thoracic spine Flashcards
T/S compression fx % and TP %
compression: 52%
TP fracture: 37%
T/S is important for what with scapula
scapular mvt
can be complex areas to assess why
both musculoskeletal injuries but also referred pain from viscera
Pain referred from visceral areas is usually what
Pain referred from visceral areas (lungs, heart and intestines) is usually poorly localized and vaguely delineated and is referred to as a segmental or multi segmental distribution
pain from lesion to MSK structure is brought on by what and why can influence visceral pain
Pain from lesions to MSK structures is brought on by posture and movement
However a cough, deep breath, PA or posture may influence visceral pain…
Subjective History Thoracic Spine
- red flag from systemic problem
- age/occupation: scheurmann’s (13-16) and idiopathic scoliosis ado female
- boundaries of pain/pain presentation
- pain with breathing
- pain deep, superficial, shooting, burning, aching
- coughing, sneezing straining
- pain into leg, arm,head neck,
- digestive problem
origin of ANS found where
between T1 and L2
ANS is responsible for
innervation of smooth muscle, cardiac muscle, glands, and blood vessels
Sympathetic and parasympathetic systems – have _ effect
opposite
SNS increase with what
Fight or Flight
Increase in stress, danger, physical activity, pain
SNS involve what activities
Involves E activities
Exercise, Excitement, Emergency, and Embarrassment
SNS reduce what
non essential activities
-> urinary and GI tract
Blood flow to organ is reduced, muscle is increased
T1-T5 innervate what
heart lung
T5-L2 innervate what
innervates stomach, intestines (up to distal ½ of large intestines), spleen and liver, pancreas
T10-L2 innervate what
distal half of large intestine, reproductive organs, urinary bladder, kidney
role of PNS
Stimulates activity to conserve and restore body resources
Concerned with keeping body energy use low
PNS is most active when
Most active in non stressful situations
SLUDD- salivation, lacrimation (tears), urination, digestion, defecation
what happen physiological after a meal and which system is actif
PNS
HR and BP and respiratory rates are low
GI tract activity high
Warm skin, pupils constricted
what is chest binding
Technique used to compress breast tissue in order to create a flatter appearance of the chest
in one Australian study _% of respondents had used binding
87
used of chest binding
For many transmasculine people, chest binding is considered a necessary rather than elective daily activity due to associated mental and emotional health
For some, it may be used as an interim measure before surgery can be obtained
concern with the use of binder
Rib fractures, back pain, chest pain, rib or spine changes, bad posture, shoulder pain, shoulder joint ‘popping’, muscle wasting, numbness, headache, overheating, fatigue, weakness, lightheadedness or dizziness, cough, respiratory infections, shortness of breath, heartburn, abdominal pain, digestive issues, breast changes, breast tenderness, scarring, swelling, acne, itch, skin changes, and skin infections
% of negative outcome from binder reported
97% of people reported at least 1 negative outcome (53% backpain, 53% overheating, 48.8% chest pain, 40% bad posture, 38.9% shoulder pain, 46.% SOB)
Common Thoracic Spine Pathologies
Scoliosis
Kyphosis
Scheurmann’s disease
Thoracic outlet syndrome
Rib fracture
Muscle strains- intercostals, scapular muscles, abdominals
Costochondral and chrondrosternal joint sprain
Manubriosternal and sternoclavicular joint sprain
Intervertebral facet joint sprain
Costovertebral and costotransverse joint sprain
spinous process position
Positioned obliquely downwards
explain the rule of 3
T1-T3:
TP at level of SP-same vertebrae
T4-T6:
TP ½ vertebral body above SP
T7-T9
TP at level of SP of vertebrae above
T10 Rules of T7-9
T11 Rules of T4-6
T12 Rules of T1-3
tubercle and head of ribs articulate with
with the vertebral and transverse costal facets on the thoracic vertebrae
posterior aspect of ribs articulate with
with the sternum via with the costocartilage
true ribs:
false ribs:
floating ribs:
true: 1-7
false: 8-10
floating ribs: T11-T12
which ribs is difficult to palpate
rib 1 , small broad and flat
rib one align with and which muscle primary attach to it
apex of right lunges, anterior scalene
costotransverse and Costovertebral joint refere pain where
along the ribs
which ligament attach to sternoclavicular and sternocostal joint
radiate ligament
interchondral ligament
what is the role of pump handle movement
elevation of ribs, increase in anterior-posterior diameter of thoracic cavity
role of bucket handle movement
elevation of rib, increase in lateral diameter of thoracic cavity
ribs that primarily do bucket handle movement
ribs that primarily do pump handle movement
bucket: false ribs 8-10
pump: true ribs: 1-7
combination of both ribs: 11-12
ribs movement with rotation to the right
Look at posterior aspect of ribs for direction of movement
Right ribs= external rotation
Left ribs= internal rotation
what are the respiratory muscle
diaphgram, serratus posterior/inf/sup, external intercostal, internal intercostal
muscle involve primary in force expiration
internal intercostal
diaphgram
muscle involve in inspiration
external intercostal
diaphgram
role of serratus post inf in respiration
aids in respiration and lower the ribs
role of serratus post super in respiration
elevated the ribs
action of thoracic diagram during inspiration and expiration
During inspiration lowers and flattens
During expiration it relaxes and ascends
what is attach to diaphgram
Pleural tissue and pericardium are attached to the diaphragm
which nerve run between pericardial sac and diaphgram
phrenic nerve
fascial connection of diaphgram connected with
psoas major and QL
Esophagus pierces diaphragm at
T10
if you have a problem at T10 which disease could you also have
Gastroesophageal reflex disease
if you have T8 compression what could be affected
Inferior Vena Cava
T8, compression will affect drainage
2/3 blood exits lower body via inferior vena cava
1/3 exits lymphatic system
thoracolumbar fascia attached where and merges with
Attaches medially to thoracic and lumbar spine and laterally to costal angles, 12th rib
Merges with lats, glute med, glute max, T.A and int/ext obliques
muscle strain of thoracic spine commonly occurs with
with coughing, twisting/rotation activities and heavy lifting
Acute with high energy mechanism or chronic overuse high rep mechanisms
muscle strain of thoracic spine will display pain where
along the muscle with palpation, possible pain with deep breaths, movement of the spine that stretches or contracts the affected muscles
rib stress fracture are common with which type of athlete
rower from continuous repetitive movement
which part of ribs is commonly affect
Posterior ribs most commonly affects due to the pull of SA
Occurs most frequently after time off when endurance is not optimal
which level of T/S is most susceptible to stress fracture
Level of T4-T7 is most susceptible to stress fractures and strains Rhomboids, lats, ES
which dynamic is affected with rib fracture
T/S, rib cage and shoulder
Incidence of symptomatic disc herniation is low/high
low
disc herniation in T/S is more common in what age and which gender is more affected
40s-50s and male
75% of T-spine herniation reported to be where
below T8
Disc herniation in T/S is associated with which type of pain
axial pain (localized to middle or low thoracic region near level of injury), radiculopathy
scoliosis follow which law
1 -> SB and rotation are opposite
non-structural scoliosis only have SB or rotation element
only SB
how a scoliosis is named
Named for the point of the apex of the curve and the side of the convexity
ex: L T7 scoliosis
explain the convex side of rib with scoliosis
ribs pushed posteriorly, angle gets sharper and overall volume is decreased
explain the concave side of ribs with scoliosis
Concave side – ribs pushed anteriorly, widens the angle
spinous process deviated toward which side with scoliosis
concave side,
what is costochondritis
Inflammation of the cartilage that connects rib to sternum
worse with coughing and deep breathing
sharp, achy or pressure like pain
improve on its own
TOS is more common in M or W
W
common MOI of TOS
Common MOI
Repetitive OH movement
Faulty posture
Improper breathing
Traumatic=whiplash/falls
common entrapment sites of TOS
between scalene’s (ant/mid), 1st rib and clavicle, pec minor…
what is ATOS and history finding
arterial TOS
claudication/rest pain of upper limb, excluding shoulder/neck, numbness, coolness,palor
which test is positive with ATOs
EAST, ULTT, adsons test
VTOS history finding and which test is positif
deep pain on movement or rest pain in upper limb, chest, shoulder
swelling and cyanotic discolouration
+Ve: EAST, ULTT, adson
NTOS history
pain in neck, trapezius, shoulder, arm, chest, occipital headache
variable pattern upper limb weakness, numbness, paraesthesias
which muscle is tender on palpation with NTOS
scalene triangle, subcoracoid space
s/s with upper plexus NTOS (C5-C7)
sensory disturbance of arm, weakness/atrophy of deltoid, bicep and brachialis
s/s with lower plexus NTOS (C8-T1)
sensory disturbance ulnar forearm and hand, weakness/atrophy of small muscle of hand, weak wrist and finger flexion
normal kyphosis and what is considered abnormal
20-40 degree
abdnormal: 40-45 +
scheuermann kyphosis occurs at what age and what is it
Can occur in young age (13-16)
Vertebrae grow at different rates during child’s growth spurt
symptom of scheuermann kyphosis
Pain to follow after periods of exertion or long periods of inactivity
what is dowager hump
increased kyphosis, from stress fracture of postmenopausal osteoporosis
what is chest breathing
Whole body moves up
Tension through the neck musculature
Use of SCM, scalene, UFT to assist in inhalation
Abdomen moves up and in
Rib flare
proper breathing mechanic
- inhale through the nose
- expansion of the abdomen- 360º (like a balloon)
- slight anterior tilt of pelvis with inhalation
-pump and bucket handle movement of the chest - no shoulder movement toward the ears
- relaxation of neck musculature
what is collapsed breathing
Whole body moves down
Shoulder’s hunched
Compression to the heart, lungs and organs
Chest and rib cage compress inferior
Belly projected forward and down like dead weight
Common in obese individuals and individuals suffering from depression
what is frozen breathing
Entire outer layer of body contracts to constrict and suppress the rising movements of breath
Breath holding and tension
Stressful situations and cold environment
what is reverse breathing
Abdomen contracts in on inspiration and out on expiration
Confusing to the body
Affects muscle movement and coordination patterns
non emergency signs of dysfunctional breathing
Cranial movement of rib cage
Inward movement of abdomen
Movement of spine (flexion/ext)
Signs of improper activation of core-stabilization during movements
- Elevation of the chest - brings the diaphragm away from ideal position for maximal activation
- Breath holding when performing tasks
- The inability to maintain the intra-abdominal pressure during the normal respiratory cycle
- Imbalanced abdominal activity with excessive contraction of the 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 the lower lateral abdomen
what can compromised breathing
Position of chest and pelvis affect synchronization of diaphragm and pelvic floor
Elevated chest impairs the contraction of costal part of diaphragm
how should chest and pelvis be during breathing
parallel
finding with anterior subluxation of ribs
rib angle = less prominent and tender
anterior rib= more prominent
motion: restriction in inhalation and exhalation
finding with posterior subluxation of rib
rib angle = more prominent and tender
anterior rib: less prominent
motion: restriction in inhalation and exhalation
finding with sup first rib subluxation
rib angle: Superior aspect of first rib elevated (5mm) anterior to UFT
ant rib: Marked tenderness of superior aspect
motion: Restriction primarily in exhalation
(scalene hypertonicity)
ant-post rib compression finding
shaft: Less prominent ant and post convexities
mid-axillary lines: More prominent
discomfort: Tenderness and tension of intercostal space above and below
motion: Restriction of respiratory activity
lateral rib compression finding
rib shaft: More prominent ant and post
mid-axillary lines: Less prominent
discomfort: Tenderness and tension of intercostal space above and below
motion: Restriction of respiratory activity
