Thoracic and Cervical Flashcards
Normal kyphotic convexity in the sagittal plane is between
20-40 degrees
Line of gravity falls anterior to
the vertebral bodies
what percent of axial trunk rotation occurs in the thoracic segments
80%
What forms the anterior wall of the thorax
sternum
Joints of manubrium
manubriosternal joints
sternoclavicular joints
Xiphoid process joint
sternoxiphoid joint
Sternocostal joints
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.
Ribs
1 to 7 increase in length
sternocostal joints
costochondral junction
chondrosternal junction
Ribs 2 to 7 display what type of motion
gliding
radiate ligaments
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.
ribs 8 to 12 are longer or shorter
shorter
ribs 11 and 12 have what attachment
no anterior attachment
costovertberal joints
heads of ribs 1 to 12
articulate with thoracic vertebral bodies
costotransverse joints
ribs 1 to 10
articulate with transverse processes
external intercostals
oblique and medial fibers
inhalation
internal intercostals
oblique and lateral fibers
forced expiration
muscle of respiration
external and internal intercostals
stabilize rib cage
play role in axial rotation of thorax
serratus posterior superior
elevates the upper ribs
serratus posterior inferior
stabilizes the lower ribs during contraction of the diaphragm
levatores costarum
elevates ribs
thoracic motion
limited flexion and extension
thoracolumbar flexion
70 to 85 degrees
thoracolumbar extension
45 degrees
lateral bending of thoracic
45 degrees
rotation of thoracic
30 to 40 degrees
lateral bending coupled with rotation in same direction
lateral bending and rotation
may be opposite directions in lower T spine
Unlikely but possible conditions
spinal stenosis
spondylolisthesis and spondylolysis
facet joint sprain
disc hernation
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
disc herniation is the thoracic spine is
very rare
typically below T8
must vulnerable segment between T11-T12 because of greater mobility
Unstable spine predisposes a person to
neurologic injury and/or deformity
Anterior column
ALL
anterior half of vertebral bodies
Middle column
posterior half of vertebral bodies
PLL
Posterior column
pedicles laminae spinous processes facet joints supraspinous, interspinous, intertransverse ligaments ligamentum flavum
One column affected
usually stable
Two columns affected
usually unstable
Three columns affected
always unstable
Isolated fx of posterior elements is
typically minor
Compression fractures can be
traumatic
atraumatic (osteoporosis)
pathologic (malignancy)
Most fractures in the t-spine occur closer to
thoracolumbar junction (T10-T12)
Burst fracture
anterior and middle column
wedge fracture
anterior column
chance
transverse entirely through the bone
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
Rib Fracture more common in
ribs 5-9 and at the posterior angle
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
Rib head displacement
costovertebral and costotransverse pain
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
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
Muscle Strain involved
potentially involved musculature: erector spinae, levator scapulae, trapezius, rhomboids, intercostals
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
Trigger points
presence of palpably tight/stiff nodule or adhesion in the musculature
commonly involves: trapezius, levator scapulae, rhomboids, latissimus dorsi
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
Hyperkyphosis is
greater than 40 degree kyphosis angle
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
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)
Scoliosis is
the c or s shaped curvature that is usually congenital
During scoliosis the anterior vertebral body
rotates towrds the convex side –> rip hump on convex side
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
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
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
Upper Crossed Syndrome tightness
tightness of suboccipitals
levator scapulae
upper trapezius crossed with tightness of pectoralis major and minor
Upper Crossed Syndrome tightness
tightness of suboccipitals
levator scapulae
upper trapezius crossed with tightness of pectoralis major and minor
upper crossed syndrome weakness
weakness of cervical flexors crossed with weakness of rhomnboids, muddle, and lower trapezius
upper crossed syndrome weakness
weakness of cervical flexors crossed with weakness of rhomnboids, muddle, and lower trapezius
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
