Thoracic Spine Flashcards
What are the functions of the thoracic spine?
- protection
- respiration
- load transfer b/t LQ and UQ
- postural stability and mobility
- rotational mobility
- transmission of power and torque from the L-spine, pelvis and legs
What is the primary cause of upper thoracic hypomobility?
habitual FHP
- lose upper thoracic extension and upper cervical flexion
For every inch the COM is displaced forward at C-spine how much pressure is put on the lumbosacral joint?
x2
What occurs secondary to altered length-tension relationships and inhibition of axioscapular muscles?
increased likelihood for scapular dyskinesis and shoulder pathology
What do you need at the thoracic spine to achieve full UE elevation?
- adequate upper thoracic extension (13-15 deg) and rotation of the first 6 ribs
At 150 deg of UL elevation, what happens at t-spine?
upper thoracic region begins to extend and IL SB/ROT
how much trunk rotation comes from the thorax?
50%
What predisposition occurs if there is rotational hypomobility in the thorax?
cervical and lumbar segmental deterioration
What occurs during gait if you have a stiff T-L joint?
torsion generated stays in the l-spine, causing breakdwon of L4/L5 and L5/S1
A stiff upper thorax increases stress to c-spine facets by how much?
200-300 fold to achieve full head rotation
What are indications for the examination of the T-spine?
- subjective hx
- cervical/lumbar instability
- shoulder pathology
In the shoulder, T-spine hypomobility is associated with what?
- RTC injuries
- GHJ instability
What is the most common site of referred pain within the vertebral column?
T-spine
Where can thoracic pain referral originate from?
- all of the viscera
- systemic illnesses
Where do cervical facet joints refer pain to?
inter-scapular region
what is the hallmark of visceral pain?
doesn’t change with posture and movement
What are some non-musculoskeletal causes of thoracic pain?
- pulmonary/pleuritic= PE, pleurisy, pancoast tumor, tracheobronchial pain
- cardiac= MI, arotic dissection, angina pectoris, pericarditis, mitral valve prolapse
- GI= Esophageal disorders, peptic ulcer, cholecysitis
- Chest wall= herpes zoster, intercostal neuralgia, nerve entrapment
What does SIN stand for?
- severity
- irritability
- nature
During the subjective exam, you must determine if pain is provoked or alleviated with:
- movement posture
- changes with respiration
- eating/drinking
- exertion
If a patient has osteopenia/osteoporosis, they are at risk for:
- compression fx in lower t-spine of elderly
2. fx in ribs laterally
What are red flags you might find during a t-spine exam?
- chest pain that occurs outside a predictable pattern
- dyspnea
- nausea or vomitting
- night pain
- recent or current UTI
- dull, gnawing pain, or burning sensation
What are the 4 regions of the thorax?
- vertebromanubrial (T1-T2)
- vertebrosternal (T3-T7)
- Vertebrochondral (T8-T10)
- Thoracolumbar (T11-T12)
What are the 2 joints for the ribs?
- costovertebral
2. costotransverse
what is the most important stabilizer of any motion segments in the spine?
Disc
What is the normal amount of flexion in t-spine?
20-45 deg
What is the normal amount of extension in t-spine?
15-20 deg
What is the normal amount of rotation in the t-spine?
45-60 deg
What is the normal amount of SB in the t-spine?
25-45 deg
In T2-T8, the superior facets face in which direction?
- face posteriorly
- directed superolaterally
In T2-T8, the inferior facets face in which direction?
- face anteriorly
- directed inferiomedially
What is the coronal orientations of facets T2-T8?
- 70-80 deg from transverse plane
- 10-15 deg from frontal plane
- limits anterior translation of superior vertebra on inferior vertebra
What are the rule of 3’s?
- T1-T3, T12 SP’s are same level as TP’s.
- T4-T6, T11: SP’s are 1/2 level below TP’s
- T7-T10: SP’s are full level below TP’s.
T11 and T12 lack what?
costal facets on their TP’s
The CTJ structure and orientation in the vertebromanubrial area is?
- concave facet on TP
- antero-inferior direction
The CTJ structure and orientation in the vertebrosternal area is?
- concave facet on TP
- antero-lateral orientation
- more rolling motion
The CTJ structure and orientation in the vertebrochondral area is?
- facet on TP is flat
- superolateral orientation
- rib sitting on TP
Describe the motion that occurs at the vertobromanubrial region during FLEXION
- 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)
Describe the motion that occurs at the vertobromanubrial region during EXTENSION
- facets move posteriorly and inferiorly
- relative superior glide and anterior roll of rib at CTJ
Describe the motion that occurs at the vertobromanubrial region during SB AND ROTATION
- ribs don’t play a role in coupling
- IL rotation and SB
Describe the motion that occurs at the vertobrochondral region during FLEXION
- 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
Which direction does the CTJ face in the vertebrochondral region
anterolaterally
Describe the motion that occurs at the vertobrochondral region during EXTENSION
- Facet: inferoposterior glide
- Rib: posterior rotation
Describe the motion that occurs at the vertobrochondral region during ROTEXION
- IL coupling of Rotation and SB
- occurs when axial rotation is 1st motion induced
Describe the motion that occurs at the vertobrochondral region during LATEXION
- IL ribs move anteriorly
- CL ribs move posteriorly
- CL coupling of SB and rotation
are the ribs 9 and 10 attached to superior vertebrae?
no
in which direction are the CTJ oriented in the vertebrochondral region TPs?
superolateral
Which direction do the ribs and facets move during inspiration in the vertebrochondral region?
Ribs: posterior rotation
Facets: antero-lateral-inferior glide
Which direction do the ribs and facets move during expiration in the vertebrochondral region?
Ribs: anterior rotation
Facets: postero-medial-superior glide
Describe the movement occurring during SB in the vertebrochondral region when the apex is within the thorax
vertebrae SF in the opposite direction below the apex of the curve
Describe the movement occurring during SB in the vertebrochondral region when the apex is below the thorax
vertebrae SF in the same direction and continue to SF once they’re compressed and stop moving
What occurs during rotation in the vertebrochondral region?
neither facets nor ribs dictate a coupling of SF when rotation is induced
What is the most flexible region in the thorax?
T11/T12
Describe the vertebra of T12
- inferior articular facets resemble the lumbar region
- superior facets are like the thoracic
Describe the flexion motion in the thoracolumbar region
- anterior sagittal rotation and translation of superior vertebra
- facets glide superior/anteriorly
- ribs spin on vertebrae (CVJ)
Describe the extension motion in the thoracolumbar region
- posterior sagittal rotation and translation of superior vertebra
- facets glide inferiorly/posteriorly
- ribs spin on vertebrae (CVJ)
What kind of SF and Rotation occurs at the thoracolumbar region?
Pure SF and ROT- no coupling
Describe the mechanics that occur during inspiration
Diaphragm descends–> rib cage expands
- volume increases, pressure decreases
Describe the mechanics that occur during expiration
Diaphragm relaxes–> rib cage contracts
- volume decreases, pressure increases
Describe the costal cage motion during rib elevation
- anterosuperior movement of sternum
- torsion of costal cartilages
What is pump handle motion and where does it occur?
- T1-T6
- anterior rib elevation
- increase in AP diameter
What is bucket handle motion and where does it occur?
- T7-T10
- lateral rib elevation
- increase in transverse diameter
What is calliper motion and where does it occur?
- T11-T12
- ER/IR rotation
describe the motion of the ribs during thoracic rotation
- IL posterior rotation
- CL anterior rotation
What muscles are the local stabilizers of the thorax?
- rotatores thoracis
- deep multifidus (3 layers)
- levator costarum brevis
- levator costarum longus
- internal and external intercostals
What are the local stabilizers at the trunk?
- TA
- diaphragm
- pelvic floor
- multifidus
What are the global stabilizers responsible for flexion control at the posterior thorax?
- semispinalis thoracic
- Spinalis thoracis
- superficial multifidus
What are the global stabilizers responsible for rotation control at the posterior thorax?
- semispinalis thoracic
2. Spinalis thoracis
What are the global stabilizers of the anterior trunk?
- oblique abdominals (rotation, extension, and lateral flexion control)
- internal oblique
- External oblique
What are the global mobilizers of the thorax?
- Erector spinae –> more active under high loads, can become overactive during low threshold, low load tasks
- iliocostalis thoracis
- iliocostalis lumborum
- longissimus thoracis - rectus abdominus–> flexion and posterior pelvic tilt
- QL (overdominance leads to SB restriction on CL side)
- Lats
Describes what occurs during respiratory rib dysfunction
- restriction in excursion of rib with respiration
- painless
- no palpable asymmetry in rib position
- primarily a soft tissue restriction
Describes what occurs during structural rib dysfunction
- traumatic
- painful
- asymmetry of rib position
- hypertonus and TTP
- Rib torsions: secondary to segmental dysfunction at Z joint
What is external rib torsion associated with:
ERS lesion of segment above
what is internal rib torsion associated with:
FRS lesion of superior vertebral segment
