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Ortho (spine) > Thoracic Spine > Flashcards

Thoracic Spine Flashcards

1
Q

What are the functions of the thoracic spine?

A
  1. protection
  2. respiration
  3. load transfer b/t LQ and UQ
  4. postural stability and mobility
  5. rotational mobility
  6. transmission of power and torque from the L-spine, pelvis and legs
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2
Q

What is the primary cause of upper thoracic hypomobility?

A

habitual FHP

- lose upper thoracic extension and upper cervical flexion

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3
Q

For every inch the COM is displaced forward at C-spine how much pressure is put on the lumbosacral joint?

A

x2

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4
Q

What occurs secondary to altered length-tension relationships and inhibition of axioscapular muscles?

A

increased likelihood for scapular dyskinesis and shoulder pathology

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5
Q

What do you need at the thoracic spine to achieve full UE elevation?

A
  • adequate upper thoracic extension (13-15 deg) and rotation of the first 6 ribs
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6
Q

At 150 deg of UL elevation, what happens at t-spine?

A

upper thoracic region begins to extend and IL SB/ROT

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7
Q

how much trunk rotation comes from the thorax?

A

50%

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8
Q

What predisposition occurs if there is rotational hypomobility in the thorax?

A

cervical and lumbar segmental deterioration

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9
Q

What occurs during gait if you have a stiff T-L joint?

A

torsion generated stays in the l-spine, causing breakdwon of L4/L5 and L5/S1

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10
Q

A stiff upper thorax increases stress to c-spine facets by how much?

A

200-300 fold to achieve full head rotation

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11
Q

What are indications for the examination of the T-spine?

A
  1. subjective hx
  2. cervical/lumbar instability
  3. shoulder pathology
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12
Q

In the shoulder, T-spine hypomobility is associated with what?

A
  • RTC injuries

- GHJ instability

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13
Q

What is the most common site of referred pain within the vertebral column?

A

T-spine

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14
Q

Where can thoracic pain referral originate from?

A
  • all of the viscera

- systemic illnesses

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15
Q

Where do cervical facet joints refer pain to?

A

inter-scapular region

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16
Q

what is the hallmark of visceral pain?

A

doesn’t change with posture and movement

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17
Q

What are some non-musculoskeletal causes of thoracic pain?

A
  1. pulmonary/pleuritic= PE, pleurisy, pancoast tumor, tracheobronchial pain
  2. cardiac= MI, arotic dissection, angina pectoris, pericarditis, mitral valve prolapse
  3. GI= Esophageal disorders, peptic ulcer, cholecysitis
  4. Chest wall= herpes zoster, intercostal neuralgia, nerve entrapment
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18
Q

What does SIN stand for?

A
  1. severity
  2. irritability
  3. nature
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19
Q

During the subjective exam, you must determine if pain is provoked or alleviated with:

A
  1. movement posture
  2. changes with respiration
  3. eating/drinking
  4. exertion
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20
Q

If a patient has osteopenia/osteoporosis, they are at risk for:

A
  1. compression fx in lower t-spine of elderly

2. fx in ribs laterally

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21
Q

What are red flags you might find during a t-spine exam?

A
  1. chest pain that occurs outside a predictable pattern
  2. dyspnea
  3. nausea or vomitting
  4. night pain
  5. recent or current UTI
  6. dull, gnawing pain, or burning sensation
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22
Q

What are the 4 regions of the thorax?

A
  1. vertebromanubrial (T1-T2)
  2. vertebrosternal (T3-T7)
  3. Vertebrochondral (T8-T10)
  4. Thoracolumbar (T11-T12)
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23
Q

What are the 2 joints for the ribs?

A
  1. costovertebral

2. costotransverse

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24
Q

what is the most important stabilizer of any motion segments in the spine?

A

Disc

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25
Q

What is the normal amount of flexion in t-spine?

A

20-45 deg

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26
Q

What is the normal amount of extension in t-spine?

A

15-20 deg

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27
Q

What is the normal amount of rotation in the t-spine?

A

45-60 deg

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28
Q

What is the normal amount of SB in the t-spine?

A

25-45 deg

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29
Q

In T2-T8, the superior facets face in which direction?

A
  • face posteriorly

- directed superolaterally

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30
Q

In T2-T8, the inferior facets face in which direction?

A
  • face anteriorly

- directed inferiomedially

31
Q

What is the coronal orientations of facets T2-T8?

A
  • 70-80 deg from transverse plane
  • 10-15 deg from frontal plane
  • limits anterior translation of superior vertebra on inferior vertebra
32
Q

What are the rule of 3’s?

A
  1. T1-T3, T12 SP’s are same level as TP’s.
  2. T4-T6, T11: SP’s are 1/2 level below TP’s
  3. T7-T10: SP’s are full level below TP’s.
33
Q

T11 and T12 lack what?

A

costal facets on their TP’s

34
Q

The CTJ structure and orientation in the vertebromanubrial area is?

A
  • concave facet on TP

- antero-inferior direction

35
Q

The CTJ structure and orientation in the vertebrosternal area is?

A
  • concave facet on TP
  • antero-lateral orientation
  • more rolling motion
36
Q

The CTJ structure and orientation in the vertebrochondral area is?

A
  • facet on TP is flat
  • superolateral orientation
  • rib sitting on TP
37
Q

Describe the motion that occurs at the vertobromanubrial region during FLEXION

A
  • anterior aspect of rib moves inferiorly, posterior aspect moves superiorly
  • ribs stop moving–> vertebral facets glide over fixed ribs @ end of range (moving anterior and superior)
38
Q

Describe the motion that occurs at the vertobromanubrial region during EXTENSION

A
  • facets move posteriorly and inferiorly

- relative superior glide and anterior roll of rib at CTJ

39
Q

Describe the motion that occurs at the vertobromanubrial region during SB AND ROTATION

A
  • ribs don’t play a role in coupling

- IL rotation and SB

40
Q

Describe the motion that occurs at the vertobrochondral region during FLEXION

A
  • Facet: superior/anterior glide
  • Ribs: anterior rotation
  • CVJ limits motion, vertebrae continues gliding on rib at TP at EOR
  • except in older pt who is stiff: everything moves together
41
Q

Which direction does the CTJ face in the vertebrochondral region

A

anterolaterally

42
Q

Describe the motion that occurs at the vertobrochondral region during EXTENSION

A
  • Facet: inferoposterior glide

- Rib: posterior rotation

43
Q

Describe the motion that occurs at the vertobrochondral region during ROTEXION

A
  • IL coupling of Rotation and SB

- occurs when axial rotation is 1st motion induced

44
Q

Describe the motion that occurs at the vertobrochondral region during LATEXION

A
  • IL ribs move anteriorly
  • CL ribs move posteriorly
  • CL coupling of SB and rotation
45
Q

are the ribs 9 and 10 attached to superior vertebrae?

A

no

46
Q

in which direction are the CTJ oriented in the vertebrochondral region TPs?

A

superolateral

47
Q

Which direction do the ribs and facets move during inspiration in the vertebrochondral region?

A

Ribs: posterior rotation
Facets: antero-lateral-inferior glide

48
Q

Which direction do the ribs and facets move during expiration in the vertebrochondral region?

A

Ribs: anterior rotation
Facets: postero-medial-superior glide

49
Q

Describe the movement occurring during SB in the vertebrochondral region when the apex is within the thorax

A

vertebrae SF in the opposite direction below the apex of the curve

50
Q

Describe the movement occurring during SB in the vertebrochondral region when the apex is below the thorax

A

vertebrae SF in the same direction and continue to SF once they’re compressed and stop moving

51
Q

What occurs during rotation in the vertebrochondral region?

A

neither facets nor ribs dictate a coupling of SF when rotation is induced

52
Q

What is the most flexible region in the thorax?

A

T11/T12

53
Q

Describe the vertebra of T12

A
  • inferior articular facets resemble the lumbar region

- superior facets are like the thoracic

54
Q

Describe the flexion motion in the thoracolumbar region

A
  • anterior sagittal rotation and translation of superior vertebra
  • facets glide superior/anteriorly
  • ribs spin on vertebrae (CVJ)
55
Q

Describe the extension motion in the thoracolumbar region

A
  • posterior sagittal rotation and translation of superior vertebra
  • facets glide inferiorly/posteriorly
  • ribs spin on vertebrae (CVJ)
56
Q

What kind of SF and Rotation occurs at the thoracolumbar region?

A

Pure SF and ROT- no coupling

57
Q

Describe the mechanics that occur during inspiration

A

Diaphragm descends–> rib cage expands

- volume increases, pressure decreases

58
Q

Describe the mechanics that occur during expiration

A

Diaphragm relaxes–> rib cage contracts

- volume decreases, pressure increases

59
Q

Describe the costal cage motion during rib elevation

A
  • anterosuperior movement of sternum

- torsion of costal cartilages

60
Q

What is pump handle motion and where does it occur?

A
  • T1-T6
  • anterior rib elevation
  • increase in AP diameter
61
Q

What is bucket handle motion and where does it occur?

A
  • T7-T10
  • lateral rib elevation
  • increase in transverse diameter
62
Q

What is calliper motion and where does it occur?

A
  • T11-T12

- ER/IR rotation

63
Q

describe the motion of the ribs during thoracic rotation

A
  • IL posterior rotation

- CL anterior rotation

64
Q

What muscles are the local stabilizers of the thorax?

A
  1. rotatores thoracis
  2. deep multifidus (3 layers)
  3. levator costarum brevis
  4. levator costarum longus
  5. internal and external intercostals
65
Q

What are the local stabilizers at the trunk?

A
  1. TA
  2. diaphragm
  3. pelvic floor
  4. multifidus
66
Q

What are the global stabilizers responsible for flexion control at the posterior thorax?

A
  1. semispinalis thoracic
  2. Spinalis thoracis
  3. superficial multifidus
67
Q

What are the global stabilizers responsible for rotation control at the posterior thorax?

A
  1. semispinalis thoracic

2. Spinalis thoracis

68
Q

What are the global stabilizers of the anterior trunk?

A
  1. oblique abdominals (rotation, extension, and lateral flexion control)
  2. internal oblique
  3. External oblique
69
Q

What are the global mobilizers of the thorax?

A
  1. Erector spinae –> more active under high loads, can become overactive during low threshold, low load tasks
    - iliocostalis thoracis
    - iliocostalis lumborum
    - longissimus thoracis
  2. rectus abdominus–> flexion and posterior pelvic tilt
  3. QL (overdominance leads to SB restriction on CL side)
  4. Lats
70
Q

Describes what occurs during respiratory rib dysfunction

A
  • restriction in excursion of rib with respiration
  • painless
  • no palpable asymmetry in rib position
  • primarily a soft tissue restriction
71
Q

Describes what occurs during structural rib dysfunction

A
  • traumatic
  • painful
  • asymmetry of rib position
  • hypertonus and TTP
  • Rib torsions: secondary to segmental dysfunction at Z joint
72
Q

What is external rib torsion associated with:

A

ERS lesion of segment above

73
Q

what is internal rib torsion associated with:

A

FRS lesion of superior vertebral segment

Ortho (spine) (4 decks)

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