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OS > Thoracic and Ribs Somatic Dysfunction Lecture > Flashcards

Thoracic and Ribs Somatic Dysfunction Lecture Flashcards

1
Q

Thoracic Spine Introduction

A
  • The Thoracic Region is the Central connection both the Cervical and Lumbar Spines, as well as the Upper Extremities and Thoracic Cage
  • Diagnosis and treatment of the Thoracic Spine is INTERDEPENDENT with these Regions, and should NOT BE CONSIDERED separately in the evaluation of a patient with Thoracic Complaints!!!
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2
Q

Heart and Lungs

A
  • Heart and Lungs are located in the THORACIC CAGE
  • Problems with the Thoracic Cage can be signs of LIFE THREATENING PROBLEMS
  • Optimal movement of the Thoracic Cage is necessary for Normal Function (Lymphatics, Involves over 100 Joints)
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3
Q

Sympathetic Nervous System

A
  • Much of the Sympathetic Nervous System outflow arises from the Thoracic Spine
  • Can MIMIC Life-Threatening Problems
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4
Q

Thoracic Anatomy

A
  • 12 Thoracic Spinal vertebrae
  • 12 Pairs of Ribs
  • Sternum
  • The clavicle and the Scapula are often involved in Thoracic injuries and pain Syndromes, but are properly considered a part of the upper extremity
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5
Q

Sternum

A

3 parts:

1) Head/ Manubrium
- Articulates with the Clavicles

2) Body/ Gladiolus
- Joined to the Manubrium at the Sternal Angle or ANGLE OF LOUIS

3) Tail/ Xiphoid
- Small portion at the INFERIOR ASPECT of the Sternum

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6
Q

Thoracic Vertebrae

A
  • Divided into three Anatomic Regions:
    1) Upper (T1-4)

2) Middle (T5-8)
3) Lower (T9-12)

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7
Q

Rules of Three

A

T1-3:
- Spinous process is on the same level as the Vertebrae

T4-6:
- Spinous process is have way down to the Vertebrae under

T7-9:
- Spinous process as at the Vertebrae below

T10:
- Same as T7-9

T11:
- Same as T4-6

T12:
- Same as T1-3

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8
Q

Thoracic Spine and SYmpathetics

A
  • Osteopathic physicians often utilize the Function Division
  • VISCERAL AFFERENT (Usually Nociceptive) NEURONA follow the Same Pathway as the SYMPATHETICS
  • Visceral disturbances often cause INCREASED MUSCULOSKELETAL TENSION in Somatic Structures INNERVATED from the corresponding Spinal Level
  • OMT can reduce Somatic Afferent Input, which REDUCES SOMATOSYMPATHETIC activity to the Organ
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9
Q

Thoracic Vertebrae

Four FUNCTIONAL DIVISIONS

A

1) T1-4: Sympathetics to the HEAD and NECK
- T1-6 INNERVATES the HEART and LUNGS

2) T5-9: Sympathetics to the UPPER ABDOMINAL VISCERA
- Stomach, Duodenum, Liver, Gall Bladder, Pancreas, and Spleen

3) T10- 11: Sympathetics to most of the LOWER ABDOMINAL Viscera
- Remainder of the Small Intestine, and Kidney, Ureters, Gonads, and Right Colon

4) T12-L2: Sympathetics to the REMAINDER of the LOWER ABDOMINAL Viscera
- Left Colon and PELVIC Organs

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10
Q

Thoracic Biomechanics

A

1) The motion capabilities in the Thoracic Spine is generally LESS THAN the Cervical and Lumbar Spine
- Spinal motions follow FRYETTE’s PRINCIPLES of Spinal Motion

  • Costal Cage mechanics affect all planes of Motion

2) General Body shapes and movement are also affected by Growth, Aging, and Lifestyle Factors
- Adaptations to Work, Athletics, Postural decompensation

  • Changes in one area affect motion in other areas
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11
Q

Thoracic Biomechanics Cont

Abnormalities affection Motion (AP)

A
  • Kyphosis
  • Costal Cage Symmetries (Pectus Excavatum and Carinatum)
  • Osteoarthritis or Osteoporosis
  • Cardiopulmonary conditions INCREASING Chest Wall Diameter
  • Postural Problems
  • Cervical and Shoulder Influences
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12
Q

Thoracic Biomechanics

Wolff’s Law

A
  • Bones and soft tissues deform (are strained) according to the stresses (forces applied over an area) that are placed on them
  • Scoliosis, Kyphosis, Arthritides, Leg length inequalities
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13
Q

Thoracic Biomechanics

Flexion and Extension

A

FLEXION is GREATER THAN Extension
- Due to the normal Kyphotic curvature and Gravity

  • Rotation is Greater in the Upper and Middle portions (Second only to the Atlantoaxial Joint, AA Joint)
  • Lower Thoracic spine moves similar to the Lumbar Spine
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14
Q

Thoracic Biomechanics

Sidebending

A
  • SIDEBENDING is limited by the RIB CAGE
  • Abnormalities affecting motion (Latera)
    1) Scoliosis +/- Kyphosis

2) Upper and Lower Motor Neuron lesions

3) Repetitive motion activity effects
- tethering affect of Myofascial Tissues

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15
Q

Thoracic Biomechanics

General

A
  • Tendency towards Spinal Flexion
  • Gravity, Posture, etc
  • Small muscles of the back are often involved in Postural Stress
  • Often responsible for maintaining Non-neutral and Neutral Somatic Dysfunction of the Vertebral Units
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16
Q

Thoracic Biomechanics

Dysfunctions

A
  • Spinal dysfunctions result from many things
    1) Neurological pathological conditions

2) Trauma
3) Visceral Disease
4) Intrinsic mechanical Asymmetries
5) Chronic asymmetric motions or activities

17
Q

The Ribs

A
  • 12 sets of Ribs correspond to the Thoracic Vertebrae
  • Bony rib connected to the Thoracic Vertebrae at the Costovertebral Articulations
  • 2 through 9 articulate with Vertebrae ABOVE and BELOW
  • 1, 10 though 12 have UNIFACETS that Articulate with the corresponding Vertebrae ONLY!!!!!!!
18
Q

Landmarks

A

1) Rib One
- Anteriorly attaches INFERIOR to Clavicle

  • Posteriorly attaches CEPHALAD to BODER of SCAPULA

2) Rib Two
- Anteriorly articulates with MANUBRIUM and Body of STERNUM

3) Rib Three
- Posteriorly at the level of SCAPULAR SPINE

4) Rib Seven
- Anteriorly attaches at XIPHISTERNAL JUNCTION

-Posteriorly at level of INFERIOR ANGLE of Scapula

5) Rib Ten
- Cartilage at lowest part of THORACIC Cafe at MIDCLAVICULAR LINE

19
Q

Typical Ribs: Ribs 2-9

A
  • Head, neck, tubercle, body is thin and flat
  • Head has TWO FACETS (Body of same for body above)
  • COSTOVERTEBRAL ARTICULATION*
  • Tubercle articulates with TRANSVERSE PROCESS
  • COSTOTRANSVERSE ARTICULATION***
20
Q

Atypical Ribs: Ribs 1, 10-12

A

Rib ONE:

  • Flattest, shortest in length, greatest curve
  • Subclavian Groove: Superior Surface
  • Head articulates with T1 ONLY!!!!!!

Rib TEN:
- Articulates with T10 ONLY!!!!

Rib ELEVEN and TWELVE:
- No neck or Tubercles, articulates with associated Vertebra, 12 (NO COSTAL GROOVE)

21
Q

Costovertebral Joint

A
  • Vertebral Body (same level nd one above)
  • Vertebral Disc (ANNULUS FIBROSIS)
  • Facets
  • Ligaments
    a) Radiate
    b) Interosseous
22
Q

Costotransverse Joint

A
  • Tubercle and Transverse process
  • Ligaments:
    a) Superior, Lateral, Intertransverse, and Costotransverse

b) Superior ligament connects TRANSVERSE PROCESS to Next LOWER RIB!!!!

23
Q

Muscles of Respiration

A

INHALATION:

a) Intercostals (Particularly the Externals)
b) Diaphragm
- Crura anchor at L1,2,3
- Attachments to Lower Ribs and Sternum

EXHALATION:

a) Rectus Abdominus
b) Internal and External Oblique
c) Transverse Abdominus

24
Q

Accessory Muscels of Respiration

A

INHALATION:

a) Sternocleidomastoid
b) Scalenes

EXHALATION:

a) Passive Recoil
b) Abdominal Muscles contribute

25
Q

Effects of Respiration

A
  • Elevation fo Sternum
  • Elevation of Ribs
  • Increase Transverse, Superior/ Inferior and Anterior/ Inferior Diameter
  • Ribs move in THREE MOTION PATTERNS
26
Q

Respiratory Motions of Ribs

A

1) PUMP HANDLE Motion
- Analogous to Flexion/ Extension

  • Rib moves ANTEIRIORLY
  • Increase in A/P Diameter
  • Rib 1 has 50% PUMP HANDLE!!!!!!!!!!!
  • Ribs 2 to 6 Predominantly PUMP HANDLE!

2) BUCKET HANDLE MOTION
- Analogous to Abduction/ Adduction

  • Rib moves LATERALLY
  • Increase TRANSVERSE DIAMETER
  • Rib 1 is 50%!!!!!!
  • Rib 7 to 10 Predominantly BUCKEY HANDLE!!!

3) CALIPER MOTIONS
- Analogous to Internal and External Rotation

  • Pivoting Motion (No Anterior Attachment)
  • Ribs 11 and 12!!!!!!!!!!
27
Q

Respiratory Research in OMM

A.J. MURPHY

A
  • A.J. MURPHY looked at PULMONARY FUNCTION and OMM
  • Found an INCREASE in TIDAL VOLUME and RESPIRATORY RATE after Treatment
  • Found an INCREASE in LUNG PERFUSION after Treatment
  • INCREASE in Gas Exchange (Oxygen, CO2, Nitrogen)
28
Q

Respiratory Research in OMM

DORAN

A
  • Doran looked at RESPIRATOR FUNCTION and LUMBAR LORDOSIS
  • Found that Treatment DECREASED LORDOSIS and INCREASED TIDAL VOLUME
  • Found INCREASE of Abdominal component to RESPIRATION after Treatment
29
Q

Harmonics Mechanics

A
  • Respiration requires SMOOTH FUNCTION
  • Dysfunction to any component
    a) DECREASE in Chest Wall Expansion

b) DECREASE in Oxygenation
c) INCREASED risk of ATELECTASIS

  • Visceral function of Chest
    a) Refer to SOMA (BODY)
30
Q

Trauma

A

1) CHEST WALL CONTUSION
- Air bags
- Seatbelt (Shoulder Harness)

2) RIB FRACTURES
- Decrease Chest expansion due to Pain
- Increase Risk of Infection
- NO RIB BELTS

31
Q

Costochondritis

A
  • Inflammation of COSTOCHONDRAL JUNCTION
  • Unable to put area to Rest (REsp Rate 14/ min = 20,160 Resp Cycles/ Day)
  • Pin point tenderness at area involved
  • Pain increased with LARGE INHALATION
  • Treatment:
    a) NSAIDS
    b) OMM (Ribs, Thoracic, Sternum, Lymphatics)
32
Q

Pneumonia

A
  • Viscerosomatic Reflex at T2-4
  • Cough (Productive or Non-productive)
    a) Rib Dysfunction
    b) Lumbar Dysfunction (Crura L1,2,3)
    c) Thoracic Dysfunction
  • Treatment (Lymphatics to Area One)
  • QUADRATUS LUMBORUM*
  • Functionally an Extension of Diaphragm
  • Trigger points/ spasm effects quality of Diaphragm Excursion (DECREASE Lymph Pumping Action)
33
Q

Iatrogenic Causes

A

1) Thoracotomy
- Lobectomy

2) Sternotomy
- Coronary Bypass Grafting

3) Effects are locally and produce Compensatory changes elsewhere

34
Q

Metabolic Causes

A

OSTEOPOROSIS

  • Decrease Strength to Matrix
  • Fractures easily
  • Use caution with some techniques (Some Contraindicated)
35
Q

Metastatic Disease

A

Common site for Metastasis

  • Breast
  • Prostate
  • Lung
36
Q

Summary

A
  • Smooth Functional Excursion of the Chest Wall is dependent on Proper Mechanics of Thoracic Spine, Ribs, Sternum, and Clavicles
  • Area of Dysfunction have effect on Respiration and Lymphatics
  • May expand to Body Physiology as a whole

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