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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
The sympathetic chain ganglion are __________ in function and run from___-___
Autonomic | T1- L2
26
What is a motion segment?
2 adjacent vertebrae and an intervertebral disc
27
How many joints are in a motion segment?
``` 2 facets 1 symphyseal (disc) ```
28
What serves as the functional unit for the spine?
Motion segments
29
What are the 2 main components of the intervertebral discs?
Annulus fibrosis | Nucleus pulposis
30
What percentage of force does the intervertebral disc attenuate?
60%
31
Which forces are intervertebral discs resistant to? Which are the worst?
Torsion Tension Shear Compression Torsion and Tension are the worst
32
The IV disc works it's best when Internal pressure (>/=/
=
33
In the IV discs, how much height is lost during the day?
2 cm
34
In the IV discs, what percentage of height is lost within the first 30 minutes of waking up?
54%
35
When is there the highest risk of IV disc injury?
Morning
36
Which position will allow for the rehydration of the anterior disc?
Hyper extension/ prone
37
Which position will allow for the rehydration of the posterior disc?
Flexion (Supine)
38
Blood supplies disc up to __________ then reliant on passive mechanical means
8 years of age
39
Where is the optimal Zone of Load for an IV disc?
Where the load is most stable and neutral
40
How many degrees off flexion are available in the thoracic spine?
45-50
41
How many degrees off extension are available in the thoracic spine?
5-10
42
How many degrees off lateral flexion are available in the thoracic spine?
40.
43
How many degrees off rotation are available in the thoracic spine?
20
44
What percentage of weight do facet joints bear?
40%
45
What percent do facet joints limit motion?
40%
46
If I abduct my arm, my lower thoracic vertebrae will...
Side bend
47
If I move my arm, my upper thoracic vertebrae will ...
Rotate toward the arm
48
If i bilaterally flex my arms, my lower thoracic spine will...
Extend
49
For the sake of arthrokinematics, in the thoracic spine, the superior vertebra behaves ______ while the inferior vertebra behaves ______
Superior- concave | Inferior- convex
50
What is fryette's first rule?
⦿ When the vertebrae are idling in neutral (ie., facets are unloaded), side bending is associated with contralateral rotation
51
Where does fryette's first rule occur?
⦿ Occurs in the thoracic and lumbar spine; upper cervical (O-A-A) in all conditions
52
What is Fryette's second rule?
When the vertebrae are in a non-neutral position (i.e. flexion or extension), side bending is associated with ipsilateral rotation.
53
Where does Fryette's second rule occur?
Occurs in lower cervical spine (C2 –C7),thoracic spine, and lumbar spine
54
True or false; Fryette's first and second rules both occur in the thoracic spine
True
55
What is Fryette's third rule?
When motion is introduced in one plane, other motions are reduced in range
56
What are the normal motion barriers?
Physiologic Elastic Anatomic (Para-physiologic space)
57
Which motion barrier is at the end of AROM?
Physiologic
58
Which motion barrier is at the end of PROM?
Elastic
59
Which motion barrier is at THE END?
Anatomic
60
Where is the para-physiologic space?
Between elastic and anatomic motion barriers
61
_____ is movement toward neutral | _____ is movement toward motion barrier
Ease/ indirect = toward neutral Bind/ direct= toward barrier
62
The ___________ barrier is indicative of somatic dys- function (impairment)
Restrictive
63
A _______ Motion Loss is present when 50% or more of the range is restricted.
MAJOR
64
(Major/ Minor) Motion Losses are present in neutral ?
Major
65
A _______ Motion Loss is present when less than 50% of the range is restricted.
MINOR
66
A minor motion loss will present as _________ in neutral and _________ away from neutral
Symmetrical in neutral | Asymmetrical away
67
True or false; Type I and Type II dysfunctions are not always pathological and can be normal
False- they're never normal
68
Which Type of Vertebral Dysfunction impacts 3+ vertebrae?
I
69
Which Type of Vertebral Dysfunction impacts 1 segment?
II
70
Which Type of Vertebral Dysfunction is found in neutral spinal position?
I
71
Which Type of Vertebral Dysfunction is found in non-normal spinal position?
II
72
Which Type of Vertebral Dysfunction can be adaptive or compensatory?
I
73
True or false; Adaptive Type I dysfunction is chronic
False Adaptive is acute Compensatory is chronic
74
Which Type of Vertebral Dysfunction is traumatically induced?
II
75
Which Type of Vertebral Dysfunction is accompanied by myofascial dysfunction?
I
76
Which Type of Vertebral Dysfunction is accompanied by articular dysfunction?
II
77
Which Type of Vertebral Dysfunction is symptomatic?
II
78
Which Type of Vertebral Dysfunction is asymptomatic?
I
79
True or false; A Type II Vertebral dysfunction may cause a Type I Dysfunction above or below it.
True
80
What is the osteokinematic position of FRS right?
Flexed Rotated Side bent right
81
What is the osteokinematic restriction of FRS right?
Extension Side bent Rotated left
82
What is the arthrokinematic position of FRS right?
Left facet is open
83
What is the arthrokinematic restriction of FRS right?
Left facet can't close
84
What is the osteokinematic position of ERS left?
Extended Rotated Side bent left
85
What is the osteokinematic restriction of ERS left?
Flexion Rotation Side bending right
86
What is the arthrokinematic position of ERS left?
Left facet is closed
87
What is the arthrokinematic restriction of ERS left?
Left facet can't open
88
What is the quality of a normal spinal motion dysfunction assessment?
Smooth/ unrestricted
89
What is the quantity used in assessing spinal motion dysfunction?
0-6 | 3 is normal
90
What are the possible end feeds in a spinal motion dysfunction assessment?
Normal, loose, or stiff
91
What are the reactivities that could be found in a spinal motion dysfunction assessment?
Low, moderate, or high
92
What is hyper-kyphosis?
◼ Sagital plane deviation ◼ > 50° (40-49° is borderline) ◼ Risk of compression frx
93
What is scoliosis?
``` ◼ Coronal plane deviation • Functional-external cause • Structural-internal cause • Idiopathic-unknown cause ◼ Named at apex/convexity ```
94
True or false; a spinal muscle sprain will result in a capsular pattern.
False- noncapsular
95
What is a spinal muscle sprain or strain? How do you test for it?
``` ⦿ Micro-trauma due to tissue elongation ⦿ Multitude of structures and layers ⦿ Clinical Tests (Pain) - Passive lengthening - Resisted muscle effort ```
96
What is the capsular pattern of the thoracic spine? When would you spect to see it?
Side bending and rotation > extension Osteoarthritis of the facet joints
97
What is spondylitis?
``` ◼ Degeneration along vertebral body margins ◼ Schmorl’s nodes ◼ Disc degeneration ◼ Spinal canal stenosis **noncapsular ```
98
What are the symptoms of disc derangement? Is that what it probably is?
⦿ Rare <1% ⦿ Traumatic/Degenerative ⦿ Intercostal Neuralgia ⦿ Painful respiration
99
What are the 4 stages of disc herniation?
Degeneration Prolapse Extrusion Sequestration
100
Tell me about T4 syndrome
``` ⦿ Unknown etiology ⦿ Generalized headache ⦿ Autonomic involvement ⦿ UE pain/paraesthesia -Non-dermatomal ⦿ Clinical Tests -T4 PPIVMs/PAIVMs (+) ```
101
What are the syndromes associated with thoracic outlet syndrome?
Costoclavicular syndrome | Hyper-abduction syndrome
102
Which muscle causes hyper-abduction syndrome?
Pec minor
103
What is thoracic outlet syndrome?
Neurovascular entrapment - gradual onset - progressive - it is a compression
104
Tell me about ankylosing spondylitis
``` ⦿ “Bamboo” Spine ⦿ Spondarthropathy -seronegative ⦿ Inflammation -Muscles and ligaments -Bone erosion ⦿ Pathologic fusion ⦿ Pulmonary complication ```
105
Tell me about herpes zoster
``` ⦿ “Shingles” ⦿ Viral ⦿ Pain/skin lesions along nerve’s course ⦿ Contagious if no immunity to virus ``` **IMMEDIATE MEDICAL REFERRAL
106
What are the 5 different types of fractures?
``` Compression Axial burst Flexion/ distraction Transverse process (rotation) Fracture- dislocation ```
107
My patient is presenting with substernal and mid-thoracic pain, increased pain with exertion, left shoulder/medial arm/jaw pain. What could it be?
Cardiac
108
My patient is presenting with dull/aching ipsilateral subcostal/costovertebral pain at T10-T12, urinary frequency/output changes. What could it be?
Renal
109
My patient is presenting with localized pain with deep inspiration or coughing. What could it be?
Pulmonary
110
My patient is presenting with mid thoracic pain and is complaining it hurts to swallow. What could this be?
Esophageal
111
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?
Gall bladder
112
My patient is presenting with right upper abdomen/right subscapular and interscapular pain/right shoulder pain. What could this be?
Hepatobiliary

Manual II (11 decks)

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