Thoracic Spine and Rib Cage [Guest Lecture] Flashcards
Describe the rule of 3
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
Describe the shape of the thoracic vertebrae
The AP and Transverse dimensions of the bodies are a uniform ratio
The body is slightly higher posteriorly
Describe the ratio of disk height to vertebral body through the spine and what this can implicate
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
Describe the impact of dysfunctional T-spine muscles
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
Describe the critical zone
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
Condition: Sudden chest pain, radiationg to back that is unrelenting (emergency situation)
Dissecting thoracic aneurism
List the 5 parts of the coronary artery disease CPR
F > 65; M > 55
Known vascular disease
Pain worse during exercise
Pain not reproduced w/palpation
Pt. feels that it is cardiac in nature
Condition: boring pain to mid T-spine after eating
Peptic Ulcer
Condition:
- Hx of cancer
- 50+ yo
- Failure of conservative tx
- Unexplained wt loss
Cancer
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
Ankylosing Spondylitis
Describe the motion of the ribs with flexion
- Superior vertebral body anteriorly translates and rotates
- Posterior rib translates superior
- Anterior rib translates inferior
- Anterior rotation of rib
Opposite for EXTENSION
Describe the motion of the ribs with rotation
- Ipsilateral rib translates inferior, rotates posterior
- Contralateral rib translates superior, rotates anterior
Describe the motion of the ribs with side bending
- Ipsilateral rib moves inferior and rotates posterior
- Ipsilateral facet extends, glides inferiolaterally
- Contralateral rib moves superior and rotates anterior
- Contralateral facet flexes, glides anteriomedially
Describe the amount of flex/ext, SB, and rotation in the upper vs. lower T-spine
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
Describe the 3 types of rib motion with respiration
Rib 1-6 = pump handle motion
Rib 7-10 = bucket handle motion
Rib 11&12 = caliper motion
Descirbe coupled motion throughout the T-spine
C7-T2 = SAME
T11-L1 = OPPOSITE
Mid = variable, follows which region it is closest to
Describe what occurs in T2-7 with full elevation of the arm
Extension, rotaiton, and SB of the segments to the ipsilateral side
Condition:
- Stiffness
- Headache
- Neck pain
- UE pain
- B “stocking glove” paresthesias
T4 Syndrome
Condition:
- Upper T-spin (T3-7)
- Flat or Reduced thoracic kyphosis
Flexion movement impairment
Condition:
- C/T junction or high T-spine segments
- Excessive kyphosis
- vertebral bodies may become wedge shaped
Extension movement impairment
Condition:
- First rib
- Limited painful caudal glide
Superior subluxation
Condition:
- 50 + yo
- Kyphotic position
- Extension activities reduc stress on vertebral body
Thoracic Vertebral Fracture
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
Functional Scoliosis
Condition:
- Lateral curve w/rotational component
- Can be congential/idiopathic
- Can’t be corrected by positioning
- Can cause wedge shaped vertebra
Structural Scoliosis
Descrbe Tx for Scoliosis
Stretch the concave side of the curve
Strengthen the convex side of the curve
Posture training
Bracing
Location: space between clavicle and first rib
Thoracic Outlet
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
Thoracic outlet syndrome
Condition:
- MOI: increased neural tension, stiff joints, natural posture
- Stiffness of C/T junction and T3-7
- Flexion restriction
Flattened Upper Thoracic Spine
Condition:
- Middle age +
- Stiffness at multiple levels
- Loss of elastic end feel
- Limited arm elevation
- Stiff/painful accessory glides
- Mm imbalance
Generalized upper/mid thoracic stiffness
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
T4 Syndrome
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 +
T4 Syndrome
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
Costal Joint Derangement
Condition:
- MOI: Chronic neck pain, poor posture, tight scalenes
- May cause thoracic outlet syndrome
- Limited end range cervical rotation and shld flex
Elevated 1st Rib
Describe how you test for an elevated 1st Rib
Stabilize 1st rib
Rotate head to contralateral side
SB to ipsilateral side
+ = pain at rib, decreased ROM, firm end feel
Condition:
- Localized pain
- Reduced motion w/respiration, coughing, and sneezing
- Local mm spasm
Rib subluxation
Anterior = concavity of rib posteriorly
Posterior = prominence of rib posteriorly
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
Thoracic Disc Lesion
Condition: Localized irriation of costosternal joint/2nd rib
Costochondritis
Condition:
- Swelling of costal cartilages
- Anterior chest pain, loacilzed and superficial
- Agg: breathing and trunk movement
- Usually resolves in 12 wks
Tietze’s Syndrome
Condition:
- Pain
- Limited chest excursion
- Limited spinal mobility
- Bone scan +
Anklyosing Spondylitis
Term: Biconcave appearance of vertebra
Fish Vertebrae
Condition: wedging of multiple vertebral bodies
Scheuermann’s Disease
Condition: Small herniation of disc material into the endplate of vertebral bodies
Schmoral’s nodes
