Thoracic Spine and Cervical Spine Flashcards
How many thoracic spine vertebrae are there?
12
What area does the thoracic spine cover?
area that has ribs
What is the costovertebral joint?
ribs + vertebrae
Facet joints are in between…
each vertebrae
Name the deep muscles of the thoracic spine.
erector spine runs from iliac crest to cervical spine
Name the intermediate muscles of the thoracic spine.
- serratus (anterior and posterior)
- rhomboid
Name the superficial muscles of the thoracic spine.
- trapezius muscle (lower)
- mid trapezius
- latissimus dorsi
What do we ask for history of thoracic spine and rib cage?
pain with breathing
What are the movements of the thoracic spine?
- flexion and extension (fairly limited in tsp)
- lateral flexion (big movement in tsp)
- rotation (big movement in tsp)
Rib fractures and costal cartilage separations occur the most where?
in collision sports
What is the MOI for rib fractures?
generally only occur with a direct blow
What is the MOI for costal cartilage separations?
- can be from direct impact (can be at site or somewhere else and bending)
- violent contraction (could be coughing or sneezing)
Where is the costal cartilage line?
where rib attaches to cartilage and to the sternum
In what area of the ribs are fractures and separations most common? Why is this?
- ribs 5-9 (bottom half)
- tend to have more blows in that area
- generally less protected
What are the signs and symptoms for rib fractures and costal cartilage separations?
- severe pain with breathing
- pain is local to where they have the injury
- point tender from palpation
- crepitis (grinding)
Name a complication from rib fractures and costal cartilage separations.
flail chest
Describe flail chest and why it is potentially dangerous.
- multiple fractures can cause a loose section in rib cage
- compromises breathing
- need to get to hospital (EMS)
- can become life threatening
- shallow respiration, lots of pain
- fractured pieces can float around and damage organs, vessels, and muscles
Why won’t they do surgery for rib fractures or costal cartilage separations?
they don’t want to affect your breathing system
How do we manage rib fractures or costal cartilage separations?
- can’t tape or brace
- can’t help breathing
- round about braces
- like to hug pillows
- up to 6 weeks of doing nothing
Name 3 special tests for rib fractures or costal cartilage separations.
- deep breaths
- rib springing
- crepitis
Describe the deep breath test.
rib fracture would cause pain at the site
Describe rib springing.
- hands on either side of rib cage, push in and let it bounce back
- pain
- only done from the side
Describe the crepitis test.
- feeling for crepitis at the area they have pain
- grinding, clicking, not attached = positive test
Where are rib heads? What can happen to them?
- Rib heads sit on/next to the vertebrae
- Capsule and ligaments that hold them
- Can be sprained/subluxed
Rib head subluxations generally only occur where?
in the back
What is the MOI for rib head subluxations? Give examples.
- typically from violent ROM
- ex. wrestling, football tackles
What are the signs and symptoms of rib head subluxations?
- inch out from the spine, very local pain in the back
- they felt some sort of pop or snap
- will not like breathing deeply
Why could people with rib head subluxations get referred pain?
- can if where rib head is sitting is aggravating a nerve root
- most nerve roots come around the rib cage
What is the comfort position for people with rib head subluxations?
- like to rest back against something (muscles of spine aren’t working)
- like to lie down
What is the special test for rib head subluxations?
no specific special test
How do we manage rib head subluxations?
- Calm down pain
- Calm down inflammation
- Calm down muscle spasm
- Use modalities
- Most go back into place after muscle spasm goes down
- Can do manual therapy if they’re stuck out of place
What is chronic rib head subluxation?
always come out of place
What kind of exercises should people with rib head subluxations (esp. chronic) be doing?
- symmetrical right to left
- Rows
- Bench press
- Lat pull downs
- Breaststroke (in pool or mimicking movement with tube or machine)
Describe facet joints.
- Joints that occur between 2 vertebrae on top of each other throughout the spine
- Vertebrae below has bone coming up from either side
- Vertebrae on top has bone that comes down that meets these 2 bones
- Very specific alignment that determines movement at the area
- *One on top is facing upwards, backwards, out to the side (allows side flexion, rotation, not a lot of flexion and extension)
- has fluid
Facet irritations tend to happen with irritations more in the _____ _______.
thoracic spine
What is happening if you have facet irritations?
Part of capsule (soft tissue) is stuck between 2 pieces of bone
What is the MOI for facet irritations?
- Caused by extreme ROM
- Can be 1 extreme motion or long sustained ROM
- Ex. fell asleep in awkward position
What are the signs and symptoms of facet irritations?
- Extreme pain closer to the spine (1⁄2 inch)
- Muscle spasm and inflammation
- Will not be a pop or snap
- Breathing will not make their pain better or worse
People with facet irritations will like what position and dislike what position?
- like flexion: opens up the joint space, not squishing capsule as much
- do not like leaning backwards
How do we manage facet irritations?
- Decreasing spasm and inflammation typically brings capsule out of the space
- Tend to not become chronic issue
Most problems with posture occurs in the _____ _____.
thoracic spine
Variations in posture can be due to _______ or _______ reasons.
- structural
- functional
What are we looking for in posture from the front?
Looking for nose lining up with sternum lining up with belly button creating a line all the way down to floor right between their feet
What are we looking for in posture from the back?
Straight line down spinous processes then straight line down to floor
What are we looking for in posture from the side?
- Hole in ear lines up with AC joint (top of shoulder)
- AC joint lines up with greater trochanter
- Greater trochanter lines up somewhere along the joint line of the knee
- Lines up with lateral malleolus
Anything falling off the line when looking at posture means…
incorrect posture
What does it mean for posture to be incorrect due to structure?
bones are physically formed that way, can’t fix it
What does it mean for posture to be incorrect due to function?
muscles/activities creating problem, can fix it
Name and describe the 3 normal curvatures to the spine.
- Cervical: lordosis (curve forward)
- Thorasic: kyphosis (curve back)
- Lumbar: lordosis (curve forward)
What are abnormalities in posture?
- Look for everything lining up, something off the line
- Abnormality away from the midline (one of the shoulders/hips higher, one leg turns out on one side etc.)
What is righting reflex?
- You have no control over it
- Regardless of what is going on in your body, everything will do what it can for the eyes to be level with horizon
- To create easiest image for your brain to interpret
What 5 postural deviations can be seen from the side?
- kyphosis
- forward head
- flatback
- swayback
- lordosis
Describe kyphosis.
- excessive hunch back
- bigger hump in tsp than you would expect
Describe forward head.
- can occur by itself or with kyphosis
- most common due to computers
- sitting in a car
Describe flatback.
- Decreased lordosis curve in lumbar
- Line goes through greater trochanter
Describe swayback.
- Lumbar curve exists but whole pelvis is moved forward
- Line does not go through greater trochanter
Describe lordosis.
- Excessive lordosis
- Can also have pelvis forward, head forward, kyphosis
What is scoliosis?
- spine is curving
- C curve: one curve that comes through the spine
- S curve: 2 curves that come through the spine
Why is scoliosis generally very damaging?
- Ribs on the side pushed out will also push out further (protruding out the back), ribs on the other side will look sunken or flat
- Muscles or internal organs will contract/lengthen according to how much space they have
For scoliosis, the ______ the deviation, the _______ the problem.
bigger, bigger
Where does scoliosis happen?
- can happen only in csp, only in tsp, or only in lsp
- can see ribs higher on one side by up to 2-3 inches
Scoliosis can be either ______ or _______.
functional or structural
Which type of scoliosis is more violent, can’t fix it?
structural
What do we do for people with structural scoliosis?
- try to create best scenario possible for them
- Give them symmetrical exercises
- Ex. gymnastics
- Swimming
- Body building
What do they do in extreme cases for people with structural scoliosis?
break their spine and put rods in them (limited in everything they can do)
How does functional scoliosis develop? Give an example.
- muscle tissue on one side is very developed while the other side is not developed at all
- ex. fencing
What does whiplash consist of? Which comes first?
- sprains and strains
- sprains first, strains second (muscles have more ROM)
What are the 2 types of collars for whiplash?
- hard collars: support head more
- soft collars: keep muscles warm
Describe torticollis.
- facet joint irritation
- head stuck to the side
- stayed in position too long
- ex. Air plane ride
How do we manage torticollis?
calm down muscle spasm
What is the one sport that burners are most common in?
football
Describe burner/brachial plexus neuroplaxia.
- stretched brachial plexus
- muscles go into spasm
- pins and needles in neck and down arm
- can become permanent if always having burners
Impact to where results in the worst injury?
- top of the head
- blowout fracture of C1 and C2
What are some of the rule changes made to avoid damaging injury?
- football: no leading with the head
- hockey: no hits from behind
What is the special test for csp?
- myotomes and dermatomes
- resisted ROM will show strains
