Thoracic spine

Question 1

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?

Answer 1

right thoracic and left lumber curves

Question 2

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

Answer 2

a) increases in lower vertebral segments

Question 3

QQ: diaphragms primary mode of action during inspiration

Answer 3

• 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

Question 4

QQ: kinematics of the ribs during normal inspiration with bucket and pump handle

Answer 4

• 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

Question 5

the vertebral body in the thoracic spine is higher posteriorly or anteriorly?

Answer 5

posteriorly to give it more of a wedge-like shape

• this is the reason for the kyphotic curvature in the thoracic spine

Question 6

the organization of the vertebrae in the thoracic spine allow for flexion/extension but what limits this?

Answer 6

the ribs

Question 7

The most rotation in the thoracic spine can be found in the…

Answer 7

upper part of the thoracic spine (less lower due to lumbar transition)

Question 8

facet orientation in thoracic region is in the ___________ plane

Answer 8

frontal

Question 9

orientation of the facet joints changes at T10-11 to the ________ plane

Answer 9

sagittal

Question 10

Thoracic flexion (arthro)

Answer 10

superior and anterior slide of the inferior facet of the superior vertebrae on the superior facet of the inferior vertebrae

Question 11

thoracic contribution to thoracolumbar flexion (85 degrees total)

Answer 11

about 30-40 degrees

Question 12

thoracic extension (arthro)

Answer 12

posterior and inferior slide of the inferior facets of the superior vertebrae on the superior facet of the inferior vertebrae

Question 13

thoracic extension is limited by

Answer 13

anterior connective tissues and posterior bony structures

Question 14

thoracolumbar extension

Answer 14

35-40 degrees total

-thoracic contribution is 20-25 degrees

Question 15

thoracic rotation (arthro)

Answer 15

inferior articular facets of the superior vertebrae slides against the superior facets below

Question 16

thoracolumbar rotation

Answer 16

40 degrees

35 from thoracic

Question 17

thoracic lateral flexion (arthro)

Answer 17

contralateral gapping, ipsilateral compression

Question 18

thoracolumbar lateral flexion

Answer 18

about 45 degrees

25 degrees from the thoracic region

Question 19

the head of the rib attaches to the vertebral body at the

Answer 19

costovertebral joint

Question 20

costovertebral joint

Answer 20

convex rib facets articulate with the concave vertebral facets (inferior/superior facet)

Question 21

costotransverse joint

Answer 21

• 10 pairs of joints (T1-T10)

- convex rib tubercles (T1-T6)

Question 22

key landmark for rib dysfunction

Answer 22

rib angle

Question 23

The superior facets articular with the vertebral bodies ________ T6 while the inferior are articulate with superior facet of V. bodies _______ T7

Answer 23

above

below

Question 24

atypical thoracic/rib articulation

Answer 24

T1, T10-12 and articulating ribs

Question 25

kinematics of upper ribs (1-6)

Answer 25

• motion occurs in the sagittal plane
• with inspiration the upper ribs and sternum increase the AP diameter of the thorax
• “pump handle”

Question 26

kinematics of lower ribs

Answer 26

• frontal plane motion
• inspiration: lower ribs increase transverse diameter
• bucket handle motion

Question 27

3 parts of the diaphragm based on bony attachments

Answer 27

• 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)

Question 28

action of the diaphragm during inspiration

Answer 28

• 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

Question 29

descent of the diaphragm is resisted by the

Answer 29

abdomen for stabilization of the position of the dome

Question 30

expiration

Answer 30

• passive process

- elastic recoil of the thorax, lungs, and diaphragm

Question 31

forced expiration activates

Answer 31

the abdominals and intercostals (internal)

Question 32

Primary inspiratory muscles

Answer 32

diaphragm, intercostals, scalenes

Question 33

forced inspiratory muscles

Answer 33

• serratus posterior
• SCM
• lats
• iliocostalis thoracis
• pec groups
• QL

Question 34

Expiratory muscles

Answer 34

• rectus abdominus, external oblique, internal oblique, transverse, abdominus
• internal intercostals
• transversus thoracis

Question 35

rib movement with forward bedning

Answer 35

osteokinematics: anterior rotation of T3-7
Arthrokinematics: superior glide with anterior roll

Question 36

rib movement with extension

Answer 36

• Osteo: posterior rotation with T3-T7

- arthrokinematics: inferior glide with posterior roll

Question 37

spring test is used to assess

Answer 37

• the first rib (costotransverse joint caudal glide)

- with this test you perform a caudal glide just lateral to T1 transverse process

Question 38

to asses passive mobility of the thoracic spine use the

Answer 38

PA spring test (posterior to anterior)