Thoracic Spine-Kietrys Flashcards
T/S Anatomy Review
- 12 T/S vertebrae
- Rib articulations
- Costovertebral joints (more on these other cards)
- Costotransverse joints(more on these other cards)
T/S Costovertebral Joints
- 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
T/S Costotransverse Joints
- Ea. rib attaches to like-numbered TP
- Ex. 7th rib attaches to TP of T7
T/S SP relationship to VBs
*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
TS Dermatomes
- 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
- Ex. T6 starts Post @ about T6 SP, but then as wraps body it does so in a slightly inf direction.
- *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.
Facet (Zygopophyseal) Joint Orientation of TS Vertebrae
- 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
If this is the T6 vertebrae,
Indicate the following:
see pics
Motion Segment dominate motions chart broken down into spinal segments
-
Upper and Mid TS
- ROTATION dominates
-
Lower TS
- segments behave more like LS
- → more Flex/Ext
- segments behave more like LS
Differential Dx of pt w/ TS Pain
-
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
Map of Referral Patterns from CS facet joints
-
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
TS Deformities and Patho’s
Kyphosis specific deformities
- 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
- Causes:
TS deformities and patho’s
Frontal plane deformity
Scoliosis
Dowager’s Hump =>
accentuated kyphosis angle @ cervicothoracic junction
“the hump”
Inc’d (accentuated) TS kyphosis w/ FHP
see pics
Gibbus Deformity
What is it?
INC in TS kyphosis localized to certain lvls rather than spread evenly over TS
Other causes of TS Kyphosis
- Scheuermann’s
- Pott’s dis→ TB of spine
- Mucopolysaccharidosis ***
Mucopolysaccharidosis
- Rare autosomal recessive hereditary dis.
- Defect in lysosomal enzyme which is important for growth and homeostasis
- Effects multiple organs and msk tissues
Gibbus deformity is due to ______
location
Scoliosis
What is it?
How is it Named?
- Named on side of CONVEXITY
- Lateral deviation in the frontal plane assoc’d w/ rotation
Scoliosis
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
- Ex. Major TS curve convex on Right; concave on Left
Scoliosis + Rib hump
TS vert rotate toward convexity of the major TS curve=> rib hump on convex side
Some ways to measure Scoliosis
- Adam’s Test/Scoliosometer
- measures hts of posterior ribs→ gives severity
- Cobb angle → X-ray
Cobb Angle for Scoliosis
BIGGER Cobb angle== GREATER scoliosis
NOTE: >45* typ mng’d surgically
Schroth Method for what ?
Less severe Scoliosis
Schroth Method
- Enhances “postural memory” via intensive exercises and “autocorrection”
- Principles:
- axial elongation
- DEflexion
- DErotation
- rotational breathing
- stabilization
- Principles:
Side Plank (Vasisthasana) for Scoliosis
- 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
Evidence for Schroth and other exercise-based methods of Scoliosis Tx
see pics:
Bracing for Scoliosis
-
Cobb angle <30*
- Exercise is adequate
-
Cobb angle 30-45*
- Bracing utilized
- 23hrs/day
-
Cobb angle >45*
- Surgery
NOTE: Key Points w/ Bracing for Scoliosis
*things to remember
- Prevents progression of curve
- UNLIKELY to reverse or correct pre-existing curve
>45* Cobb Angle
Requires surgery
TS Disc Herniations
-
C7-T1 disc
- → C8 nerve root
-
T1-T2 disc
- → T1 nerve root
-
T2-T3 disc
- → T2 nerve root
- etc…
TS Radiculopathy Patterns
UE sx’s vs. Trunk sx’s
-
T1/T2
- → UE sx’s
-
T3/T12
- → Trunk sx’s
Pathologies of the T/S
DJD
- Of IVJs: Spondylosis
- Facet jts
Patho’s of the T/S
DDD
Gen wear and tear
Patho’s of the T/S
Facet Joint Disorders
- DJD
- HypOmobility
- Irritability/inflamm
Pathologies of the T/S
Various + explanations
- 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
Rib Injuries
*Facts
- Self-limiting
- resolves in time
-
Costochondritis
- involves costo cartilage in ribs or sternum
- result of resp. dis.
- *coughing
Herpes Zoster (Shingles) along a TS dermatome
*lies dormant in spine
see pics
