Thoracic spine and ribs Flashcards
2 most catastrophic injuries at Tx-spine
Compression fx (52%)
TP fractures (37%)
Subjective history thoracic spine
Red flags from systemic problems
Age/occupation - Scheurmann’s (13-16 yo) and idopathic scoliosis (ado females)
Boundaries of pain/pain presentation
Pain with breathing
Pain deep/superficial/shooting/burning/aching?
Coughing? Sneezing straining?
Pain into legs/arms/head/neck?
Digestive problems?
you’re doing great
SWEETIE
nerve roots of autonomic nervous system
T1-L2
2 parts of the autonomic nervous system
sympathetic and parasympathetic systems
Fight or flight system
Sympathetic
System where non essential activities are reduced and blood flow to organs is reduced, muscles is increased
Sympathetic
What are the E activities in the sympathetic nervous system?
Exercise
Excitement
Emergency
Embarassment
Body functions - T1-T5
Heart and lungs
Body functions - T5-L2
Stomach
Intestines (up to distal 1/2 of large intestines)
Spleen
Liver
Pancreas
Body functions - T10-L2
Distal half of large intestine
Reproductive organs
Urinary bladder
Kidney
Stimulates activity to conserve and restore body resources
Parasympathetic ns
what is the acronym SLUDD
Parasympathetic ns
salivation - lacrimation - urination - digestion - defecation
technique used to compress breast tissue in order to create a flatter appearance of the chest
Chest binding
How are the spinous processes positioned in general?
obliquely downwards
What is the rule of 3’s
T1-T3 = TP at level of SP of the same vertebrae
T4-T6 = TP 1/2 vertebral body above SP
T7-T9 = TP at level of SP of vertebrae above
T10 rules of T7-T9
T11 Rules of T4-T6
T12 rules of T1-T3
True ribs
1-7
False ribs
8-10
Floating ribs
T11-12
Difficult to palpate
Apex of right lung
Anterior scalenes
Rib 1
2 ligaments of the sternum/clavicle joint
Radiate lig
Interchondral ligs
Pump handle movement does what
increase in antero-posterior diameter of thoracic cavity
Bucket handle movement does what
Increase in lateral diameter of thoracic cavity
Rib mvt with rotation - Rotn to the R
Right ribs = external rotn
Left ribs = internal rotn
what is the primary breather
diaphragm
Muscles of inspiration
SCM
Scalenes
External intercostals
Pec minor
Diaphragm
Muscles of expiration
Internal intercostals
Diaphragm
Rectus abdominis
Role of serratus posterior inferior
aids in respiration and lowers the ribs
Role of serratus posterior superior
aids in respiration and elevates the ribs
Diaphragm __ and ___during inspiration
Lowers and flatten
Diaphragm __ and ___during expiration
relaxes and ascends
The diaphragm has fascial connections with which 2 muscles
Psoas major and QL
Esophagus pierces diaphragm at ___
T10
Inferior vena cava is at the level of
T8
Where does the thoracolumbar fascia attaches
medially to thoracic and lumbar spine and laterally to costal angles and 12th ribs
Commonly occurs with coughing, twisting/rotation activities and heavy lifting
Will display pain along the muscle with palpation, possible pain with deep breaths. mvt of the spine
Muscle strains in the Tx-spine
Rib stress fx is common in which sport
Rowers 9%
Anterior or posterior rib most affected by rib stress fx
posterior due to pull of serratus anterior
Which level in the Tx-spine are most susceptible to stress fractures and strains? why
T4-T7 because of rhomboids/lats/ES
which injury is less common in the t-spine compared to l-spine and c-spine
disc herniation
Side bending in one direction
Rotation in opposite direction
Scoliosis
Causes of scoliosis
Congenital, idiopathic, neuromuscular, degenerative
How do you name a scoliosis
named for the point of the apex of the curve and the side of the convexity
ex: (L) T7 scoliosis
review slide 37
convex vs concave side
inflammation of the cartilage that connects rib to sternum
costochondritis
cause of costochondritis
unknown
irritation following excessive rotation/coughing
Common MOI of TOS
repetitive OH mvt
Faulty posture
Improper breathing
Traumatic = whiplash/fall
2 types of TOS and their incidence
Neurological - most common
Vascular (arterial 1-2% and venous 3-5%)
Women or men at more risk of TOS
Women
Common entrapment sites for TOS
Between scalenes and 1st rib and clavicle, pec minor…
review table slide 43
ATOS
VTOS
NTOS
Scheuermann’s kyphosis
can occur in young age
vertebrae grow at different rate during child’s growth spurt
pain to follow after periods of exertion or long periods of inactivity
normal kyphosis angle vs abnormal
20-40d is normal
40-45+ considered abnormal
Dowager’s hump
increased kyphosis
from stress fractures or postmenopausal osteoporosis
Proper breathing mechanics
relaxation of neck musculature
inhalation through the nose
expansion of the abdoment (360d)
Neutral spine to optimize breath
No shoulder movement towards the ears
Pump and bucket handle movement of the chest
Slight anterior tilt of pelvis with inhalation
whole body moves up
tension through the neck musculature
use of SCM, scalene, UFT to assist in inhalation
abdomen moves up and in
rib flare
chest breathing
whole body moves down
shoulder’s hunched
compression to the heart, lungs and organs
chest and rib cage compress inferior
belly projected forward and down like dead weight
common in obese individuals and suffering from depression
collapsed breathing
entire outer layer of body contracts to constrict and suppress the rising movements of breath
breath holding and tension
stressful situations and cold environment
frozen breathing
abdomen contracts in on inspiration and out on expiration
confusing to the body
Reverse breathing
signs of dysfunctional breathing
cranial movement of rib cage
inward movement of abdomen
movement of spine (flexion/ext)
read slide 56
improper activation of core-stabilization during movements
compromised breathing - you would normally want the chest and pelvis ___
parallel
Anterior subluxation of rib
rib angle less prominent
anterior rib more prominent
restriction in expir/inspir
Posterior subluxation of rib
rib angle more prominent
anterior rib less prominent
restriction in expir/inspir
superior first rib subluxation
superior aspect of first rib elevated anterior to UFT
marked tenderness of superior aspect
restriction primarily in exhalation