on MRI as incidental finding
Neuro: dermatomes, myotomes, and abdominal reflexes could be affected but difficult to isolate
Diagnosis: MRI
Tx: TE, injection, surgery
29
disc herniation is the thoracic spine is
very rare
typically below T8
must vulnerable segment between T11-T12 because of greater mobility
30
Unstable spine predisposes a person to
neurologic injury and/or deformity
31
Anterior column
ALL
| anterior half of vertebral bodies
32
Middle column
posterior half of vertebral bodies
| PLL
33
Posterior column
```
pedicles
laminae
spinous processes
facet joints
supraspinous, interspinous, intertransverse ligaments
ligamentum flavum
```
34
One column affected
usually stable
35
Two columns affected
usually unstable
36
Three columns affected
always unstable
37
Isolated fx of posterior elements is
typically minor
38
Compression fractures can be
traumatic
atraumatic (osteoporosis)
pathologic (malignancy)
39
Most fractures in the t-spine occur closer to
thoracolumbar junction (T10-T12)
40
Burst fracture
anterior and middle column
41
wedge fracture
anterior column
42
chance
transverse entirely through the bone
43
Fracture of t-spine
MOI: trauma, axial overload, rapid flexion (seatbelt injury), extreme rotation or sheer
Complaints: pain, loss of function
ROM: limited and painful
Neurological exam: motor, sensory, reflexes can all suffer deficits
Dx: x-ray, CT
Tx: thoracolumbosacral orthosis, TE, surgery for unstable
44
Rib Fracture more common in
ribs 5-9 and at the posterior angle
45
Rib fracture
MOI: direct trauma, repetitive muscle contraction or forceful coughing can cause stress fx
Complaints: localized pain, pain with deep inhalation and trunk movement
ADL: breathing, lifting
Affects on ROM: may be decreased due to pain
Neuro: N
Dx: x-ray
Tx: rest, stabilization, NSAIDs
46
Rib head displacement
costovertebral and costotransverse pain
47
Costovertebral and costotransverse pain
articulation of rib head and neck with vertebral body and transverse process
MOI: blunt trauma, forceful coughing, poor posture, overuse
Comp: localized sharp pain with deep inhalation, trunk movement, or overhead arm movement; may report clicking sensation
ROM&Stren: trunk rotation may be limited due to pain; strength N
Dx: physical exam, r/o other conditions
Tx: mobilization/manipulation
48
Costochondritis
irritation/inflammation of costochondral junction
```
MOI: acute trauma or repetitive stress
Comp: anterior chest wall pain, tenderness over affected joint
ADL: labored breathing, lifting
Affects on ROM: N
Dx: r/o cardiac pathology
Tx: rest, NSAID's
```
49
Muscle Strain involved
potentially involved musculature: erector spinae, levator scapulae, trapezius, rhomboids, intercostals
50
Muscle strain
MOI: acute
Complaints: spasm/tightness, no neuropathy, feels better at rest
ADL: active movements
Neuro: N
ROM&S: decreased strength and pain with active contraction
decreased AROM due to pain and weakness, decreased ROM due to pain
Dx: MMT, important to r/o other pathologies
Tx: decrease pain, soft tissue work, TE to restore function
51
Trigger points
presence of palpably tight/stiff nodule or adhesion in the musculature
commonly involves: trapezius, levator scapulae, rhomboids, latissimus dorsi
52
Trigger points MOI
MOI: acute, overuse, poor posture, or psychological stress
Comp: localized sharp pain with a referral pattern
ROM&S: may be decreased due to pain
Dx: physical exam, injection
Tx: massage, myofascial release, trigger point release, cupping, IASTM, dry needling, injection, TE
53
Hyperkyphosis is
greater than 40 degree kyphosis angle
54
scheuermann's disease
juvenile form of kyphosis
affects vertebral body growth plate and causes wedge-shaped vertebral bodies at three or more levels and typically causes pain with flexion
55
Hyperkyphosis
Age related: affects 20-40% of eldery population
Postural kyphosis: results of poor posture, weakened musculature
Can lead to pulmonary difficulties
Dx: measurement of Cobbs angle, standing lateral spine radiographs, kypohmeter
Tx: TE (breathing correction, thorax mobility, stability and strengthening, postural re-education)
56
Scoliosis is
the c or s shaped curvature that is usually congenital
57
During scoliosis the anterior vertebral body
rotates towrds the convex side --> rip hump on convex side
58
Scoliosis Diagnosis
Complaints: pain, muscle fatigure and or spasm
ROM&S: limitations to trunk motion
muscles on concave side usually shortened and tight
muscles on convex side usually lengthened and weak
N: normal
Dx: physical exam, x-ray
Tx: TE, orthosis, surgery
59
Forward head posture
commonly acquired postural deviation
poor seated posture, constant use of electronics
head forward in relation to shoulders, rounded shoulder, lower c-spine increased extension to maintain upright head posture
60
Forward head posture diagnosis
Complaints: pain in involved musculature
ROM&S: decreased strength in involved musculature
Dx: occiput to wall distance (OWD)
Tx: TE, postural re-education
61
Upper Crossed Syndrome tightness
tightness of suboccipitals
levator scapulae
upper trapezius crossed with tightness of pectoralis major and minor
61
Upper Crossed Syndrome tightness
tightness of suboccipitals
levator scapulae
upper trapezius crossed with tightness of pectoralis major and minor
62
upper crossed syndrome weakness
weakness of cervical flexors crossed with weakness of rhomnboids, muddle, and lower trapezius
62
upper crossed syndrome weakness
weakness of cervical flexors crossed with weakness of rhomnboids, muddle, and lower trapezius
63
Red flags and referrals
significant trauma
cardiopulmonary concerns (angina, SOB)
back pain associated with fever, nausea, vomiting)
Hoffman's, babinski, clonus- upper motor neuron syndrome, spinal cord
Hx: cancer, unexplained weight loss, immunosuppression, prolonged use of steroids, IV drug user, UTI
pain that is constant, severe, progressive
Pain not relieved by rest
failure to respond to conservative treatment
