Thoracic Spine Flashcards
What are the 3 sections of the thoracic spine
T1-3
T4-9
T10-12
What are the 4 parts of the thoracic spine and rib cage
Transverse processes
Spinous processes
Rib tubercles - where transverse processes join giving the costotranverse joint and costovertebral joint
Intercostal space - where intercostal muscles lie
How many joints are in the front and back of rib cage
12
Sternocondral joints
Costocondral junctions
How do we palpate the thoracic vertebra
Rules of 3 - due ti the length of the spinous processes which changes from the upper to the lower, they become longer as we go down
T1-3 = transverse processes are level with the corresponding spinous process
T4-6= TP are 1/2 segment above the SP
T7-9 = TP are above the SP
What are the components of the passive system of the thoracic spine
Has a spinal canal
Structure and position of the nervous system
The exchange between the sympathetic nervous system in the autonomic nervous system takes place in the thoracic spine
What is involved in the active system of the thoracic spine
Muscular system = intercostals, abdominals, spino-scapular, spino-humeral, scapuloheral muscle groups
How to differentiate between MSK and visceral pain in clinical examination
MSK =
pain affected by movement or posture
Onset usually mechanical
Pain area well defined
Pain reproduced by t spine palpation
Night pain
Visceral =
Posture and movement make no difference
Nom mechanical
Pain area diffuses
Palapation of t spine has no effect
What are possible underlying pathologies in the thoracic spine
MSK =
Trauma - fracture, ligament, muscle
Degenerative joint disease
T4 syndrome
T outlet syndrome
Postural thoracic pain
Referred pain
Non- MSK
Metabolic disorders
Infections like TB
Tumours
Visceral pain
What should be observed in objective examination
Scoliosis
Kyphosis
Note the chest - pigeon chest or funnel chest or barrel chest
What ROM tests should be done for thoracic spine assessment
Flexion
Extension
Side flexion
Rotation
Deep inspiration
Deep expiration
Combined movement to include deep inspiration and expiration
What PAVIMS can be done for thoracic spine assessment
IN SUPINE AP of costochondral, interchondral and sternocostal joints
IN PRONE PA of IV joints T1-12
Unilateral PA of facet joints
PA of the Costco-transverse joints
Longitudinal caudad of first rib
PA ribs 2-12
What nuerodynamic tests can be done for thoracic assessment
Slump test
SLR
Passive neck flexion
Upper limb tension test
What are specific disorders of the thoracic spine
Paget’s disease
AS
rheumatoid arthritis
OA
DISH
Scheuermanns disease
Thoracic canal stenosis
Thoracic disc herniayion
What is thoracic outlet syndrome
???
What is scheuermanns disease
Form of osteochindrosis with degenerative changes in the intervertebral disc and end plates
A growth disorder, anterior body grows slowly or abnormally, increasing kyphosis
Affecting T5-L1
What is the clinical presentation of scheuermanns disease
Smooth rounded dorsal kyphosis, most evident on flexion
Reduced spinal mobility
Tight hamstrings
Reduced disc space
How to treat scheuermanns disease
If Inactive phase =
Light exercise
Postural correction with brace
Rest from pain producing activities
If Inburnt out phase =
Encourage self management
Paced return to activity and exercise
Avoid heavy loading
What is osteoporosis
Reduced bone mass resulting in reduced bone mineral density
Results from failure to achieve peak bone mass or from accelerated bone loss
Can be from oestrogen deficiency
Typical picture of those with osteoporosis
More prevalent in women and elderly
Early menopause or post menopause
Sedentary lifestyle
Thin body type
Ammenhorea
How is the female athlete triad related to osteoporosis
Disordered eating, ammenhorea and osteoporosis seen in females who participate in activities that emphasise a lean physique
What are symptoms of osteoporosis
Pain due to bony fracture
Diffuse skeletal pain
Loss of height
Stooped posture
Sudden pain history
Management of osteoporosis
Prophylaxis and eliminate risk factors
Manual therapy - soft tissue
Electro therapy
Postural assessment
Exercise
Calcium intake
Pain management
What are special tests for thoracic spine assessment
Adson test
Roos test
What is the Roos test done for and how is it performed
Thoracic outlet syndrome
84% sensitivity
30% specificity
Patient has both arms in 90* abduction and external rotation, shoulder and elbows are in frontal place of chest
Patient is to open and close hands slowly over a 3 minute period
+ =
heaviness
Gradual increase in neck and shoulder pain - ischaemic pain
Parathesia in foearm and fingers
Arm paleness
Inability to complete gets
