Thoracic spine Flashcards
QQ: during the forward flexion test you notice a moderate rib hump on the right thoracic spine and a smaller hump on the left, how would you describe these curves?
right thoracic and left lumber curves
QQ: in normal individuals, flexion/extension in the thoracic spine…
a) increases in lower vertebral segments
b) increases in upper thoracic segments
c) remains the same throughout
d) decreases in lower vertebral segments
a) increases in lower vertebral segments
QQ: diaphragms primary mode of action during inspiration
- during inhalation the diaphragms center moves more caudally
- the edges move more rostrally
- this compresses the abdominal cavity
- moves ribs up and out
- expands thoracic cavity
QQ: kinematics of the ribs during normal inspiration with bucket and pump handle
- with pump handle breathing upper ribs and sternum increase diameter of thoracic cavity in AP direction
- bucket handle breathing: lower ribs increase diameter of thoracic cavity in horizontal plane
the vertebral body in the thoracic spine is higher posteriorly or anteriorly?
posteriorly to give it more of a wedge-like shape
- this is the reason for the kyphotic curvature in the thoracic spine
the organization of the vertebrae in the thoracic spine allow for flexion/extension but what limits this?
the ribs
The most rotation in the thoracic spine can be found in the…
upper part of the thoracic spine (less lower due to lumbar transition)
facet orientation in thoracic region is in the ___________ plane
frontal
orientation of the facet joints changes at T10-11 to the ________ plane
sagittal
Thoracic flexion (arthro)
superior and anterior slide of the inferior facet of the superior vertebrae on the superior facet of the inferior vertebrae
thoracic contribution to thoracolumbar flexion (85 degrees total)
about 30-40 degrees
thoracic extension (arthro)
posterior and inferior slide of the inferior facets of the superior vertebrae on the superior facet of the inferior vertebrae
thoracic extension is limited by
anterior connective tissues and posterior bony structures
thoracolumbar extension
35-40 degrees total
-thoracic contribution is 20-25 degrees
thoracic rotation (arthro)
inferior articular facets of the superior vertebrae slides against the superior facets below
thoracolumbar rotation
40 degrees
35 from thoracic
thoracic lateral flexion (arthro)
contralateral gapping, ipsilateral compression
thoracolumbar lateral flexion
about 45 degrees
25 degrees from the thoracic region
the head of the rib attaches to the vertebral body at the
costovertebral joint
costovertebral joint
convex rib facets articulate with the concave vertebral facets (inferior/superior facet)
costotransverse joint
- 10 pairs of joints (T1-T10)
- convex rib tubercles (T1-T6)
key landmark for rib dysfunction
rib angle
The superior facets articular with the vertebral bodies ________ T6 while the inferior are articulate with superior facet of V. bodies _______ T7
above
below
atypical thoracic/rib articulation
T1, T10-12 and articulating ribs
kinematics of upper ribs (1-6)
- motion occurs in the sagittal plane
- with inspiration the upper ribs and sternum increase the AP diameter of the thorax
- “pump handle”
kinematics of lower ribs
- frontal plane motion
- inspiration: lower ribs increase transverse diameter
- bucket handle motion
3 parts of the diaphragm based on bony attachments
- costal part- upper margins of lower 6 ribs
- sternal part- posterior side of the xiphoid
- crural part- attached to bodies of upper 3 lumbar vertebrae (right and left crus)
action of the diaphragm during inspiration
- 60-80% of work for inspiration
- dome flattens and lowers- increases vertical diameter of thorax
- diaphragm descends and central tendon moves inferiorly
- diaphragm continues to contract resulting in elevation and posterior rotation of the ribs
descent of the diaphragm is resisted by the
abdomen for stabilization of the position of the dome
expiration
- passive process
- elastic recoil of the thorax, lungs, and diaphragm
forced expiration activates
the abdominals and intercostals (internal)
Primary inspiratory muscles
diaphragm, intercostals, scalenes
forced inspiratory muscles
- serratus posterior
- SCM
- lats
- iliocostalis thoracis
- pec groups
- QL
Expiratory muscles
- rectus abdominus, external oblique, internal oblique, transverse, abdominus
- internal intercostals
- transversus thoracis
rib movement with forward bedning
osteokinematics: anterior rotation of T3-7
Arthrokinematics: superior glide with anterior roll
rib movement with extension
- Osteo: posterior rotation with T3-T7
- arthrokinematics: inferior glide with posterior roll
spring test is used to assess
- the first rib (costotransverse joint caudal glide)
- with this test you perform a caudal glide just lateral to T1 transverse process
to asses passive mobility of the thoracic spine use the
PA spring test (posterior to anterior)
