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TherEx Upper Quadrant > Thoracic Spine / Ribs > Flashcards

Thoracic Spine / Ribs Flashcards

1
Q

Thoracic Vertebrae Features

A

Anterior wedging (slightly larger in posterior portion) creates Kyphotic posture

Demifacets to articulate with ribs

Vertebral canal is round / smaller than in cervical and lumbar regions (increased risk of herniation, area still protected by ribs)

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2
Q

Thoracic Spinous Processes

A

Long / slopes progressively angle more downward

SPs are triangular and project horizontally at T11 / T12

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3
Q

Thoracic Transverse Processes

A

Long / round / club-like

Angle posterolaterally and slightly superior

ALL have oval shaped anterior facet for articulation with the tubercles of corresponding ribs (except T11 and T12)

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4
Q

Thoracic Rule of 3’s

A

SP position to TP

T1-T3: Same level

T4-T6: Half vertebral level lower

T7-T9: One vertebral level lower

T10-T12: Same level

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5
Q

Sternum serves as the ___ for the ribs and ___ for the UE.

A

anterior connection point, anchor point

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6
Q

Sternal Notch / Xiphoid Process (Spinal Levels)

A

Sternal Notch: T2/3

Xiphoid Process: T9/10

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7
Q

True Ribs vs. False Ribs vs. Floating Ribs

A

True Ribs: 1-7 (attach to the Sternum)

False Ribs: 8-10 (attach via cartilage to 7th rib)

Floating Ribs: 11 and 12

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8
Q

Rib Attachment to Vertebral Body

A

Superior rib facets attach to superior vertebral body

Inferior facet attaches to corresponding vertebral body

2nd Rib attaches to T1 superiorly and T2 inferiorly

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9
Q

“Atypical” Ribs

A

1st / 10th / 11th / 12th - attach to only one facet on the corresponding vertebral body

2nd Rib - attaches to T1 and T2 but attaches anteriorly to junction of manubrium and body of sternum

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10
Q

Interbody Joints

A

Flat vertebral surfaces

Allow for translations to occur

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11
Q

Facet Joints

A

Synovial / planar in structure

Inferior articulation matches superior articulations and faces anterior / inferior / slightly medial

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12
Q

Costovertebral Joints

A

Synovial plane joints

Between the heads of the ribs and the vertebral bodies - allow gliding / sliding costal motions

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13
Q

Costotransverse Joints

A

Tubercle of the ribs with the facets at the tip of the TPs of their own vertebra

Synovial membrane / thin articular capsule - allow gliding and slight rotational motions

Upper Thoracic - convex TP with concave rib

Lower Thoracic - planar joints

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14
Q

Upper Ribs vs. Lower Ribs

Pump vs. Bucket Handle

A

Upper Ribs - Pump Handle movement (change in anterior / posterior diameter)

Lower Ribs - Bucket Handle movement (change in transverse / lateral diameter)

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15
Q

“Normal” Thoracic Posture

A

40 degrees kyphosis - occurs from wedging of the vertebrae (anterior aspect smaller than posterior aspect)

Infrasternal Angle - 90-100 degrees

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16
Q

Impaired Thoracic Alignment Examples

A

Kyphosis - Increase in flexion curve / can lead to increase force on vertebral body and disc (tight RA)

Flat Back - Decrease in flexion curve / scapular winging appearance (decreased expansion of posterior ribcage / posterior musculature has increased resting tension)

Posterior Trunk Sway - Upper back shifted back and hips are swayed forward (shoulders posterior to the hips / decreased posterior trunk extensors / increased RA)

Rotation - asymmetry of rib cage / contralateral side more prominent / almost always functional (repeatedly moving in one direction)

Scoliosis

Asymmetrical contour of ribcage

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17
Q

What can we notice about the positioning of the ribcage in this picture?

A

R ribcage more prominent (less arm gap on R)

Slight rotation to the L

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18
Q

Wide Infrasternal Angle

A

> 100 degrees

Tight Internal Oblique / long External Oblique

Squished front to back / sides are flared - can’t properly use Bucket Handle

Leads to Sacral Nutation / innominate extension, adduction, IR

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19
Q

A wide Infrasternal Angle is more common in which postures?

A

Lumbar Lordosis / Thoracic Kyphosis (Upper Crossed Syndrome)

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20
Q

Wide Infrasternal Angle Treatment

A

Treat in supine - allows for more posterior expansion

Need more upper rib cage expansion and lower rib cage compression

Wall supported downward reach / side lying

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21
Q

Narrow Infrasternal Angle

A

<90 degrees

Tight External Oblique (from descended diaphragm) / long Internal Oblique

Squished side to side and can’t move F/B (pump handle)

Leads to Sacral Counter Nutation / innominate flexion, abduction, ER

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22
Q

A Narrow Infrasternal Angle is often seen in which posture abnormality?

A

Flatback Posture

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23
Q

Narrow Infrasternal Angle Treatment

A

Treat in prone / quadruped - allows for more anterior expansion

Need upper rib cage compression and lower rib cage expansion

Quadruped breathing / hooklying

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24
Q

How to Measure Infrasternal Angle

A

Xiphoid Process is apex of measurement

Measure from side of the ribs (typically 7-10 cartilage side)

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25
Rib Expansion During Inhalation
Rib cage should expand 5-10 cm with max inhalation (lower end of this range with arms elevated - pre-opens ribs, higher with arms down) <3 cm change is considered impaired / indicates possible shortness in abdominal obliques
26
If the Subcostal Margin does not expand during inhalation with the patient's arms raised, what does this mean?
Possible shortness of External Obliques
27
Shoulder and Thoracic Coupled Motions
Bilateral shoulder elevation / thoracic extension Unilateral elevation / ipsilateral rotation and lateral flexion Upper T-Spine frontal plane facet orientation leads to ipsilateral coupling of rotation and SB Lower T-Spine sagittal plane facet orientation leads to contralateral coupling of rotation and SB
28
Identify the Intervention:
Thoracic Extension over chair Locks out L-spine Good for kyphotic patients Gaining extension following MT
28
How to Assess Rib Mobility with Inspiration / Expiration
Use tape measure at 4th Intercostal Space Big breathe out / big breathe in Should increase 2-5 inches with inspiration
29
Identify the Intervention:
Pec Major Stretch (Clavicular Head) Clavicular Head flexes humerus
30
Identify the Intervention:
Pec Major Stretch (Sternal Head) Sternal Head adducts / extends Humerus from flexed position
31
Identify the Intervention:
Pec wall stretch
32
Identify the Intervention:
Thoracic Extension over foam roll - short lever Knees bent to put less stress on Psoas
33
Identify the Intervention:
Thoracic Extension over foam roll - long lever
34
Identify the Intervention:
Prayer Stretch for Lats / Thoracic Spine Prayer position / elbows on table and rock body backward while pushing chest down Can inhale and push chest down towards floor during exhale
35
Identify the Intervention:
Child's Pose Rock back for thoracic flexion / forward for extension
36
Identify the Intervention:
Cat / Camel for thoracic flexion / extension
37
Identify the Intervention:
Threading the Needle Works Clavicular head of Pec Caution with long levers because of GH joint torque
38
Identify the Intervention:
Crime Scene Pose For Upper Back / Ribcage restriction Pt prone / arm up (elbow crease at eye level) on affected side / ipsilateral leg slightly flexed and ER / other arm at side with palm up / look towards elbow crease of the arm that is up / press wrist, elbow, knee gently into the ground and keep ribs in contact with the floor / breathe through nose for 5 counts and exhale for 5 counts / hold for 60 seconds and switch sides
39
Identify the Intervention:
Swiss Ball Backward Bend (Elbows Up) For Lower Chest restriction Lie on SB with had tipped backward / place hands on head and let elbows flare until you feel a light stretch Breathe deeply for 3-4 sets of 60 seconds
40
Identify the Intervention:
Swiss Ball Backward Bend (Hand Down) For Upper Chest restriction Lie on back over SB with head tipped backward / place hands on belly and gently droop one towards the floor / press hand gently into ball when you feel the restriction Breathe deeply for 3-4 sts of 60 seconds
41
Identify the Intervention:
Crocodile Breathing with Pads For Lower Back / Ribcage + Upper Chest restriction Pt prone with pad under Lower Ribs and Pubic Bone / rest arms OH / focus on keeping lower ribs in contact with the pad Repeat for 3-4 sets of 60 seconds
42
Identify the Intervention:
Sidelying Expansion For Lower Ribs Have affected side up
43
Identify the Intervention:
Anterior Rib Expansion Hands behind head - T ext with inspiration and flex with expiration
44
Identify the Intervention:
Seated Posterior Rib Expansion Keep forearms parallel and rest elbows on block Avoid scapular retraction - this locks out ribs
45
Identify the Intervention:
Crocodile Breathing For general Back / Ribcage (posterior) expansion
46
Identify the Intervention:
Quadruped Posterior Rib Expansion
47
Thoracic Flexion exercises are beneficial for patients with a ___ Posture.
Flatback
48
Identify the Intervention:
Seated Thoracic Flexion
49
Identify the Intervention:
Assisted Thoracic Flexion Just hold band, do not pull
50
Identify the Intervention:
Rockback Thoracic Flexion
51
Identify the Intervention:
Segmental Flexion - lifting off wall segment by segment Alternative: Pt seated / PT's knee at lower T-Spine / heel of hand at SP segment by segment
52
Identify the Intervention:
Open Books For thoracic rotation Avoid shearing of GH Joint with long lever
53
Identify the Intervention:
Seated Thoracic Rotation
54
Identify the Intervention:
Wall Windmill For thoracic rotation
55
Identify the Intervention:
Loaded Threading the Needle Avoid scapular retraction (Rhomboid activity)
56
Identify the Intervention:
Prone Chest Lift Strengthening / core stability
57
Identify the Intervention:
Prone Elbow Lift Strengthening / core stability
58
Identify the Intervention:
Quadruped Arm / Leg Lift Thoracic Extensor endurance (R side)
59
Identify the Intervention:
Wall Angel Cervical alignment / T/S ext / pec stretch / scapular stabilization / posterior ribcage endurance
60
Identify the Intervention:
Prone Series Easier on plinth / harder on physioball ITYLWs

TherEx Upper Quadrant (5 decks)

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