Thoracic/Ribs Flashcards
Rule of 3s: thoracic landmarks
T1-3: SP same level as TP
T4-6: SP 1/2 level below TP
T7-9: SP 1 level below TP
T10-12: same level
Disc height to vertebral body size
Smaller discs in thoracic region than lumbar or cervical,
This contributes to decreased motion in thoracic region
True ribs vs false vs floating
Ribs 1-7 are true ribs with sternal attachments
Ribs 8-12 are “false”
Ribs 11, 12 are floating, with no anterior attachment
Rib movement during breathing
upper rib cage rises in sagittal plane
lower ribs widen in frontal plane
Thoracic level of “critical zone”
T4-9
Decreased blood flow, narrower spinal canal
stiffness here can have widespread effect
Zygoaphophaseal joint pain referral
Most likely distal than proximal.
most intense symptoms one segment below and slightly lateral
What motions tension the sympathetic chain
flexion, contralateral SB/rot
Due to location of sympathetic chain, manipulation of what region may improve s/s of altered neurodynamics
Middle thoracic
s/s of T4 syndrome
HA, neck pain UE pain, BUE “stocking glove” parasthesia—
Manipulation of T4 region may improve conductivity of hands
What may be reason for T4 syndrome
influence of middle thoracic region on sympathetic nervous system
What region of Tspine are flexion impairments more common
upper/middle.
T3-6
postural sign of Tspine flexion impairment
reduction of kyphosis, often following whiplash injury
What type of injury may lead to flexion impairment of upper tspine
whiplash
Where are Tspine extension impairments most common
CTJ
postural sign of Tspine extension impairment
Increased kyphosis
s/s of dissecting thoracic aneurysm
chest pain, may radiate to back.
Sudden onset
unrelenting
not relieved with position change
CPR to rule in/out CAD
- Age >65 (55 for men)
- Known CVD
- Pain worse with exercise
- not reproduceable with palpation
- Patient believes cardiac origin
2 predictor variables met, Sn of .98
3 predictor variables met, Sn .87, Sp .8, +LR 4.52
Thoracic pain triggered or relieved by eating may be sign of?
peptic ulcer
Where would inflammed gall bladder pain refer?
right upper quadrant and infrascapular region
Ankylosing spondylitis CPR
- stiffness of greater than 30 min
- improvement with exercise, not rest
- awakening due to pain in 2nd half of night only
- alternating buttock pain
2 met= Sn.7, Sp.81
3 met=Sn.33, Sp.94
Chest expansion values
Normal: 5cm at nipple
Less than 2.5cm considered pathological
Key physical characteristic of ankylosing spondylitis
decreased chest expansion
Risk of vertebral fx with osteopenia?
relatively low, but should be considered
What motion occurs with serratus anterior activation with UE fixed?
posterior translation of rib
What treatment should be considered for acute/irritable cervical condition
T/s manipuation
Potential predictors for shoulder pain improving with t/s manip? (4 items)
- pain free flexion of 127 or less
- GH IR of less than 53
- not on pain meds for shoulder
- negative neer
