Thoracic Spine Flashcards
Thorax requires a lot of
mobility
why is the thorax a difficult area to assess
MSK injuries and referred pain from viscera
ANS origin found between
T1 and L2
ANS responsible for
innervation of smooth muscle, cardiac muscle, glands and blood vessels
SNS
fight of flight
T1-T5 innervate
heart, lungs
T5-L2 innervates
stomach, intestines, spleen and liver, pancreas
T10-L2 innervates
distal half of large intestine, reproductive organs, urinary bladder, kidney
PNS
most active in non stressful situations
SLUDD
chest binding
compress breast tissue
concerns with use of binding
bad outcomes (used as a sense of safety in social spaces)
pectus carinatum
chest out
pectus excavatum
chest in
common T spine pathologies
scoliosis
kyphosis
thoracic outlet syndrome
rib fracture
muscle strains
costochondral and chondrosternal joint sprains
manubriosternal and strenoclavicular joint sprain
intervertebral facet joint sprain
rule of 3s T1-T3
TP at same level of vertebrae
rule of 3s T4-T6
tp 1/2 above sp
T7-T9 rule of 3s
tp at level of sp of vertebrae above
T10 TP position
same as T7-T9
Rule of 3’s for T11 SP
same as T4-T6
Rule of 3’s for T12 SP
same as T1-T3
true ribs
1-7
false ribs
8-10
floating ribs
At the levels of T11-T12
Rib 1 anatomy
apex or right lung
ant scalenes
what joint allows bucket handle mvt
costovertebral
movement of ribs
pump handle
bucket handle
if rotation to the right, the ribs are in
R = external rotation
L= internal rotation
respiratory muscles
diaphragm
serratus posterior
external intercostals
internal intercostals
serratus posterior- inferior
aids in respiration and lowers the ribs
serratus posterior-superior
aids in respiration and elevates the ribs
diaphragm
primary muscle of respiration
dome
seperates thorax from abdomen
flattens in inspiration
goes ups with expiration
what attaches to diaphragm
pleural tissue and pericardium
what nerves run between pericardial sac and diaphragm
phrenic nerves (C3,4,5)
facial connection of the diaphragm to what
psoas major and QL
esophagus pierces diaphragm at
T10
thoracolumbar fascia attaches medially to
thoracic and lumbar spine and laterally to costal angles, 12th rib
thoracolumbar fascia merges with
lats
glute med
glute max
T A
and int/ext obliques
MOI of muscle strains of T/S
coughing
twisting/rotation activities and heavy lifting
ribs stress fractures common in
rowers (9%)
what ribs are affected by stress fx
most commonly posterior ribs (T4-T7) due to the pull of SA, rhomboids, lats, ES
disc herniation is as common in T/S than rest of spine
false
disc herniation most common in what population and where
males in 40-50s, 75% below T8
disc herniation is associated with what pain
axial pain, radiculopathy
law of scoliosis
1
rotation and side bend opposite
scoliosis named after what
apex of the curve and side of the convexity
scoliosis effect on ribs - convex side
ribs pushed posterior, angle gets sharper and overall volume is decreased
scoliosis effects on ribs- concave
ribs pushed anteriorly, widens the angle
cobb angle
angle between start and end of the curve
costochondritis
inflammation of the cartilage that connects the ribs to the sternum
costochondritis s&s
sharp achy or pressure like pain
worse with coughing and deep breathing
improves on its own
thoracic outlet 2 types
neuro (most common 95%)
vascular (arterial 1-2% venous 3-5%)
Thoracic outlet syndrome most common in
women
TOS MOI
repetitive OH movement
faulty posture
improper breathing
traumatic/whiplash/falls
common entrapment sites for TOS
between scalenes (ant/mid)
1st rib
clavicle
pec minor
Scheuermann’ kyphosis
can occur in young age (13-16)
vertabrae grow at different rate during child’s growth spurt
pain to follow after periods of exertion or long periods of inactivity
Dowager’s hump
increased kyphosis
from stress fractures or postmenopausal osteoporosis
proper breathing mechanics
nose
expansion of abdomen
slight anterior tilt of pelvis with inhalation
pump and bucket handle mvt of the chest
no shoulder mvt
relaxation of neck muscles
chest breathing
whole body moves up
tension through neck muscles
rib flare
what muscles are used with chest breathing
SCM
scalene
UFT
collapsed breathing
whole body moves down
shoulders hunched
compression to the heart, lungs and organs
chest and rib cage compress inferior
belly projected forward and down
collapsed breathing common in
obese individuals and people suffering from depression
frozen breathing
entire outer layer of body contracts to constrict and suppress the rising movements of breath
breath holding and tension
when can frozen breathing happen
cold environment or stressful situations
reverse breathing
abdomen contracts in on inspiration and out on expiration
non emergent signs of dysfunctional breathing
cranial movement on rib cage
inward movement of abdomen
movement of spine (flex/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 does an elevated chest impair (breathing)
contraction of the costal part of the diaphragm
rib dysfunction
rib dysfunction
