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MS II > Thoracic Spine - Review > Flashcards

Thoracic Spine - Review Flashcards

1
Q

What structures provide strengthening and stabilizing forces to, and affect the motion of the T-spine?

A
  • The ribs
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2
Q

Do inter-rib motions, or intervetebral motions stop first?

A
  • Inter-rib stops first
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3
Q

What arthrokinematic motion occurs in the T-spine at the end range of osteokinematic motions?

A
  • Motion of transverse process on a fixed rib
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4
Q

What type are the arthrokinematics relationships of the joint surfaces of the costotransverse joints?

A
  • Convex rib on concave transverse process for ribs 1 - 7/8

- Planar surfaces for ribs 8 - 10

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5
Q

What is the ROM for T-spine flexion? (goniometry and tape changes)

A
  • 0 - 25/45 degrees

- ~ 2.7 cm

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6
Q

What 4 structures limit an opening semental motion of the T-spine?

A
  • Supraspinatus
  • Infraspinatus
  • Capsular ligaments
  • Posterior longitudinal ligament
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7
Q

What type of force is produced on the nucleus pulposis during T-spine flexion?

A

Posteriorly directed

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8
Q

At what 3 joints does motion occur during flexion of the T-spine?

A
  • Costovertebral
  • Sternocostal
  • Costochondral
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9
Q

What is the ROM for T-spine extension? (goniometry and tape changes)

A
  • 0 - 25/45 degrees

- ~ 2.5 cm

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10
Q

What limits segmental T-spine extension/ closing?

A
  • Approximation of spinous processes
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11
Q

What type of force is produced on the nucleus pulposis during T-spine extension?

A
  • Anterior force
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12
Q

At what 3 joints does motion occur during extension of the T-spine?

A
  • Costovertebral
  • Sternocostal
  • Costochondral
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13
Q

What is normal ROM lateral flexion of the T-spine? (goniometry only)

A
  • 0 - 20/40 degrees
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14
Q

What type of force is produced on the nucleus pulposis during lateral flexion of the T-spine?

A
  • Lateral force
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15
Q

What type of motion occurs at the intercostal spaces during lateral motion on the convex and on the concave side?

A

Convex: Widen, enlarging rib cage
Concave: Close, shrinking rib cage

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16
Q

What is the normal ROM of rotation of the T-spine? (goniometry only)

A
  • 0 - 35/50 degrees
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17
Q

What limits the opening and closing motions of the T-spine during rotation?

A
  • Rib cage deformations
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18
Q

Through what structures of the T-spine does the axis of rotation pass?

A
  • The bodies of the vertebrae
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19
Q

What motion occurs at the disc during T-spine rotation? What effect does this have in comparison with the L-spine?

A
  • Disc twists and rotates as opposed to shearing in the lumbar spine allowing for greater rotation ROM per segment
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20
Q

How much rotation is allowed per segment in the T-spine? The L-spine?

A

T-spine: 3 degrees

L-spine: 1 degree

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21
Q

What are the joint surfaces of the costovertebral joint?

A
  • Convex rib on both vertebral bodies, and the annulus of the disc
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22
Q

What structure divides the inside of the joint capsule of the costovertebral joint into 2 sections?

A
  • An interosseus ligament
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23
Q

What ligament reinforces the joint capsule of the costovertebral joint?

A
  • Annular ligament
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24
Q

What are the joint surfaces of the costotransverse joints?

A

1 - 7/8: convex rib tubercle on concave transverse process

8 - 10: Transverse surfaces

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25
Q

What 3 ligaments stabilize ribs 8 - 10?

A
  • Interosseus
  • Posterior costotransverse
  • Superior costotransvserse
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26
Q

Through what joints does rib motion occur?

A
  • Costotranverse

- Costovertebral

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27
Q

Describe the 4 planes of motion of the ribs?

A

Upper ribs: In sagittal plane (raises sternum and expands AP dimension of rib cage
Middle ribs: 45 degrees to frontal plane
Lower ribs: In frontal plane (Medial lateral expansion of the rib cage )

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28
Q

What type of motion occurs at the Lower ribs?

A

Bucket handle

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29
Q

What type of motion occurs in the inferior ribs?

A

Caliper motion

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30
Q

What type of motion occurs in the upper ribs?

A
  • Pump handle
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31
Q

What type of motion occurs in the middle ribs?

A
  • Combination of pump and bucket handle
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32
Q

What 3 muscles are found in the superficial layer of the posterior T-spine?

A
  • Trapezius muscles
  • Rhomboids
  • Latissimus dorsi
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33
Q

What 2 muscles are found in the 2nd layer of the posterior T-spine?

A
  • Splenius

- Serratus posterior

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34
Q

What 3 muscles are found in the 3rd layer of the posterior T-spine?

A
  • Iliocostalis
  • Longissimus
  • Semispinalis
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35
Q

What 5 muscles are found in the 4th layer of the posterior T-spine?

A
  • Levator costorum
  • Interspinalis
  • Intertransversarii
  • Multifidii
  • Rotatores
36
Q

What are the 5 muscles of the ribs?

A
  • External intercostals
  • Internal intercostals
  • Levator costae
  • Sternocostalis
  • Diaphragm
37
Q

Which intercostal assists in inhalation? Which assists in exhalation?

A

Inhalation: External
Exhalation: Internal

38
Q

What is the function of the levator costae?

A
  • Elevates ribs
39
Q

Where is the sternocostalis located? What is its function?

A
  • Retrosternal location

- Exhalation muscle

40
Q

What is the function of the diaphragm?

A
  • Increases all 3 dimensions of the ribs

- Inhalation

41
Q

What are the 5 impairment-based classifications of the T_spine?

A
  • Thoracic hypomobility
  • T-Spine hypomobility with UE referred pain
  • T-Spine hypomobility with neck pain
  • T-Spine hypomobility with LBP
  • Thoracic clinical instability

(see Olsen 204 for more)

42
Q

What type of intervention shows promise in the literature for T-Spine ROM increases and pain relief?

A
  • Manipulation
43
Q

How is T-spine hypomobility differentiated from rib hypomobility?

A
  • Perform PA over spine

- Perform PA over rib

44
Q

Which is treated first if T-spine and rib hypomobility occur concurrently?

A
  • T-spine first

- Then address lingering rib hypomobility

45
Q

What is another name for T-spine hypomobility with Upper Extremity referred pain?

A
  • T4 syndrome
46
Q

What is T-Spine hypomobility with UE Referred pain/ T-4 Syndrome? What are its 4 clinical symptoms?

A
  • UE extremity paresthesias/ pain
  • Cervical spine pain (may or may not be present)
  • T4 region stiffness
  • (+) ULTT (Usually median, but not always)
47
Q

What condition is T4 syndrome often misdiagnosed as?

A
  • Carpal tunnel
48
Q

What is the theory behind T4 syndrome?

A
  • Irritated nerve root ganglion
49
Q

What 3 areas may symptoms be referred to in T4 syndrome?

A
  • C-spine
  • Head
  • Upper extremities
50
Q

What level of evidence shows success for T4 syndrome with upper T-Spine manips?

A

Level 4/ case study

51
Q

What are the 6 CPR for T-Spine manips for patients with C-spine pain?

A
  • Symptoms < 30 days
  • No symptoms distal to shoulders
  • No increase in symptoms on looking up
  • FABQ < 12 points
  • Decreased upper T-spine kyphosis
  • C-spine extension < 30 degrees

3/6 is an indication

52
Q

What are the 3 components of an FABQ?

A
  • Physical Activities
  • Work Activities
  • Smoke Screen
53
Q

What are the 2 factors would be tested in a patient with suspected T-Spine Hypomobility with Shoulder Impairments classification?

A
  • Passive Intervertebral movements of the T-spine

- Observation of the T-spine during active elevation; re-checked with manual retraction of the scapula

54
Q

What 2 treatments should be used when treating a patient classified into the T-spine Hypomobility with Shoulder Impairments category?

A
  • Mobilizations/ Manipulations

- Postural re-education

55
Q

What shoulder structures are commonly affected by T-spine hypomobilitY?

A
  • Rotator cuff (impingement)
56
Q

What soft tissue links the T-spine and L-spine?

A
  • Thoraco-lumbar fascia
57
Q

Where is T-spine stiffness typically compensated for?

A

The L-spine

58
Q

How can manipulation of the T-spine relieve symptoms in the L-spine?

A
  • The manipulation may inhibit hyperactive musculature
59
Q

If a patient’s T-Spine stiffness is affecting their lower back, what impairment category are classified into?

A

T-Spine Hypomobility with LBP

60
Q

Are hyper or hypomobile T-spines more common?

A

Hypomobile

61
Q

What are some clinical signs for T-spine instability?

A
  • Ache with sustained upright posture; relief with recumbent positions
  • Aberrant movement with AROM
  • Hypermobile passive intervertebral motion (especially flexion)
62
Q

What are 4 possible precursors that are linked to Thoracic Clinical Instability?

A
  • Systemic Hypermobility
  • Severe postural deviations
  • S/P trauma (MVA)
  • S/P T-Spine surgery
63
Q

What are 4 tests for systemic hypermobility?

A
  • Thumb to forearm
  • Hyper extension at elbows
  • Hyper extension at knees
  • Ability to palm floor
64
Q

What are 6 cardiac symptoms that could be mistaken for T-spine pain?

A
  • Chest pain
  • Chest heaviness
  • No mechanical link to pain
  • Abdominal Pain
  • Shortness of breath
  • Cough
65
Q

What are 7 clinical signs that your patient may have a malignancy, and not T-spine pain?

A
  • History of malignancy
  • Age > 50
  • No improvement with Treatment
  • Unexplained weight loss
  • Pain at multiple sites
  • Pain at rest
  • PM pain
66
Q

What is a sign from the history that the patient may have a fracture?

A
  • Major trauma
67
Q

What are 2 signs that a patient may have an infection instead of T-spine impairments?

A
  • Fever

- Night seats

68
Q

What is the most common reason for T-spine pain?

A
  • Overuse/ postural deviations
69
Q

What are 2 causes of sprains and strains of the T-spine?

A
  • Overuse/ postural deviations

- Trauma

70
Q

What are 2 causes of referred pain to the T-spine?

A
  • C-spine pain

- Abdominal/ thoracic organs

71
Q

What is a sign that the pain may be visceral and not musculoskeletal?

A
  • Movement and pain are unrelated
72
Q

What 2 pathologies does T-spine disc lesions mimic?

A
  • Fractured ribs or chondral problems

- Visceral disease

73
Q

How can a fractured rib/ chondral problem be distinguised from a disc lesion?

A
  • AP pressure on the sternum does not provoke pain with a disc lesion
74
Q

A fracture through which column of the T-spine tends to result in serious problems?

A

The middle

75
Q

In which column of the T-spine is instability due to fracture not uncommon?

A

Posterior

76
Q

Fracture through which column of the T-spine does not usually result in severe symptoms?

A
  • Anterior
77
Q

What is a Schmorl’s node?

A

Protrusion of nucleus pulposis into vertebra

78
Q

Are Schmoral’s nodes typically symptomatic?

A

No.

79
Q

What is the surgical intervention for instability/ hypermobility of the T-spine?

A
  • Rods
  • Plates
  • Pedical screws
80
Q

What is the conservative intervention for instability/ hypermobility of the T-spine?

A
  • Stabilization exercises
  • Orthsoes
  • Corsets
  • Strapping
81
Q

What tissues are COMMONLY affected by rib fractures?

A
  • The ribs themselves, and the costal cartilage
82
Q

What needs to monitored with a rib fracture?

A

Need to avoid/ monitor pneumothorax

83
Q

How are rib fractures typically treated?

A

Conservatively without immobilization

84
Q

What is costochondritis?

A
  • Painful swelling of the costochondral junction due to trauma or infection
85
Q

What are 3 signs of costochondritis?

A
  • Localized, palpable swelling
  • Pressure on sternum or lateral borders of sternum elicits pain at the junction
  • There is pain on deep breathing or coughing
86
Q

What is the conservative treatment for costochondritis?

A
  • NSAIDs
  • Rest
  • OCC injections
87
Q

What are 2 proprioceptive techniques for posture correction of the T-spine?

A
  • Corsets

- Taping

MS II (20 decks)

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