Thoracic Spine

Question 1

Typical thoracic vertebrae

Answer 1

T2-T9 (typical due to nature of rib attachment)

Each body has two demi-facets on each side for ribs

Question 2

Direction of pedicles in thoracic spine

Answer 2

Straight posterior –> Narrows vertebral canal (esp. T3-5)

Question 3

T1 costal facets

Answer 3

Has one full costal facet superiorly for rib 1
**Rib 1 only articulates with T1
One demifacet inferiorly for rib 2

Question 4

T10-T12

Answer 4

Normally lack costotransverse joints

Question 5

Costotransverse joints

Answer 5

Facet on transverse process articulates with the articular tubercle of rib
Planar joints --> gliding (possible subluxation)
Costotransverse ligament (thickening of capsule) and superior costotransverse ligament

Question 6

Costochondritis

Answer 6

Irritation of cartilage attachment of ribs to sternum (compression)

• Overuse
• Poor posture

Question 7

Ankylosing Spondylitis correlates with what?

Answer 7

Thoracic kyphosis

Hypomobility of thoracic segments can lead to compensatory hypermobility of adjacent segments

Question 8

Apophyseal joints of thoracic spine

Answer 8

Face in the frontal plane with a mild forward slop

–> would facilitate rotation, but motion is limited by the presence of costotransverse and costovertebral joints

Question 9

Costovertebral Joints

Answer 9

Head of rib connects with a pair of costal demifacets on the thoracic vertebral bodies and the IVD between the bodies
Capsular and radiate ligaments
Ribs 1, 11, 12 have individual vertebrae (rather than sharing like 2-10)

Question 10

Sternocostal joints

Answer 10

Anterior cartilagenous joints of the first 7 ribs articulating with the sides of the sternum
Two parts:
1. Costochondral junction
2. Chondrosternal junction

Question 11

PR2

Answer 11

Posterior Rib 2 tender point - palpate lateral to spinous process of T2

Question 12

Cervical Rotation and Lateral Flexion Test

Answer 12

Purpose: Assess 1st rib restriction
- Head rotated away from the symptomatic side
- Pt’s ear gently flexed to the chest
Positive test: Bony restriction blocks lateral flexion
Compare one side to the other

Question 13

Pump Handle Mechanics

Answer 13

Ribs 1-6

Question 14

Bucket Handle Mechanics

Answer 14

Ribs 7-10

*Motion patients are more likely to lose

Question 15

Movement of ribs 11 and 12 during breathing

Answer 15

No significant elevation - these ribs are fixated by quadratus –> Caliper motion (expansion side to side)

Question 16

What fraction of normal respiration tidal volume does diaphragm contribute?

Answer 16

2/3 in sitting

3/4 in supine (has to work harder in supine because ribs don’t mobilize as well)

Question 17

Transverso-Spinalis muscles

Answer 17

Semispinalis
Multifidi
Rotatores

Question 18

Intrinsic Trunk Muscles

Answer 18

Deep: Transversospinalis

Erector Spinae

Question 19

Erector Spinae

Answer 19

Spinalis
Longissimus
Iliocostalis

Question 20

Normal Kyphosis

Answer 20

40-45 Degrees

Question 21

Where are the different motions greater in the thoracic spine?

Answer 21

Rotation: Greater in upper and mid-thoracic
Flexion/extension: Greater in lower thoracic
Lateral bending: Greater in lower thoracic

Question 22

Pectoralis Minor Syndrome

Answer 22

Compression of brachial plexus and subclavian under contracted pec minor

Question 23

Thoracic Outlet Syndrome

Answer 23

Compression of brachial plexus and sublcavian between anterior and middle scalenes