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MSPT II > Thoracic Spine-Kietrys > Flashcards

Thoracic Spine-Kietrys Flashcards

1
Q

T/S Anatomy Review

A
  • 12 T/S vertebrae
  • Rib articulations
  • Costovertebral joints (more on these other cards)
  • Costotransverse joints(more on these other cards)
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2
Q

T/S Costovertebral Joints

A
  • Ea. rib attaches to like-numbered vertebrae
    • Ex. 1st rib attaches to T1 VB
  • In addition, mid-thoracic ribs also attach to VB one level ABOVE
    • Ex. 7th rib attaches to to T7 AND T6 @ demi-facets loc’d on superior surface of T7 and the inferior surface of T6
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3
Q

T/S Costotransverse Joints

A
  • Ea. rib attaches to like-numbered TP
    • Ex. 7th rib attaches to TP of T7
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4
Q

T/S SP relationship to VBs

A

*Esp @ mid-TS lvls→ SP of a given vert. lvl corresponds to the vertebrae one lower in #

Ex. The SP of T8 is about the same lvl as VB of T9

see pics

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5
Q

TS Dermatomes

A
  • Wrap body like belts→ drop inf as they go from post to ant.
    • Ex. T6 starts Post @ about T6 SP, but then as wraps body it does so in a slightly inf direction.
      • see T6 is lower in front than on back
  • *NOTE: derms overlap so a radiculopathy @ a given TS lvl would NOT cause complete anasthesia.
    • You would instead find reduced awareness of lt touch sensation/partial numb.
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6
Q

Facet (Zygopophyseal) Joint Orientation of TS Vertebrae

A
  • TS facets are more in frontal (coronal) plane
    • remember hand orientation example
  • Orientation permits rotation in the TS motion segs.
    • Picture this: Facet surfs sliding med/lat during rotation of TS motion segment
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7
Q

If this is the T6 vertebrae,

Indicate the following:

A

see pics

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8
Q

Motion Segment dominate motions chart broken down into spinal segments

A
  • Upper and Mid TS
    • ROTATION dominates
  • Lower TS
    • segments behave more like LS
      • → more Flex/Ext
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9
Q

Differential Dx of pt w/ TS Pain

A
  • Possible sources:
    • Cardiac and GI structures
    • TS structures
    • Peri-scap musculature
    • Ribs
    • Referral from mid-lower CS
      • TO upper-mid thoracic and scap regions
    • Referral from Upper LS
      • TO lower TS region
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10
Q

Map of Referral Patterns from CS facet joints

A
  • Clinical example: pt has irritation of right C6-7 facet joint
    • pt may very well have right lower neck pain, BUT might also exp pain in the right scap region

see pics

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11
Q

TS Deformities and Patho’s

Kyphosis specific deformities

A
  • INCd thoracic kyphosis (structural)
    • Causes:
      • Scheuermann’s
      • TS compression fx
      • Long standing poor postural habits that evolved into structural adaptations in bone and soft tissue
    • Dowager’s Hump
    • Gibbus deformity
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12
Q

TS deformities and patho’s

Frontal plane deformity

A

Scoliosis

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13
Q

Dowager’s Hump =>

A

accentuated kyphosis angle @ cervicothoracic junction

“the hump”

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14
Q

Inc’d (accentuated) TS kyphosis w/ FHP

A

see pics

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15
Q

Gibbus Deformity

What is it?

A

INC in TS kyphosis localized to certain lvls rather than spread evenly over TS

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16
Q

Other causes of TS Kyphosis

A
  • Scheuermann’s
  • Pott’s dis→ TB of spine
  • Mucopolysaccharidosis ***
17
Q

Mucopolysaccharidosis

A
  • Rare autosomal recessive hereditary dis.
  • Defect in lysosomal enzyme which is important for growth and homeostasis
  • Effects multiple organs and msk tissues
18
Q

Gibbus deformity is due to ______

A

location

19
Q

Scoliosis

What is it?

How is it Named?

A
  • Named on side of CONVEXITY
  • Lateral deviation in the frontal plane assoc’d w/ rotation
20
Q

Scoliosis

A

TS vert rotate toward side of convexity of the major TS curve

  • Causes a rib hump on conVEX side
    • Ex. Major TS curve convex on Right; concave on Left
      • TS vert assoc’d w/ this curve rotate to the Right→ right rib hump on the post. chest wall
21
Q

Scoliosis + Rib hump

A

TS vert rotate toward convexity of the major TS curve=> rib hump on convex side

22
Q

Some ways to measure Scoliosis

A
  • Adam’s Test/Scoliosometer
    • measures hts of posterior ribs→ gives severity
  • Cobb angle → X-ray
23
Q

Cobb Angle for Scoliosis

A

BIGGER Cobb angle== GREATER scoliosis

NOTE: >45* typ mng’d surgically

24
Q

Schroth Method for what ?

A

Less severe Scoliosis

25
Q

Schroth Method

A
  • Enhances “postural memory” via intensive exercises and “autocorrection”
    • Principles:
      • axial elongation
      • DEflexion
      • DErotation
      • rotational breathing
      • stabilization
26
Q

Side Plank (Vasisthasana) for Scoliosis

A
  • See pics
    • Left hand of floor would be for a pt w/ a Left scoliosis (conVEX on left). In this posture, the paravertebral muscles on L. side of spine are contracting isometrically to maint. a straight-spine position. In a pt w/ scoliosis, it makes sense to strengthen the mm’s on the ConVEX side of the curve, and stretch the mm’s on the ConCAVE side of curve
27
Q

Evidence for Schroth and other exercise-based methods of Scoliosis Tx

A

see pics:

28
Q

Bracing for Scoliosis

A
  • Cobb angle <30*
    • Exercise is adequate
  • Cobb angle 30-45*
    • Bracing utilized
    • 23hrs/day
  • Cobb angle >45*
    • Surgery
29
Q

NOTE: Key Points w/ Bracing for Scoliosis

*things to remember

A
  • Prevents progression of curve
  • UNLIKELY to reverse or correct pre-existing curve
30
Q

>45* Cobb Angle

A

Requires surgery

31
Q

TS Disc Herniations

A
  • C7-T1 disc
    • → C8 nerve root
  • T1-T2 disc
    • → T1 nerve root
  • T2-T3 disc
    • → T2 nerve root
  • etc…
32
Q

TS Radiculopathy Patterns

UE sx’s vs. Trunk sx’s

A
  • T1/T2
    • → UE sx’s
  • T3/T12
    • → Trunk sx’s
33
Q

Pathologies of the T/S

DJD

A
  • Of IVJs: Spondylosis
  • Facet jts
34
Q

Patho’s of the T/S

DDD

A

Gen wear and tear

35
Q

Patho’s of the T/S

Facet Joint Disorders

A
  • DJD
  • HypOmobility
  • Irritability/inflamm
36
Q

Pathologies of the T/S

Various + explanations

A
  • Costovertebral and Costotransverse jt disorders
  • Costochondritis
  • Rib injuries
    • sublux of vertebral attach.
    • fx
  • Postural dysf/syndrome
  • *Compression Fx’s→ usually related to osteoporosis
  • Ankylosing spondylitis
    • usually SI, but works its way up
37
Q

Rib Injuries

*Facts

A
  • Self-limiting
    • resolves in time
  • Costochondritis
    • involves costo cartilage in ribs or sternum
    • result of resp. dis.
      • *coughing
38
Q

Herpes Zoster (Shingles) along a TS dermatome

A

*lies dormant in spine

see pics

MSPT II (20 decks)

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