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Ax Final > Thoracic Ax > Flashcards

Thoracic Ax Flashcards

1
Q

What does the Thorax require?

A

Lots of mobility
(production of force for many movements, important area for scapular movement)

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2
Q

Why can the thorax be a complex area to assess

A

Due to the possibility of referred pain from the viscera

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3
Q

Pain from lesions to MSK structures is brought on by what?

A

by posture and movement, however a cough, deep breath, PA or posture may influence visceral pain

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4
Q

What is not as common in the T-spine as in the C-spine and lumbar spine?

A

Neuro issues

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5
Q

Where is the origin of the autonomic nervous system found?

A

between T1 and L2

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6
Q

What is the autonomic nervous system responsible for?

A

innervation of smooth muscle, cardiac muscle, glands and blood vessels

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7
Q

What does the sympathetic nervous system involve?

A

Fight or flight response
involves E activities: Excitement, exercise, emergency, and embarrassment
Non essential activities reduced
Blood flow to organs is reduced, increased to muscles

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8
Q

What does T1-T5 innervate?

A

heart and lungs

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9
Q

What does T5-T10 innervate?

A

innervates stomach, intestines (up to distal half of large intestines), spleen and liver, pancreas

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10
Q

What does T10-L2 innervate?

A

distal half of large intestine, reproductive organs, urinary bladder, kidney

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11
Q

What does the parasympathetic nervous system do?

A

Stimulates activity to conserve and restore body resources (wants to keep body energy use low)
SLUDD: salivation, lacrimation, urination, digestion, defecation
Most active in non stressful situation
Relaxes after a meal : HR and BP and resp. rates are low, GI tract activity high, warm skin, pupils constricted

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12
Q

What is the concerns with the use of chest binders?

A

97% of people reported at least 1 negative outcome (backpain, overheating, chest pain, bad posture, shoulder pain, SOB)
Peer-reviews found that 28 outcomes were linked to binder use: rib Fx, back pain, chest pain, rip/spine changes, bad posture, shoulder pain, shoulder joint popping, muscle wasting, etc…

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13
Q

What are the three types of chest dysfunctions?

A

Pectus carinatum; sternum popping out
Pectus excavatum: sternum caving in
Barrel chest: whole rib cage more prominent, can see ribs below nipple line

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14
Q

How are the spinous processes positioned in the thoracic spine?

A

obliquely downwards

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15
Q

What is the rule of 3’s?

A

T1-T3: SP levels with TP
T4-T6: SP half level below TP
T7-T9: SP full level below TP
T10: SP level below TP
T11: SP half level below TP
T12: SP even with TP

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16
Q

Which ribs are the true ribs?

A

1-7

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17
Q

Which ribs are the false ribs?

A

8-10

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18
Q

Which ribs are the floating ribs?

A

11-12

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19
Q

What are the characteristics of Rib 1?

A

Small, broad and flat making it difficult to palpate, right at the apex of the R lung
Can cause TOS by being hypomobile or stuck caudally

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20
Q

Where do the costotransverse and costovertebral joint refer pain?

A

typically refer pain along the rib

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21
Q

What are the ligaments holding the sternoclavicular and sternocostal joints?

A

radiate ligament
interchondral ligaments

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22
Q

What are the rib movements when breathing?

A

The top ribs mostly have a pump handle movement
the lower ribs have a bucket handle movement
ribs 11 and 12 have a caliper motion

23
Q

How do the ribs move with spinal rotation?

A

For direction of movement look at posterior aspect of rib.
Rot to R
R ribs: ER
L ribs: IR

24
Q

What are the respiratory muscles?

A

Diaphragm (primary breather)
Serratus posterior (inferior and superior)
External intercostals
Internal intercostals

25
Q

What does serratus posterior inferior do?

A

aids respiration and bring ribs down

26
Q

What does serratus posterior superior do?

A

Aids in respiration and elevates the ribs

27
Q

What are the characteristics of the diaphragm?

A

primary muscle of respiration
Dome like shape
Separates thorax from abdomen
during inspiration lowers and flattens
During expiration it relaxes and ascends
Pleural tissue and pericardium are attached to it
Phrenic nerves (C3,4,5) run between pericardial sac and diaphragm
Fascial connection with psoas major and QL

28
Q

At what level does the esophagus pierce the diaphragm?

A

At T10

29
Q

At what level does the inferior Vena Cava pierce the diaphragm?

A

T8, compression will affect drainage
2/3 blood exists lower body via inferior vena cava
1/3 exists via lymphatic system

30
Q

What is the thoracolumbar fascia?

A

It covers the deep muscles
Attaches medially to T and L spine and laterally to costal angles, 12th rib
Merges with Lats, glute med, glute max, transverse abdominus and internal/external obliques

31
Q

How do muscle strains of the Tspine commonly occur?

A

with couching, twisting/rotation activities and heavy lifting. Acute with high energy mechanism or chronic overuse high rep mechanism

32
Q

What are the S/S of muscle strains of the Tspine?

A

pain along the muscle with palpation, possible pain with deep breath, movement of spine that stretches or contracts the affected muscles

33
Q

What are the characteristics of rib stress fractures?

A

common in rowers (9% incidence) due to continuous repetitive motion
Posterior ribs most commonly affected due to pull of the SA (occurs most frequently after time off when endurance not optimal)
T spine, rib cage and shoulder dynamics all affected (Level of T4-T7 most susceptible to stress fractures and strains due to rhomboids, lats, ES)

34
Q

Characteristics of disc herniations in the T/S.

A

not common compared to L/S and C/S
incidence of symptomatic disc herniation is low
More common in males 40-50year old
Can occur at any level in T/S but 75% reported below T8
Associated with axial pain and radiculopathy

35
Q

What is scoliosis?

A

Side bending in one direction, rotation in opposite direction (Law 1)
Non structural scoliosis typically only has the side bending element not rotation
Can be congenital, idiopathic, neuromuscular, degenerative
Named for the point of the apex of the curve and the side of the convexity

36
Q

What happens to the ribs when there is T/S scoliosis?

A

Convex side: ribs pushed posteriorly, angle gets sharper and overall volume is decreased

Concave side: ribs pushed anteriorly, widens the angle

37
Q

What is costochondritis?

A

Inflammation of the cartilage that connects rib to sternum
Cause is unknown
Sharp, achy or pressure like pain
Worse with coughing and deep breathing
Condition typically improves on its own

38
Q

Which type of TOS is more common?

A

Neurological TOS most common (95%)
Vascular (arterial 1-2%, venous 3-5%)

39
Q

What are common MOI of TOS?

A

Repetitive OH movement
Faulty posture
Improper breathing
Traumatic= whiplash/falls

40
Q

What is Scheuermann’s Kyphosis (disease)?

A

Can occur in young age (13-16)
Vertebrae grow at different rates during child’s growth spurt
Pain to follow after periods of exertion or long periods of inactivity

41
Q

What is the Dowager’s hump?

A

Increased kyphosis
From stress fracture or postmenopausal osteoporosis

42
Q

What are the proper breathing mechanics?

A

Inhalation through the nose
expansion of abdomen 360 degrees
Pt is in neutral spine to optimize breath
slight anterior tilt of pelvis with inhalation
Pump and bucket handle movement of chest
no shoulder movement towards the ears
Relaxation of neck musculature

43
Q

What is chest breathing?

A

Whole body moves up
Tension through neck musculature
Use of SCM, scalene, UFT to assist in inhalation
Abdomen moves up and in
Rib flare

44
Q

What is collapsed breathing?

A

Whole body moves down
Shoulder’s hunched
Compression to the heart, lungs, organs
chest and rib cages compress inferior
belly projected forward and down like dead weight
Common in obese individuals and those suffering from depression

45
Q

What is Frozen breathing?

A

Entire outer layer of body contracts to constrict and suppress the rising movements of breath
Breath holding and tension
Stressful situations and cold environment

46
Q

What is reverse breathing?

A

Abdomen contracts in on inspiration and out on expiration
Confusing to the body, affects muscle movement and coordination patterns

47
Q

What are signs of dysfunctional breathing?

A

Cranial movement of rib cage
Inward movement of abdomen
Movement of spine (Flexion/extension)

48
Q

What are signs of improper activation of core stabilization during movements?

A

elevation of chest
Breath holding when performing tasks
Inability to maintain the intra-abdominal pressure during normal respiratory cycle
Imbalanced abdominal activity with excessive contraction of rectus abdominis and lack of activity of the lateral and posterior parts of the abdominal wall
Belly breathing pattern where only the front of the abdomen expands
Concavities at lower lateral abdomen

49
Q

What does the position of the chest and pelvis affect?

A

affects the synchronization of diaphragm and pelvic floor
elevated chest impairs the contraction of costal part of diaphragm
Want chest and pelvis parallel

50
Q

What are the characteristics of an anterior subluxation of the rib?

A

Rib angle: less prominent and tender
Anterior rib: more prominent

51
Q

What are the characteristics of a posterior subluxation of the rib?

A

Rib angle: more prominent and tender
Anterior rib: less prominent

52
Q

What are the characteristics of a superior first rib subluxation?

A

Superior aspect of first rib elevated (5mm) anterior to UFT
Marked tenderness of superior aspect
restriction primarily in exhalation (scalene hypertonicity)

53
Q

What are the characteristics of an anterior-posterior rib compression?

A

Rib shaft: less prominent ant and post convexities
Mid-axillary lines: more prominent
Tenderness and tension of intercostal space above and below

54
Q

What are the characteristics of a lateral compression of the rib cage?

A

Rib shaft: more prominent ant and post
Mid axillary lines: less prominent
Tenderness and tension of intercostal space above and below

Ax Final (5 decks)

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