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722: Clinical Management of the Musculoskeletal System II > Thoracic Spine > Flashcards

Thoracic Spine Flashcards

1
Q

Which region of the spine is the stiffness and least mobile? Why?

A

thoracic spine, due to the rib cage

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2
Q

Each thoracic vertebrae is involved in how many articulations?

A

at least 7 and as many as 13

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3
Q

What 2 things cause thoracic kyphosis?

A
  • lesser anterior height of the thoracic vertebral body

- slight wedge shape of the thoracic discs (2mm higher posteriorly)

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4
Q

The apex of the thoracic kyphosis occurs at what spinal level?

A

T7-T8 (T6-7?)

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5
Q

The average thoracic kyphosis ranges from ___-__ degrees

A

20-40

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6
Q

Which thoracic vertebrae are typical and which are atypical?

A

T2-T10 are typical

T1 and T12 are atypical

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7
Q

Describe the shape of the thoracic vertebral bodies

A

Circular almost in that they are roughly as wide as they are long with the AP and ML dimensions equal

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8
Q

The anterior surface of the thoracic vertebral bodies are con__ the posterior surfaces are con__.

A

convex

concave

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9
Q

The vertebral bodies from T2-T10 _____ in size and change shape as you move caudally

A

increase

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10
Q

In comparison to the remainder of the spine the IVDs of the thoracic spine are _____ and _____.

A

narrower and flatter

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11
Q

The IVDs constitute approximately how much of the length of the thoracic spine?

A

1/6th

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12
Q

Nerve roots in the thoracic spine are situated behind the inferior-posterior aspect of the upper vertebral body rather than then disc, why is this?

A

It decreases the risk of root compression

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13
Q

The spinal canal in the thoracic spine is relatively narrow, especially between what spinal levels?

A

T4-T9

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14
Q

At T_ there is a significant decrease in movement of the spinal cord in relation to the surrounding structures. What does this lead to?

A

T6

The creation of a tension point

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15
Q

What is the clinical significance of tension points?

A

Because they are vulnerable sites within the nervous system, they cause a variety of complaints

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16
Q

The TPs of the thoracic spine are ___ with their corresponding vertebral body

A

level

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17
Q

What is difference about the transverse process of T1-T10?

A

They possess a concave joint surface for articulation with the ribs

(T11 and T12 do not have castal facets)

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18
Q

In what direction do the first 3 and last 3 spinous processes face?

A

almost horizontal

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19
Q

The long spinous processes from T4-T9 face what way?

A

steeply inclined downward

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20
Q

The spinous processes of the thoracic spine are designed to do what?

A

to endure and distribute the compressive forces produced by weight bearing

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21
Q

At T1 the compressive load is approximately _% of body weight, at T8 it is approximately __%, and at T12 it is approximately __%.

A

9

33

47

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22
Q

The spinous processes from T1-T3 are level with what?

A

their own vertebral body

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23
Q

The spinous processes from T4-T6 are level with what?

A

the IVD

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24
Q

The spinous processes from T7-T9 are level with what?

A

the transverse processes of the vertebral body below it

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25
Q

The spinous processes from T10-T12 are level with what?

A

the same plane as the transverse processes

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26
Q

Describe the orientation of the upper and lower thoracic facet joints

A

The upper facet joints resemble the cervical facets

The lower facet joints resemble the lumbar facets

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27
Q

Due to thoracic cage articulations _____ plane motions are limited while _____ plane motions are accommodated

A

sagittal

axial

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28
Q

What direction do the superior articular facets face?

A

Posterior
Lateral
Superior

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29
Q

What direction do the inferior articular facets face?

A

Anterior
Medial
Inferior

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30
Q

The thoracic facet joints face __-__ degrees away from the frontal plane

A

20-30

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31
Q

What ribs are true ribs?

A

ribs 1-7

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32
Q

What ribs are false ribs?

A

ribs 8-12

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33
Q

Where do the false ribs attach distally?

A

to the costochondral cartilage of their superior neighbor

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34
Q

Which ribs are typical?

A

3-9

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35
Q

What is a typical rib characterized by?

A

a posterior end, which is composed of a head, neck and tubercle

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36
Q

Which ribs are atypical?

A

1, 2, 10-12

37
Q

What is an atypical rib characterized by?

A

2 articular facets, a superior costal facet, and an inferior costal facet

38
Q

Why are ribs 1-2 and 10-12 considered atypical?

A

Because they only articulate with their own vertebrae via one facet, and the lower two do not articulate with the costochondrium anteriorly

39
Q

Where the head of the ribs articulate with the VB they develop an projection and form the ______ joint

A

costovertebral

40
Q

Describe the costovertebral joint

A

It is a compound synovial joint that is divided into a superior and inferior compartment by the intra articular ligament

41
Q

The intra articular ligament connects which 2 structures?

A

the head of the rib with the disc

42
Q

The synovial joint between the facets of the TPs of the vertebra and the rib tubercle is called the _____ joint

A

costotransverse

43
Q

Because the articular capsule of the costotransverse joint is weak it must be strengthened by 3 ligaments, what are they?

A
  • medial costotransverse ligament
  • lateral costotransverse ligament
  • superior costotransverse ligament
44
Q

How do the first 7 ribs join the sternum?

A

via individual costal cartilage

45
Q

How do ribs 8-10 attach the sternum?

A

via fused costal cartilage

46
Q

How do ribs 11 and 12 attach the sternum?

A

They don’t, they are free floating

47
Q

The sternocostal joint between the cartilage of the first rib and the sternum is a ______

A

synchondrosis

48
Q

What does the cartilage of the 2nd rib articulate with?

A

Demi facets on both the manubrium and the sternum in a synovial joint

49
Q

The synovial joint between the 2nd rib and the manubrium/sternum is divided into 2 parts by what?

A

the intra articular sternocostal ligament

50
Q

The sternum has con___ facets that articulate with the costocartilage of ribs -

A

concave

3-6

51
Q

The 7th rib articulates with what 2 structures?

A

the xyphoid process and the sternum

52
Q

What do the costochondral joints allow?

A

deformation of the costal cartilage during inspiration

53
Q

Is the manubriosternal synchondrosis separate or ossified?

54
Q

What does the ligamentum flavum attach?

A

The lamina and pedicles superiorly and inferiorly

55
Q

The ligamentum flavum strengthens what aspect of the facet joint?

56
Q

The elastic fibers of the ligamentum flavum outnumber the collagen fibers _:1

57
Q

What do the elastic properties of the ligamentum flavum create?

A

a resting compression of the IVD, which adds some stability to the spine and also ensures that it won’t bunch up and impinge on the spinal cord during extension

58
Q

The ligamentum flavum restricts which motion?

59
Q

What does the ALL function to limit?

A

extension and AP translation

60
Q

What does the PLL function to limit?

A

flexion and posterior translation

61
Q

Blood supply to the thoracic region is via what arteries?

A

the posterior branches of the posterior intercostal arteries

62
Q

Blood is drained from the thoracic region is via what veins?

A

The anterior and posterior venous plexuses

63
Q

What are the 3 primary effects the increased stability/decreased mobility of the thoracic spine has?

A
  • it influences the motions available in other spinal regions as well as the shoulder girdle
  • it increases the potential for postural impairments
  • it provides an important weight-bearing mechanism for the vertebral column
64
Q

What is considered the most important stabilizer in the thoracic functional unit mechanics?

65
Q

What is the overall flexion ROM in the thoracic spine?

A

20-45 degrees

66
Q

What resists end range flexion?

A

the posterior half of the annulus and the impaction of the facet joints

67
Q

What is the overall extension ROM in the thoracic spine?

A

15-20 degrees

68
Q

What resists end range extension?

A

The relative stiffness of the anterior IVD, the ALL, and bony contact of the inferior facet and the SPs

69
Q

What motion do the ribs make during extension?

A

They rotate posteriorly

70
Q

What is the overall side-bending ROM in the thoracic spine?

A

25-45 degrees

71
Q

Describe the biomechanics during side-bending

A

The ipsilateral facet glides inferiorly and the contralateral facet glides superiorly

72
Q

Side-bending is restrained by what 2 things?

A
  • compression of the IVDs

- approximation of the ribs

73
Q

Where does the axis of rotation lie?

A

Within the VB in the mid-thoracic joints

Anterior to the VB in the upper and lower joints

74
Q

At what 2 points in the spine can rotation occur?

A

At the TL and CT junctions

75
Q

What is the overall rotation ROM in the thoracic spine?

76
Q

Side-bending and rotation are coupled to the _____ side in the UTS and _____ way in the middle and low thoracic spine

A

SAME

EITHER (although typically opposite)

77
Q

Elevation of the rib increases the AP diameter of the chest in a so-called “____ handle” motion

78
Q

Elevation of the rib increases the transverse diameter of the chest in a so-called “____ handle” motion

79
Q

During inspiration the sternum is raised and the costal cartilage becomes more ______

A

horizontal

80
Q

What are the primary muscles of inspiration?

A
  • diaphragm
  • levator costorum
  • external intercostals
81
Q

What are the primary muscles of expiration?

A

the internal intercostals

82
Q

The spine of the scapula is on what spinal level?

83
Q

The inferior angle of the scapula is on what spinal level?

84
Q

The medial border of the scapula is _ cm lateral to the SPs

85
Q

What is Dowager’s formation?

A

fatty hump in the upper thoracic spine

86
Q

Explain the palpation “Rule of 3’s” for the thoracic spine

A
  • T1-T3 the SPs are approximately level with their own VB
  • T4-T6 the SPs are level with the IVD below
  • T7-T9 the SPs are in line with the TPs of the VB below
  • T10 the SP is level with the TPs of the vertebra below
  • T11 the SP is level with the IVD below
  • T12 the SP is level with its own VB
87
Q

What are the goals during the acute phase of thoracic spine rehabilitation?

A
  • decrease pain, inflammation, and muscle spasm
  • promote healing of tissues
  • increase pain free ROM
  • regain soft tissue extensibility
  • regain neuromuscular control
    initiate postural education
  • promote correct breathing techniques
  • educate patient about activities to avoid and positions of comfort
88
Q

What are the goals during the functional phase of thoracic spine rehabilitation?

A
  • achieve significant reduction in symptoms
  • restore full and pain free ROM
  • fully integreate the entire UE and LE kinetic chains
  • complete restoration of respiratory function
  • restore upper quadrant strength and neuromuscular control

722: Clinical Management of the Musculoskeletal System II (12 decks)

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