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PTRS 845 Final > Thoracic Spine and Rib Cage [Guest Lecture] > Flashcards

Thoracic Spine and Rib Cage [Guest Lecture] Flashcards

1
Q

Describe the rule of 3

A

T1-3: TP at same level as spinous process

T4-6: TP 1/2 level above spinous process

T7-9: TP 1 level above spinous process

T10-12: TP at same level as spinous process

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2
Q

Describe the shape of the thoracic vertebrae

A

The AP and Transverse dimensions of the bodies are a uniform ratio

The body is slightly higher posteriorly

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3
Q

Describe the ratio of disk height to vertebral body through the spine and what this can implicate

A

C: 2:5 (largest)

T: 1:5 (smallest)

L: 1:3 (close 2nd largest)

A bulging disc is more likely to occur in a larger disc, thus bulges are less common in the T-spine

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4
Q

Describe the impact of dysfunctional T-spine muscles

A

If the origin within the T-spine is moving (i.e. mm attached to instable TP) then less force can be produced by the mm

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5
Q

Describe the critical zone

A

From T4-9 where the spinal canal is narrowed, which is supplied by only the anterior spinal artery — recall T6 = tension point

Area more prone to disc herniation and injury

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6
Q

Condition: Sudden chest pain, radiationg to back that is unrelenting (emergency situation)

A

Dissecting thoracic aneurism

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7
Q

List the 5 parts of the coronary artery disease CPR

A

F > 65; M > 55

Known vascular disease

Pain worse during exercise

Pain not reproduced w/palpation

Pt. feels that it is cardiac in nature

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8
Q

Condition: boring pain to mid T-spine after eating

A

Peptic Ulcer

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9
Q

Condition:

  • Hx of cancer
  • 50+ yo
  • Failure of conservative tx
  • Unexplained wt loss
A

Cancer

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10
Q

Condition:

  • Stiffness > 30 min
  • Back pain improved w/exercise NOT rest
  • Awakening during 2nd half of night due to back pain
  • Alternating butt pain
  • Less than 2.5 cm of chest expansion
A

Ankylosing Spondylitis

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11
Q

Describe the motion of the ribs with flexion

A
  • Superior vertebral body anteriorly translates and rotates
  • Posterior rib translates superior
  • Anterior rib translates inferior
  • Anterior rotation of rib

Opposite for EXTENSION

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12
Q

Describe the motion of the ribs with rotation

A
  • Ipsilateral rib translates inferior, rotates posterior
  • Contralateral rib translates superior, rotates anterior
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13
Q

Describe the motion of the ribs with side bending

A
  • Ipsilateral rib moves inferior and rotates posterior
  • Ipsilateral facet extends, glides inferiolaterally
  • Contralateral rib moves superior and rotates anterior
  • Contralateral facet flexes, glides anteriomedially
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14
Q

Describe the amount of flex/ext, SB, and rotation in the upper vs. lower T-spine

A

Flex/Ext = motion increases as you move down the T-spine

SB = limited in upper, increased in lower segments

Rot = greatest in upper, significantly reduced in lower

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15
Q

Describe the 3 types of rib motion with respiration

A

Rib 1-6 = pump handle motion

Rib 7-10 = bucket handle motion

Rib 11&12 = caliper motion

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16
Q

Descirbe coupled motion throughout the T-spine

A

C7-T2 = SAME

T11-L1 = OPPOSITE

Mid = variable, follows which region it is closest to

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17
Q

Describe what occurs in T2-7 with full elevation of the arm

A

Extension, rotaiton, and SB of the segments to the ipsilateral side

18
Q

Condition:

  • Stiffness
  • Headache
  • Neck pain
  • UE pain
  • B “stocking glove” paresthesias
A

T4 Syndrome

19
Q

Condition:

  • Upper T-spin (T3-7)
  • Flat or Reduced thoracic kyphosis
A

Flexion movement impairment

20
Q

Condition:

  • C/T junction or high T-spine segments
  • Excessive kyphosis
  • vertebral bodies may become wedge shaped
A

Extension movement impairment

21
Q

Condition:

  • First rib
  • Limited painful caudal glide
A

Superior subluxation

22
Q

Condition:

  • 50 + yo
  • Kyphotic position
  • Extension activities reduc stress on vertebral body
A

Thoracic Vertebral Fracture

23
Q

Condition:

  • Lateral curve w/o rotational component
  • Can lead to mm spasm, inflammation, injury
  • Can be corrects with position changes
  • Tx underlying cause and it will resolve
A

Functional Scoliosis

24
Q

Condition:

  • Lateral curve w/rotational component
  • Can be congential/idiopathic
  • Can’t be corrected by positioning
  • Can cause wedge shaped vertebra
A

Structural Scoliosis

25
Q

Descrbe Tx for Scoliosis

A

Stretch the concave side of the curve

Strengthen the convex side of the curve

Posture training

Bracing

26
Q

Location: space between clavicle and first rib

A

Thoracic Outlet

27
Q

Condition

  • Ache in neck, shld, arm, or hand
  • N/T on inside of forearm and 4th and 5th fingers esp w/shld flex
  • Weak/clumsy hands
  • Sweeling/redness in arms/hands
  • Difficulty w/OH activities
A

Thoracic outlet syndrome

28
Q

Condition:

  • MOI: increased neural tension, stiff joints, natural posture
  • Stiffness of C/T junction and T3-7
  • Flexion restriction
A

Flattened Upper Thoracic Spine

29
Q

Condition:

  • Middle age +
  • Stiffness at multiple levels
  • Loss of elastic end feel
  • Limited arm elevation
  • Stiff/painful accessory glides
  • Mm imbalance
A

Generalized upper/mid thoracic stiffness

30
Q

Condition: Subjective

  • Bilat parathesia in glove distribution
  • Intermittent posterior thoracic pain or scapula pain
  • Sx worst in evening and with thoracic slump/flexion
  • Position of comfort is laying completely flat
A

T4 Syndrome

31
Q

Condition: Objective

  • Increased cervical lordosis and C/T kyphosis
  • Flattened/restricted upper T-spine
  • Minimal thoracic movement w/single arm elevation
  • Local tenderness and sx reproduced w/mobilization between T2-7
  • Local hypomobility
  • ULTT/Slump +
A

T4 Syndrome

32
Q

Condition:

  • Reduced costal mobility (rotation)
  • Agg: twist or reach
  • Pain: breathing, trunk rot, unilateral PA over C/T junction
  • Pain and stiffness w/rib mobility
A

Costal Joint Derangement

33
Q

Condition:

  • MOI: Chronic neck pain, poor posture, tight scalenes
  • May cause thoracic outlet syndrome
  • Limited end range cervical rotation and shld flex
A

Elevated 1st Rib

34
Q

Describe how you test for an elevated 1st Rib

A

Stabilize 1st rib

Rotate head to contralateral side

SB to ipsilateral side

+ = pain at rib, decreased ROM, firm end feel

35
Q

Condition:

  • Localized pain
  • Reduced motion w/respiration, coughing, and sneezing
  • Local mm spasm
A

Rib subluxation

Anterior = concavity of rib posteriorly

Posterior = prominence of rib posteriorly

36
Q

Condition:

  • Pain isolated to upper back or radiate in dermatomal pattern
  • Pain shooting around or through chest wall
  • Possible sensory deficits and neurological weakness
  • Agg: movement, deep breathing, cough/sneeze
A

Thoracic Disc Lesion

37
Q

Condition: Localized irriation of costosternal joint/2nd rib

A

Costochondritis

38
Q

Condition:

  • Swelling of costal cartilages
  • Anterior chest pain, loacilzed and superficial
  • Agg: breathing and trunk movement
  • Usually resolves in 12 wks
A

Tietze’s Syndrome

39
Q

Condition:

  • Pain
  • Limited chest excursion
  • Limited spinal mobility
  • Bone scan +
A

Anklyosing Spondylitis

40
Q

Term: Biconcave appearance of vertebra

A

Fish Vertebrae

41
Q

Condition: wedging of multiple vertebral bodies

A

Scheuermann’s Disease

42
Q

Condition: Small herniation of disc material into the endplate of vertebral bodies

A

Schmoral’s nodes

PTRS 845 Final (11 decks)

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