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OCS - Current Concepts of Ortho PT > Thoracic Spine and Rib Cage > Flashcards

Thoracic Spine and Rib Cage Flashcards

1
Q

What is STarT Back Screening Tool used for?

A

Determine risk of pain becoming chronic

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2
Q

T/F: STarT Back Screening Tool is validated for thoracic back pain

A

False, it’s been extensively researched for LBP

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3
Q

T/F: body mass index is associated with higher risk of thoracic spine pain in men/women

A

False

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4
Q

Risk factors for thoracic back pain

A

Male, >50 y/o, tall, frequent/sustained fwd trunk bending (>2hrs/day), unable to change position @ work, driving >4hrs/day

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5
Q

Vertebrae lined up with root (medial triangle) of the spine of the scapula

A

T3 spinous process

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6
Q

Vertebrae lined up with inferior angle of the scapula (IAS)

A

T7 spinous process

NOTE: one study found T8, can vary based on the individual

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7
Q

Rule of 3’s (spinous process vs transverse process)

A

T1-T3 = same
T4-T6 = 1/2 vertebral height below
T7-T9 = 1 full below
T10-T12 = same

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8
Q

Geelhoed’s rule vs Rule of 3’s?

A

Geelhoed’s rule > Rule of 3’s

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9
Q

Geelhoed’s rule

A

Spinous processes of ALL t-vertebrae are located in TRANSVERSE plane w/ transverse processes of adjacent caudal vertebra

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10
Q

True ribs

A

Ribs 1-7

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11
Q

False ribs

A

Ribs 8-12

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12
Q

Floating ribs

A

Ribs 11-12

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13
Q

Joint where rib and vertebral body connect

A

Costovertebral joint (has sup/inf demi-facets)

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14
Q

Joint where rib and transverse process connect

A

Costotransverse joint

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15
Q

Typical ribs

A

Ribs 3-9

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16
Q

Atypical ribs

A

Ribs 1, 10-12th

NOTE: rib 2 attaches to T1-T2 but considered atypical because fo the attachment to the junction of the manubrium/sternum

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17
Q

T/F: ribs have an attachment to the thoracic disk

A

True, typical ribs (3-9) have a crest that attaches

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18
Q

Movement of upper vs lower ribs during inspiration (movement and in what plane)

A

Upper = rises (flexes) in sagittal plane
Lower = widen (abduct) in frontal plane

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19
Q

Ligaments/structures limiting: spinal flexion

A
  • Ligamentum nuchae
  • Interspinous and supraspinous ligaments
  • Ligamentum flava
  • Posterior longitudinal ligament
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20
Q

Ligaments/structures limiting: spinal extension

A
  • Anterior longitudinal ligament
  • Anterior annulus fibrosus
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21
Q

Ligaments/structures limiting: spinal side-bending

A
  • Intertransverse ligaments
  • Contralateral annulus fibrosus
  • Facet joint capsules
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22
Q

Ligaments reinforcing costovertebral joint

A

Radiate & capsular ligaments

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23
Q

Ligaments reinforcing costrotransverse joint

A

Costrotransverse & superior constotransverse ligaments

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24
Q

Traps assist with coupling motion of the scapula including _____

A

Upward rotation and posterior tipping (during elevation of humerus)

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25
Q

Spinal extensor weakness/reduced muscular density has been associated with?

A

Thoracic hyperkyphosis, osteoporosis, decreased quality of life, and increased risk of falling in older adults

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26
Q

Serratus Anterior assists with coupling motion of the scapula including _____

A

Protraction and Upward rotation and posterior tipping (during elevation of humerus)

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27
Q

3 attachments of origin of the pec major

A

Clavicle, sternum, costal cartilages of ribs 1-6

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28
Q

Portion of pec major that can help with GH flexion

A

Clavicular portion (works in conjunction with coracobrachialis and anterior deltoid)

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29
Q

Pec minor attaches to which ribs?

A

Ribs 3-5th

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30
Q

Shortening or hypertonicity of pec minor can cause what motion(s) of the scapula?

A

Protraction & anterior tipping

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31
Q

What cervical segments do the anterior, middle, and posterior scalenes attach?

A

Ant: C3-C6
Middle: C2-C7
Post: C4-C6

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32
Q

Scalene(s) that attach to the 1st rib

A

Anterior and middle

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33
Q

Scalene(s) that attach to the 2nd rib

A

Posterior

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34
Q

3 portions of the diaphragm

A

Sternal (back of xiphoid process), costal (internal coastal cartilages lower 6 ribs), lumbar (first 2-3 lumbar vertebrae)

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35
Q

Do the thoracic spinal nerves exit above or below its respective segment?

A

Below

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35
Q

Which muscles contribute to transverseospinalis

A
  1. Rotatores
  2. Multifidus
  3. Semispinalis
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36
Q

Thoracic posterior rami: Medial branch of UPPER 6 segments innervates

A

Semispinalis and multifidus muscles, skin of the upper back

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37
Q

Thoracic posterior rami: Medial branch of LOWER 6 segments innervates

A

Transversospinalis & longissimus

NOTE: eventually becomes cutaneous

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37
Q

Thoracic posterior rami medial branch has ascending/descending branches to which structures?

A

Facet joints (above & below)

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38
Q

Thoracic posterior rami lateral branch innervates

A

Longissimus and iliocostalis muscles and constotransverse joints

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39
Q

Thoracic anterior rami become which nerves?

A

Intercostal nerves

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40
Q

12th anterior rami forms which nerve?

A

Subcostal nerve

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41
Q

Which nerves innervate the abs?

A

Terminal branches of the anterior rami of spinal nerves (aka intercostals) T7-T11 & subcostal nerve (T12)

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42
Q

T/F: The superior part of the first intercostal (T1) forms part of the brachial plexus?

A

True

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43
Q

Which nerve originates from the 2nd intercostal nerve?

A

Intercostobrachial nerve (lateral cutaneous branch)

Responsible for: sensation to floor of axilla

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44
Q

Sinuvertebral nerve (aka Luschka nerve) is sensation for

A

Supplies dura, disck, medial aspect of facet joints, and PLL

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45
Q

What is the “critical zone” of the t-spine and importance

A

T4-T9; narrowest part of spinal canal

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46
Q

T4 syndrome

A

Paresthesias (can be “stocking glove”), numbness, neck and/or UE pains associated with/without HA and upper back stiffness.

In addition, no hard neurological signs are present.

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47
Q

T/F: There are several studies reporting the symptom referral pattern for thoracic disc pathology

A

False, there are no studies

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48
Q

Motion in the thoracic sagittal plane is what

A

Flexion/extension

NOTE: Increased ROM caudally

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49
Q

Thoracic forward flexion causes superior vertebra to move _____?

A

Translates fwd (transverse plane), rotates fwd (sagittal plane)

NOTE: rib forwardly rotates (hypothesis)

50
Q

Thoracic extension causes superior vertebra to move _____?

A

Posterior translation (transverse plane), rotates posteriorly (sagittal plane)

NOTE: rib rotates posteriorly (hypothesis)

51
Q

Thoracic side-bending causes superior vertebra to move _____?

A

Small ipsilateral lateral translation (horizontal plane)

52
Q

Right side-bending causes which motion of superior vertebra inferior facets (R & L)?

A

R inf facet glides: inferolaterally
L inf facet: glides superomedially

53
Q

Does thoracic rotation cause contralat or ipsilat coupling during side-bending?

A

Neither, lack of agreement in studies

54
Q

Which part of the thoracic spine rotates the most?

A

Upper segments, significantly reduced in lower

NOTE: one study found middle was most (T4-T8)

55
Q

Upper ribs (1-7) move in which motion during inspiration?

A

Pump-handle (anterior ribs rise)

56
Q

Lower ribs (8-10) move in which motion during inspiration?

A

Bucket handle (ribs move laterally and superiorly)

57
Q

Floating ribs (11-12) move in which motion during inspiration?

A

Caliper motion (posterior and lateral during inspiration)

58
Q

Which part of the thoracic spinal cord segment is reported to be a tension point?

A

T6 region

59
Q

Flexion movement impairments:
- Inability to do what?
- Common region
- Etiology

A
  • Inability of the spinal unit to rotate forward in the sagittal plane
  • Upper to middle
  • Rear-impact collision (whiplash-type)
60
Q

Extension movement impairments:
- Inability to do what?
- Common region
- Etiology

A
  • Inability of the spinal unit to rotate backward in the sagittal plane
  • Upper t-spine/CT junction, can be lower
  • Age related changes (wedging, DDD)
61
Q

A unilat thoracic spine flexion impairment could be evident during combined motion testing involving:

A

Flexion, contralateral rotation, contralateral side-bending

62
Q

A unilat thoracic spine extension impairment could be evident during combined motion testing involving:

A

Extension, ipsilateral rotation, ipsilateral side-bending

63
Q

T/F: Thoracic spine limitations is associated with decreased quality of life and increased risk of falling.

A

True

64
Q

Cause of 1st rib elevation

A

Exact mechanism unknown, plausible by soft tissue tension as opposed to jt subluxation

65
Q

Primary thoracic spine pain makes up what % of spinal pain and more common in which sex?

A

15%, more common in women

66
Q

Common visceral conditions that cause thoracic pain

A

MI, dissecting thoracic AA, peptic ulcer, acute cholecystitis, renal colic, and acute pyelonephritis

67
Q

Majority of visceral organs are innervated by what?

A

Thoracic spinal nerves

68
Q

Condition with symptoms: Chest pain with radiation into t-spine, sudden onset, unrelenting, unrelieved by position changes

A

Dissecting thoracic aneurysm

69
Q

Symptoms of peptic ulcer

A

“Boring” type pain in epigastric region, triggered or relieved by eating

70
Q

Symptoms of cholecystitis

A

Right upper quadrant and infrascapular pain, moderate fever, N&V, occur 1-2hrs post ingestion of heavy meal

71
Q

Murphy’s test

A

For cholecystitis
- Inhale & hold a deep breath while palpating the right subcostal area (under ribs)

72
Q

Referral of pain to what region with pacreatitis

A

TL junction

73
Q

Referral of pain to what region with pyelonephritis and renal stones

A

Costovertebral angle or flank area

  • Typically accompanied by fever, N&V, renal colic
74
Q

What is renal colic?

A

Flank pain accompanied by lower abdominal pain and spreds into the labia or testicles

75
Q

What risk factor has the highest probability of thoracic spine cancer?

A

Hx of cancer

76
Q

Cancers that commonly spread to the thoracic spine

A

Breast, lung, colon

77
Q

Predictor variables for ankylosing spondylitis

A
  • AM stiffness >30 mins
  • Less back pain with exercise but not rest
  • Waking up at night (SECOND half only)
  • Alternating buttock pain

2 + = Sen 0.7/Spec 0.81

3+ = Sen 0.33/Spec 0.94

78
Q

What is the key physical exam finding of ankylosing spondylitis

A

Limited chest expansion (<2.5cm, NORM = 5cm)

79
Q

Ankylosing spondylitis risks:
- Sex
- Age
- Gene involvement

A
  • Males (3:1)
  • 15-40 y/o
  • HLA-B27 (gene test has high false +)
80
Q

Hallmark sign in cases of spinal infection

A

Fever

81
Q

Risk factors for osteoporosis

A
  • Caucasian
  • Hx of smoking
  • Early menopause
  • Thin
  • Sedentary lifestyle
  • Steroid tx
  • Excessive consumption of caffeine or alcohol
82
Q

Effectiveness of vertebroplasty

A

No significant difference in pain, function, disability

83
Q

What imaging is recommended where cancer or infection of the thoracic spine region is suspected

A

MRI and bone scan

84
Q

RED flag items for cancer

A
  • Personal/family hx of cancer
  • Significant unexplained weight loss
  • Unrelenting night pain
  • Hx smoking
  • > 50 y/o
85
Q

RED flag items for infection

A
  • Fever
  • Chills
  • Night sweats
  • Recent infection (i.e. pneumonia)
  • IV therapy or drug use
  • Recent surgery
86
Q
  • RED flags for visceral or GI disorders
A
  • Bowel/bladder dysfunction
  • Abdominal pain
  • Reflux
  • Excessive NSAID use
  • Alcohol abuse
87
Q

RED flags for cardiopulmonary issues

A
  • Chest pain or SOB w/ physical exertion
  • Personal/family hx of cardiovascular disease
  • Thoracic/chest wall pain that is throbbing or pulsatile
88
Q

Association between abnormal posture (using CT) and pain

A

No association

89
Q

Example of Symptom Modification Procedure (SMP)

A

Using tape on thoracic back pain patient, symptoms eased can guide tx

90
Q

Hyperkyphosis of thoracic spine is said to be a Cobb angle of what?

A

> 50° on lateral XR

91
Q

Locations of inclinometers for assessing thoracic kyphosis

A

T1-T2 and T12-L1

NOTE: Perform 3x, average numbers, sum of 2 angles is gross measure of kyphosis

92
Q

Validity of Cobb angle vs dual inclinometer

A

Requires further study

93
Q

Reliability for quantification of forward bending and R/L side-bending using inclinometers

A

Moderate reliability

94
Q

Minimal detectable change for thoracic rotation ROM

A

6°

95
Q

T/F: Increases in cervical ROM within a tx session predicts an increase in cervical ROM between tx sessions

A

True

96
Q

What test if negative effectively rules OUT cervical radiculopathy?

A

ULTT A - median nerve

97
Q

Reliability of spinal segmental motion palpation?

A

Poor to fair reliability

98
Q

Best test to assess 1st rib dysfunction

A

Cervical rotation lateral flexion test

+ = limited side-bending

99
Q

Best tx approach for low-medium risk of prolonged thoracic pain

A

Exercise & manual

100
Q

Best tx approach for high risk of prolonged thoracic pain

A

Education, cognitive therapy, exercise interventions to reduce maladaptive movement (breathing etc)

101
Q

Tietze syndrome

A

Unilat pain in specific upper rib PLUS swelling at costosternal region

102
Q

Costochondritis

A

Bilat pain involving multiple ribs and NO swelling

103
Q

Tietze’s syndrome typically affects which ribs

A

2nd-3rd ribs

104
Q

Slipping rib syndrome:
- location of pain
- age

A

Pain in lower chest wall, most common in children and young adults

Cause: irritation of intercostal nerve, 9th to 10th rib

105
Q

Young female athlete, lower chest wall pain, clicking and sharp

A

Slipping rib syndrome

106
Q

Test for slipping rib syndrome

A

Hooking maneuver (hook fingers under lower ribs), + = pain and possible click

NOTE: unknown diagnostic accuracy

107
Q

Rehab for older adults w/ thoracic pain

A

Exercise programs: spinal extensor musculature strengthening, upper/lower quarter stretching, postural awareness, balance, t-spine mobs

108
Q

When dealing with rib pain, which manual therapy tx should come first: thoracic or rib

A

Typically thoracic as ribs tend to be highly irritable

109
Q

Osteoporosis t-score

A

-2.5 or more SD below reference standard

110
Q

Osteopenia t-score

A

-1 to -2.5 or more SD below reference standard

111
Q

You can manipulate a single segment

A

Manips likely produce forces to the REGION as opposed to specific segment

112
Q

T/F: manips in the opposite or pain-free direction often leads to a decrease in pain and restoration of movement

A

True

113
Q

Movement impairments of the middle and lower thoracic spine can be associated with which muscle inhibition?

A

Lower traps

114
Q

What is the TLS test?

A

Timed loaded standing test for osteoporosis, holding 2# dumbbells at 90° flexion, assesses extensor endurance

115
Q

When should patient perform exercises when in conjunction with manual therapy?

A

Immediately afterwards working into movement previously restricted or painful ROM

116
Q

Purpose of barrel-hug stretch

A

Improve or maintain thoracic flexion in upper/middle t-spine

117
Q

Evidence for use of t-spine manips in treating shoulder pain

A

Conflicting evidence

118
Q

Evidence for use of t-spine manips in treating cervical pain

A

Positive results, no technique is superior to another

119
Q

T/F Majority of primary t-spine pain is specific?

A

False, primarily non-specific in pathobiological diagnosis

120
Q

Chest wall pain patients can benefit from what type of treatment

A

Targeted rehab involving exercise and manual therapy

121
Q

Which ribs can be implicated in posterior shoulder girdle and supraclavicular pain

A

1st-2nd ribs

122
Q

Which functional outcome measure is best for thoracic dysfunction?

A

Unknown, research validated outcome measures are lacking

Can use: upper t-spine (NDI), lower t-spine (Mod oswestry), PSFS, NPRS, TLS test

123
Q

Pain around T6 and also pain with deep inhalation.. Think what visceral pathology to rule out

A

Cholecystitis

124
Q
A

OCS - Current Concepts of Ortho PT (12 decks)

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