Thoracic Spine Flashcards
Thoracic Kyphosis can be caused by
Osteoporosis
Scheuermann’s disease
ankylosing spondylitis
Osteoporosis
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
Each vertebral compression fracture…
may result in up to 9% reduction in functional volume of lungs
Changes in vertebral bodies is called…
wedging and results in the kyphotic curvature of the spine
What are S/S of vertebral compression fracture
focal tenderness at spinous process
localized pain at fracture or ribs
usually stable fractures
neural signs are rare
Dowager’s hump
increasing kyphosis from compression fractures forces the diaphragm to press down on abdominal cavity during contraction. Limits tidal volume of lungs
Important to remember w/osteoporosis
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
Scheurermann’s Disease
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)
What should you avoid with scheurermann’s disease?
high impact exercises
exercise doesn’t change the deformity, but helps to maintain mobility and strength
Ankylosing Spondylitis
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
Extreme caution with AS
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
How should AS be treated with exercise?
- Address primary msk problems
- address secondary problems, like balance, cardio-respiratory
- facilitate PA
Scoliosis can be divided into
Structural
Non-structural
Structural Scoliosis
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
Causes of structural scoliosis
idiopathic
neuromuscular disease
disorder of the bone
Non-structural scoliosis
reversible curve that can be changed with forward or side bending, lying supine, realignment of pelvis, correcting leg-length discrepancy
Causes of Non-structural scoliosis
leg-length discrepancy
muscle guarding/spasms
habitual or asymmetrical postures
Naming direction of idiopathic curve
- describe by exam of pt from posterior aspect
- identify vertebra to be the apex of curve, which is the vertebra that deviates furthest from midline
- apex vertebrae identifies the region of the spine the curve is located in
- Define direction of curve based on direction of convexity
Convex side
longer side
Concave side
short side
S shaped curve
double curve, in which both the thoracic and lumbar curve cross the midline. lumbar curve is typically larger than thoracic curve
What are possible impairments that may result from scoliosis?
- mobility in jts, muscles, and fascia on concave side decrease
- lengthened tissues on convex may results activation issues
- decreased rib expansion may result in impaired breathing
Potential sources of symptoms for scoliosis
muscle fatigue and ligament strain on convex side
nerve root irritation on concave side
jt irritability from approx of facets on concave side
Interventions for thoracic kyphosis
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
ADLS
important to teach the hip hinge instead of bending through thoracic spine
Stretching thoracic spine
side lying or bending on convex side to stretch tight structures on concave side of curve
Strengthening thoracic spine
lay on concave side to strengthen convex side
Working on thoracic lordosis
improve impairments related to shoulder girdle
modify traditional exercises to prevent thoracic ext
self mob techniques promote thoracic flexion
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?
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
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.
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.
