Thoracic spine, Ribs Flashcards
Is the thoracic spine a main source or contributor to pain?
Contributor, approx 15% of cases
The rule of 3s describes location of bony landmarks in the thoracic spine. It was defined due to the length of the spinous process varying by region. Where are the spinous processes for T1-3 according to rule of 3s?
Spinous and transverse processes are at the same level T1-3
The rule of 3s describes location of bony landmarks in the thoracic spine. It was defined due to the length of the spinous process varying by region. Where are the spinous processes for T4-6 according to the rule of 3s?
Spinous processes are 1/2 vertebral level below transverse processes in T4-6
The rule of 3s describes location of bony landmarks in the thoracic spine. It was defined due to the length of the spinous process varying by region. Where are the spinous processes for T7-9?
Spinous processes are one full vertebra below transverse processes in T7-9
The rule of 3s describes location of bony landmarks in the thoracic spine. It was defined due to the length of the spinous process varying by region. Where are the spinous processes for T10-12?
Spinous processes are at the same level to which they are attached in T10-12
What part of the rib articulates with the costal facet of the thoracic spine?
Rib tubercle
What part of the rib articulates with the demifacet of the thoracic spine?
Head of the rib
Where is the rib angle found on the rib cage?
Posterolateral aspect of the rib cage, rib angles laterally to anteriorly
What contributes to the kyphotic/kyphosis of the thoracic spine?
Height of the vertebral body is higher posteriorly
What is the orientation in the frontal plane?
60 deg
Cervical spine is 45 deg
Lumbar is vertical
Two factors for the thoracic spine/rib cage are thought to contribute to lower levels of mobility:
1) rib cage attachment
2) thinner disks
Which ribs attach to the sternum what are they called?
True ribs - 1-7
Which ribs attach to cartilage and not directly to the sternum and what are they called?
False ribs - 8-12
Do ribs 11-12 have an anterior attachment?
No - floating ribs
What is the joint called where the head of the rib attaches to the transverse process of the thoracic spine?
Costotransverse joint
What is the motion of the upper ribs during inspiration/expiration?
Flexion/extension - pump handle
What is the motion of the lower ribs during inspiration/expiration?
Abd/adduction - bucket handle
True/false: weakness in erector spinae contributes to fall risk.
True
Do thoracic spinal nerves exit above or below their respective disks?
Below - ie: T1 nerve exits below T1 disk, same in the lumbar region
In cervical region, nerve roots exit above due to C8
Zygapophyseal/facet joints are innervated by what two branches of nerves?
Same level and one above - ie: L3-4 facet is innervated by L2 and L3
What diagnosis consists of bilat UE paresthesia in stocking glove pattern, headaches, neck pain, UE pain, and can have sweating?
T4 syndrome
What area of the thoracic spine is the critical zone due to small diameter of the spinal canal with decreased blood supply?
T4-9
What area of the thoracic spine tends to have decreased extension and can contribute to older adults not achieving better shoulder flexion/elevation?
Lower thoracic spine
Is rotation of the tspine more prominent in the upper or lower portion?
Upper
In terms of neural dynamics, what is the tension point of the dura? (where above moves toward Cspine, below toward Lspine)
T6
Where do flexion impairments tend to happen in the thoracic spine?
Upper, middle portions - loss of kyphosis (T3-7)
Where do extension impairments tend to happen in the thoracic spine?
CT junction, high Tspine as well as lower Tspine
How many joints/articulations are at each thoracic level?
12 4 facet joints 2 IVD articulations 4 costovertebral 2 costotransverse
Define Murphy sign:
With pt in supine; palpation of the R subcostal margin while pt is inspiring - wincing = potential gallbladder inflammation
Where is a common referral site for pancreatitis?
TL junction
What are four common/key factors regarding a diagnosis of ankylosing spondylitis?
1) stiffness >30 minutes in duration
2) improvement in back pain with exercise, but not rest
3) awakening due to back pain, esp 2nd half of night
4) alternating buttock pain
What is an objective finding of the tspine that may contribute to anklylosing spondylitis diagnosis?
Limited chest expansion - typically 5 cm noted at nipple line - less than 2.5 cm is abnormal
What gender, age group is most often affected by ankylosing spondylitis?
Men, 15-40 y.o
What eye condition is associated with anklylosing spondylitis?
Uveitis - acute eye pain, sensitive to light
What are 7 associated risk factors for developing osteoporosis?
1) white race
2) hx of smoking
3) early menopause
4) thin body build
5) sedentary lifestyle
6) steroid treatment
7) excessive consumption alcohol/caffeine
When analyzing Cobb angles, what value is considered hyperkyphotic?
> 50 degrees
How is the first rib assessed for mobility?
Seated cervical rotation, lateral flexion test - indicates opposite rib involvement
