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Manual II > Thoracic Spine > Flashcards

Thoracic Spine Flashcards

1
Q

What is the coronal facet orientation of the thoracic vertebrae?

A

60 degrees

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2
Q

Which thoracic vertebrae are atypical and why?

A

T1 and t12, because they have unifaceted ribs

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3
Q

Which ribs are unifacets and which are demifacets? What does it mean?

A

Uni- articulates with one vertebra (T1 and T12)

Demi- 2 vertebrae (T2-T11)

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4
Q

Which thoracic spine segments have their spinous processes and transverse processes at the same level?

A

T1- T3

T12

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5
Q

Which thoracic spine segments have their spinous processes 1/2 level below their transverse processes?

A

T4-T6

T11

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6
Q

Which thoracic spine segments have their spinous processes 1 full level below their transverse processes?

A

T7-T10

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7
Q

Anterior Longitudinal ligament

A

◼ Anterior bodies/discs
◼ Restrains extension
◼ Occiput to sacrum

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8
Q

Posterior Longitudinal ligament

A

◼ Posterior bodies/discs
◼ Restrains flexion
◼ C2 to sacrum

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9
Q

Supraspinous ligament

A

◼ Spinous processes
◼ C7 to L3-4
◼ Restrains flexion

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10
Q

Interspinous ligament

A

◼Spinous processes
◼ C7 to L3-4
◼ Restrains flexion
◼ Anchors T-L fascia

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11
Q

Ligamentum Flavum

A

◼ C2 to sacrum along posterior canal
◼ 80% Elastin “yellow”
◼ Assists regaining upright position
◼ Attaches to facet anteromedially and prevents impingement

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12
Q

Intertransverse ligaments

A

◼ Transverse processes
◼ C2 to sacrum
◼ Restrains lateral flexion

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13
Q

Costovertebral ligaments connect in which directions?

A

◼ Superior
◼ Lateral
◼ Radiate

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14
Q

Why study the muscles of the thoracic spine?

A

⦿ Diagnostic entity
⦿ Identify primary motion restrictor
⦿ Role in treatment

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15
Q

What are the 3 layers of thoracic spine muscles?

A

Superficial
Intermediate
Deep

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16
Q

What is the difference between unisegmental and polyysegmental muscles?

A

Unisegmental- segment to segment

Polysegmental- segment to 2 or greater segments away

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17
Q

What are the deep thoracic muscles? Which are unisegmental/ polysegmentlal?

A

TRANSVERSOSPINALIS

Uni- rotatores brevis

Poly- Rotatores longus
- Multifidi

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18
Q

Deep thoracic muscles are often responsible for ___________ position of Type ____ spinal dysfunction

A

Maintaining

Type II

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19
Q

What are the intermediate thoracic muscles?

A 
Erector Spinae
◼ Spinalis
◼ Longissimus
◼ Iliocostalis
Other
◼ Serratus Posterior
• Superior 
• Inferior
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20
Q

The erector spinae are often responsible for ___________ position of Type ____ spinal dysfunction

A

Maintaining

Type I

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21
Q

What are the superficial thoracic muscles?

A

Trapezius
Latissimus dorsi
Rhomboids
Pectorals

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22
Q

Which superficial thoracic muscle is most likely to weaken rather than tighten?

A

Rhomboids

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23
Q

Which thoracic superficial muscles are more likely to tighten rather than weaken?

A

Trapezius
Latissimus dorsi
Pectorals

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24
Q

What are the spinal nerves of the thoracic vertebrae?

A

12 pairs, T1-T12

Motor and sensory

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25
Q

The sympathetic chain ganglion are __________ in function and run from___-___

A

Autonomic

T1- L2

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26
Q

What is a motion segment?

A

2 adjacent vertebrae and an intervertebral disc

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27
Q

How many joints are in a motion segment?

A 
2 facets
1 symphyseal (disc)
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28
Q

What serves as the functional unit for the spine?

A

Motion segments

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29
Q

What are the 2 main components of the intervertebral discs?

A

Annulus fibrosis

Nucleus pulposis

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30
Q

What percentage of force does the intervertebral disc attenuate?

A

60%

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31
Q

Which forces are intervertebral discs resistant to? Which are the worst?

A

Torsion
Tension
Shear
Compression

Torsion and Tension are the worst

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32
Q

The IV disc works it’s best when Internal pressure (>/=/

A

=

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33
Q

In the IV discs, how much height is lost during the day?

A

2 cm

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34
Q

In the IV discs, what percentage of height is lost within the first 30 minutes of waking up?

A

54%

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35
Q

When is there the highest risk of IV disc injury?

A

Morning

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36
Q

Which position will allow for the rehydration of the anterior disc?

A

Hyper extension/ prone

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37
Q

Which position will allow for the rehydration of the posterior disc?

A

Flexion (Supine)

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38
Q

Blood supplies disc up to
__________ then
reliant on passive
mechanical means

A

8 years of age

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39
Q

Where is the optimal Zone of Load for an IV disc?

A

Where the load is most stable and neutral

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40
Q

How many degrees off flexion are available in the thoracic spine?

A

45-50

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41
Q

How many degrees off extension are available in the thoracic spine?

A

5-10

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42
Q

How many degrees off lateral flexion are available in the thoracic spine?

A

40.

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43
Q

How many degrees off rotation are available in the thoracic spine?

A

20

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44
Q

What percentage of weight do facet joints bear?

A

40%

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45
Q

What percent do facet joints limit motion?

46
Q

If I abduct my arm, my lower thoracic vertebrae will…

47
Q

If I move my arm, my upper thoracic vertebrae will …

A

Rotate toward the arm

48
Q

If i bilaterally flex my arms, my lower thoracic spine will…

49
Q

For the sake of arthrokinematics, in the thoracic spine, the superior vertebra behaves ______ while the inferior vertebra behaves ______

A

Superior- concave

Inferior- convex

50
Q

What is fryette’s first rule?

A

⦿ When the vertebrae are idling in neutral (ie., facets are unloaded), side bending is associated with contralateral rotation

51
Q

Where does fryette’s first rule occur?

A

⦿ Occurs in the thoracic and lumbar spine; upper cervical (O-A-A) in all conditions

52
Q

What is Fryette’s second rule?

A

When the vertebrae are in a non-neutral position (i.e.
flexion or extension), side
bending is associated with
ipsilateral rotation.

53
Q

Where does Fryette’s second rule occur?

A

Occurs in lower cervical
spine (C2 –C7),thoracic
spine, and lumbar spine

54
Q

True or false; Fryette’s first and second rules both occur in the thoracic spine

55
Q

What is Fryette’s third rule?

A

When motion is
introduced in one plane,
other motions are
reduced in range

56
Q

What are the normal motion barriers?

A

Physiologic
Elastic
Anatomic
(Para-physiologic space)

57
Q

Which motion barrier is at the end of AROM?

A

Physiologic

58
Q

Which motion barrier is at the end of PROM?

59
Q

Which motion barrier is at THE END?

60
Q

Where is the para-physiologic space?

A

Between elastic and anatomic motion barriers

61
Q

_____ is movement toward neutral

_____ is movement toward motion barrier

A

Ease/ indirect = toward neutral

Bind/ direct= toward barrier

62
Q

The ___________ barrier is indicative of somatic dys- function (impairment)

A

Restrictive

63
Q

A _______ Motion Loss is present when 50% or more of the range is restricted.

64
Q

(Major/ Minor) Motion Losses are present in neutral ?

65
Q

A _______ Motion Loss is present when less than 50% of the range is restricted.

66
Q

A minor motion loss will present as _________ in neutral and _________ away from neutral

A

Symmetrical in neutral

Asymmetrical away

67
Q

True or false; Type I and Type II dysfunctions are not always pathological and can be normal

A

False- they’re never normal

68
Q

Which Type of Vertebral Dysfunction impacts 3+ vertebrae?

69
Q

Which Type of Vertebral Dysfunction impacts 1 segment?

70
Q

Which Type of Vertebral Dysfunction is found in neutral spinal position?

71
Q

Which Type of Vertebral Dysfunction is found in non-normal spinal position?

72
Q

Which Type of Vertebral Dysfunction can be adaptive or compensatory?

73
Q

True or false; Adaptive Type I dysfunction is chronic

A

False
Adaptive is acute
Compensatory is chronic

74
Q

Which Type of Vertebral Dysfunction is traumatically induced?

75
Q

Which Type of Vertebral Dysfunction is accompanied by myofascial dysfunction?

76
Q

Which Type of Vertebral Dysfunction is accompanied by articular dysfunction?

77
Q

Which Type of Vertebral Dysfunction is symptomatic?

78
Q

Which Type of Vertebral Dysfunction is asymptomatic?

79
Q

True or false; A Type II Vertebral dysfunction may cause a Type I Dysfunction above or below it.

80
Q

What is the osteokinematic position of FRS right?

A

Flexed
Rotated
Side bent right

81
Q

What is the osteokinematic restriction of FRS right?

A

Extension
Side bent
Rotated left

82
Q

What is the arthrokinematic position of FRS right?

A

Left facet is open

83
Q

What is the arthrokinematic restriction of FRS right?

A

Left facet can’t close

84
Q

What is the osteokinematic position of ERS left?

A

Extended
Rotated
Side bent left

85
Q

What is the osteokinematic restriction of ERS left?

A

Flexion
Rotation
Side bending right

86
Q

What is the arthrokinematic position of ERS left?

A

Left facet is closed

87
Q

What is the arthrokinematic restriction of ERS left?

A

Left facet can’t open

88
Q

What is the quality of a normal spinal motion dysfunction assessment?

A

Smooth/ unrestricted

89
Q

What is the quantity used in assessing spinal motion dysfunction?

A

0-6

3 is normal

90
Q

What are the possible end feeds in a spinal motion dysfunction assessment?

A

Normal, loose, or stiff

91
Q

What are the reactivities that could be found in a spinal motion dysfunction assessment?

A

Low, moderate, or high

92
Q

What is hyper-kyphosis?

A

◼ Sagital plane deviation
◼ > 50° (40-49° is borderline)
◼ Risk of compression frx

93
Q

What is scoliosis?

A 
◼ Coronal plane deviation
• Functional-external cause 
• Structural-internal cause 
• Idiopathic-unknown cause
◼ Named at apex/convexity
94
Q

True or false; a spinal muscle sprain will result in a capsular pattern.

A

False- noncapsular

95
Q

What is a spinal muscle sprain or strain? How do you test for it?

A 
⦿ Micro-trauma due to
tissue elongation 
⦿ Multitude of structures
and layers 
⦿ Clinical Tests (Pain)
- Passive lengthening
- Resisted muscle effort
96
Q

What is the capsular pattern of the thoracic spine? When would you spect to see it?

A

Side bending and rotation > extension

Osteoarthritis of the facet joints

97
Q

What is spondylitis?

A 
◼ Degeneration along
vertebral body margins 
◼ Schmorl’s nodes 
◼ Disc degeneration 
◼ Spinal canal stenosis
**noncapsular
98
Q

What are the symptoms of disc derangement? Is that what it probably is?

A

⦿ Rare <1%
⦿ Traumatic/Degenerative
⦿ Intercostal Neuralgia
⦿ Painful respiration

99
Q

What are the 4 stages of disc herniation?

A

Degeneration
Prolapse
Extrusion
Sequestration

100
Q

Tell me about T4 syndrome

A 
⦿ Unknown etiology 
⦿ Generalized headache 
⦿ Autonomic involvement 
⦿ UE pain/paraesthesia
-Non-dermatomal 
⦿ Clinical Tests
-T4 PPIVMs/PAIVMs (+)
101
Q

What are the syndromes associated with thoracic outlet syndrome?

A

Costoclavicular syndrome

Hyper-abduction syndrome

102
Q

Which muscle causes hyper-abduction syndrome?

103
Q

What is thoracic outlet syndrome?

A

Neurovascular entrapment

  • gradual onset
  • progressive
  • it is a compression
104
Q

Tell me about ankylosing spondylitis

A 
⦿ “Bamboo” Spine 
⦿ Spondarthropathy
-seronegative 
⦿ Inflammation
-Muscles and ligaments
-Bone erosion 
⦿ Pathologic fusion 
⦿ Pulmonary complication
105
Q

Tell me about herpes zoster

A 
⦿ “Shingles” 
⦿ Viral 
⦿ Pain/skin lesions along
nerve’s course 
⦿ Contagious if no immunity to virus

**IMMEDIATE MEDICAL REFERRAL

106
Q

What are the 5 different types of fractures?

A 
Compression
Axial burst
Flexion/ distraction
Transverse process (rotation)
Fracture- dislocation
107
Q

My patient is presenting with substernal and mid-thoracic pain, increased pain with exertion, left shoulder/medial arm/jaw pain. What could it be?

108
Q

My patient is presenting with dull/aching ipsilateral subcostal/costovertebral pain at T10-T12, urinary frequency/output changes. What could it be?

109
Q

My patient is presenting with localized pain with deep inspiration or coughing. What could it be?

110
Q

My patient is presenting with mid thoracic pain and is complaining it hurts to swallow. What could this be?

A

Esophageal

111
Q

My patient is presenting with mid-epigastric/ right shoulder- scapular pain, especially when he eats fatty foods or large quantities of food. What could this be?

A

Gall bladder

112
Q

My patient is presenting with right upper abdomen/right subscapular and interscapular pain/right shoulder pain. What could this be?

A

Hepatobiliary

Manual II (11 decks)

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