Thoracic Region Flashcards
Fryette’s Principles
When any part of the lumbar or thoracic spine is in neutral position, side-bending of a vertebra will be opposite to the side of rotation of that vertebra.
When any part of the spine is in a position of extension or flexion, the side-bending of a vertebra will be to the same side as the rotation of that vertebra.
Initiating motion of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion.
1st layer of back muscles
Layer 1: trapezius, latissimus dorsi, lumbodorsal fascia
2nd layer of back muscles
levator scapulae, major and minor rhomboids
3rd layer of back muscles
Erector spinae mass including spinalis, semispinalis, longissimus, and iliocostalis
4th layer of back muscles
Multifidi, rotatores and intertransversarii
Denslow’s findings re: spinal facilitation
Denslow (1940’s) – found variability in reflex excitability in the paraspinal muscles of the thoracic spine
These often asymptomatic areas had increased muscle activity as well as pain and tenderness when palpated.
Later studies by Denslow found that associated visceral organs were affected via altered sympathetic output.
Korr’s findings re: spinal facilitation
Korr – “facilitated segment”- plays a part in the etiology of SD because that area is hyperirritable and hyper-responsive – muscles in that region will be hypertonic
categorize the defensive reflex
somatosomatic
categorize distension of the gut causing increased contraction of the gut muscle
viscerovisceral
categorize stimulation of abdominal skin inhibiting gut activity
somatovisceral
categorize upper back pain with an MI (reflex)
viscerosomatic
How do the interacting reflexes work?
Afferent input travels along the dorsal roots and enters the spinal gray matter (dorsal horn). It is here that there is lots of overlap of input – almost every interneuron receives input from both a visceral and a somatic source.
Sympathetic nervous system innervation vertebral levels
T1-4 Head and Neck
T2-8 Upper Extremities
T1-6 Heart and Lungs
T5-9 Upper abdominal viscera
T9-L1 Small intestine,
kidney, ureter,
gonads, right colon
T11-L2 Left colon, pelvic
organs, lower extremitiesa huge long list of ddxes of pain in the thoracic region
Muscle strain Osteopenia/porosis Facet arthropathy Vertebral fracture Diskitis Scoliosis Viscerosomatic reflex Multiple myeloma TB (Pott’s disease) Vertebral metastases Rotator cuff injury Myocardial ischemia/infarction Aortic aneurysm Pneumonia Pleurisy Asthma COPD Bronchitis, coughing Peptic ulcer Cholycystitis/lithiasis Pyelonephritis Pancreatitis
mid back pain after hanging wallpaper
muscles, nerves, SD
What position was she in while hanging the wallpaper?
extended
What muscles are likely to be involved with having her arms overhead for extended periods?
Trapezius, semispinalis, levator scapulae
Which nerves innervate those muscles?
C3-4, T1-6, C3-5
What type of Somatic Dysfunction (SD) would you anticipate in her vertebrae and where?
Mid-T’s, extended, cervical
