Thoracic Spine

Question 1

Thoracic Kyphosis can be caused by

Answer 1

Osteoporosis
Scheuermann’s disease
ankylosing spondylitis

Question 2

Osteoporosis

Answer 2

60s-70s onset of pain
can cause compression fractures on vertebral bodies
multiple fractures leads to kyphosis

remember that compression fractures are secondary to the osteoporosis

Question 3

Each vertebral compression fracture…

Answer 3

may result in up to 9% reduction in functional volume of lungs

Question 4

Changes in vertebral bodies is called…

Answer 4

wedging and results in the kyphotic curvature of the spine

Question 4

What are S/S of vertebral compression fracture

Answer 4

focal tenderness at spinous process
localized pain at fracture or ribs
usually stable fractures

neural signs are rare

Question 5

Dowager’s hump

Answer 5

increasing kyphosis from compression fractures forces the diaphragm to press down on abdominal cavity during contraction. Limits tidal volume of lungs

Question 6

Important to remember w/osteoporosis

Answer 6

protect the spine from further fracture
don’t forcefully flex or compress the spine during ADLs or exercise

do not have lifting clear the shoulders/clean lifting. Places significant load on axial spine, causing compression to vertebral bodies

Question 7

Scheurermann’s Disease

Answer 7

idiopathic disorder that results in kyphosis, occurs in 20s

degenerative weakening of vertebral end plates, causing nucleus pulposus to protrude into end plates (boney necrosis/schmorl’s nodes)

Question 8

What should you avoid with scheurermann’s disease?

Answer 8

high impact exercises

exercise doesn’t change the deformity, but helps to maintain mobility and strength

Question 9

Ankylosing Spondylitis

Answer 9

rheumatic disease–inflammation of ligaments in lumbar spine and SI joints

starts in lumbar and progresses upwards, causes FUSION of spine. Loss of spinal movement, loss of curvature.

can also demonstrate pain/stiffness in BILATERAL SI joints, thoracic region, shoulders, restricted respiratory excursion

Question 10

Extreme caution with AS

Answer 10

AO-AA subluxation is extremely common due to ligament weakening

risk of fracture in CT and TL junctions due to fused spine and fragile bone

Question 11

How should AS be treated with exercise?

Answer 11

1. Address primary msk problems
2. address secondary problems, like balance, cardio-respiratory
3. facilitate PA

Question 12

Scoliosis can be divided into

Answer 12

Structural
Non-structural

Question 13

Structural Scoliosis

Answer 13

irreversible lateral curve with fixed rotation

spine is rotated towards the convex side

causes a prominence of ribs posteriorly on convex side, anteriorly on concave side

Question 14

Causes of structural scoliosis

Answer 14

idiopathic
neuromuscular disease
disorder of the bone

Question 15

Non-structural scoliosis

Answer 15

reversible curve that can be changed with forward or side bending, lying supine, realignment of pelvis, correcting leg-length discrepancy

Question 16

Causes of Non-structural scoliosis

Answer 16

leg-length discrepancy
muscle guarding/spasms
habitual or asymmetrical postures

Question 17

Naming direction of idiopathic curve

Answer 17

1. describe by exam of pt from posterior aspect
2. identify vertebra to be the apex of curve, which is the vertebra that deviates furthest from midline
3. apex vertebrae identifies the region of the spine the curve is located in
4. Define direction of curve based on direction of convexity

Question 18

Convex side

Answer 18

longer side

Question 19

Concave side

Answer 19

short side

Question 20

S shaped curve

Answer 20

double curve, in which both the thoracic and lumbar curve cross the midline. lumbar curve is typically larger than thoracic curve

Question 21

What are possible impairments that may result from scoliosis?

Answer 21

1. mobility in jts, muscles, and fascia on concave side decrease
2. lengthened tissues on convex may results activation issues
3. decreased rib expansion may result in impaired breathing

Question 22

Potential sources of symptoms for scoliosis

Answer 22

muscle fatigue and ligament strain on convex side
nerve root irritation on concave side
jt irritability from approx of facets on concave side

Question 23

Interventions for thoracic kyphosis

Answer 23

self-mobs
manual or self stretching of pecs, intercostals, lumbar spine extensors, shoulder adductors
strengthen thoracic extensors, deep neck flexors
manual and soft tissue mobs for restrictions

Question 24

ADLS

Answer 24

important to teach the hip hinge instead of bending through thoracic spine

Question 25

Stretching thoracic spine

Answer 25

side lying or bending on convex side to stretch tight structures on concave side of curve

Question 26

Strengthening thoracic spine

Answer 26

lay on concave side to strengthen convex side

Question 27

Working on thoracic lordosis

Answer 27

improve impairments related to shoulder girdle
modify traditional exercises to prevent thoracic ext
self mob techniques promote thoracic flexion

Question 28

Your patient is a 65 yo female with COPD, she presents with an increased thoracic kyphosis and has an old thoracic vertebral compression fracture from a fall. The goal is to increase thoracic segmental mobility and to increase extension to improve overhead reaching. Which of the following is the best intervention and why?

Answer 28

Small foam roll and standing

-good position for COPD (supine is harder to breathe)
-reaching back towards the wall includes overhead component
-foam roll or tennis balls helps to increase mobilization

Question 29

Your patient presents with this scoliosis. Describe the implications to the structures that surround the spine and the internal organs. What are the possible structural
impairments? Describe your intervention strategies for
these potential impairments.

Answer 29

The left iliac crest appears higher, but this results from the shift of the thorax with fullness on the right and elimination of the waistline; the “high” hip is only apparent, not real.
* When the thoracic spine is involved, this rotation causes the ribs on the convex side of the curve to push posteriorly, causing a rib “hump” and narrowing the thoracic cage on the convex side.
* As the vertebral body rotates to the convex side of the curve, the spinous process deviates toward the concave side. The ribs on the concave side move anteriorly, causing a “hollow” and a
widening of the thoracic cage on the concave side
* Rib expansion and lung function may be impaired on the left side.
* Muscles are elongated on the right side, are working in a chronically lengthen position, and may
not produce concentric force well into a shortened range. Left side is the opposite.