Thoracic spine, Ribs

Question 1

Is the thoracic spine a main source or contributor to pain?

Answer 1

Contributor, approx 15% of cases

Question 2

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?

Answer 2

Spinous and transverse processes are at the same level T1-3

Question 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?

Answer 3

Spinous processes are 1/2 vertebral level below transverse processes in T4-6

Question 4

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?

Answer 4

Spinous processes are one full vertebra below transverse processes in T7-9

Question 5

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?

Answer 5

Spinous processes are at the same level to which they are attached in T10-12

Question 6

What part of the rib articulates with the costal facet of the thoracic spine?

Answer 6

Rib tubercle

Question 7

What part of the rib articulates with the demifacet of the thoracic spine?

Answer 7

Head of the rib

Question 8

Where is the rib angle found on the rib cage?

Answer 8

Posterolateral aspect of the rib cage, rib angles laterally to anteriorly

Question 9

What contributes to the kyphotic/kyphosis of the thoracic spine?

Answer 9

Height of the vertebral body is higher posteriorly

Question 10

What is the orientation in the frontal plane?

Answer 10

60 deg
Cervical spine is 45 deg
Lumbar is vertical

Question 11

Two factors for the thoracic spine/rib cage are thought to contribute to lower levels of mobility:

Answer 11

1) rib cage attachment

2) thinner disks

Question 12

Which ribs attach to the sternum what are they called?

Answer 12

True ribs - 1-7

Question 13

Which ribs attach to cartilage and not directly to the sternum and what are they called?

Answer 13

False ribs - 8-12

Question 14

Do ribs 11-12 have an anterior attachment?

Answer 14

No - floating ribs

Question 15

What is the joint called where the head of the rib attaches to the transverse process of the thoracic spine?

Answer 15

Costotransverse joint

Question 16

What is the motion of the upper ribs during inspiration/expiration?

Answer 16

Flexion/extension - pump handle

Question 17

What is the motion of the lower ribs during inspiration/expiration?

Answer 17

Abd/adduction - bucket handle

Question 18

True/false: weakness in erector spinae contributes to fall risk.

Answer 18

True

Question 19

Do thoracic spinal nerves exit above or below their respective disks?

Answer 19

Below - ie: T1 nerve exits below T1 disk, same in the lumbar region

In cervical region, nerve roots exit above due to C8

Question 20

Zygapophyseal/facet joints are innervated by what two branches of nerves?

Answer 20

Same level and one above - ie: L3-4 facet is innervated by L2 and L3

Question 21

What diagnosis consists of bilat UE paresthesia in stocking glove pattern, headaches, neck pain, UE pain, and can have sweating?

Answer 21

T4 syndrome

Question 22

What area of the thoracic spine is the critical zone due to small diameter of the spinal canal with decreased blood supply?

Answer 22

T4-9

Question 23

What area of the thoracic spine tends to have decreased extension and can contribute to older adults not achieving better shoulder flexion/elevation?

Answer 23

Lower thoracic spine

Question 24

Is rotation of the tspine more prominent in the upper or lower portion?

Answer 24

Upper

Question 25

In terms of neural dynamics, what is the tension point of the dura? (where above moves toward Cspine, below toward Lspine)

Answer 25

T6

Question 26

Where do flexion impairments tend to happen in the thoracic spine?

Answer 26

Upper, middle portions - loss of kyphosis (T3-7)

Question 27

Where do extension impairments tend to happen in the thoracic spine?

Answer 27

CT junction, high Tspine as well as lower Tspine

Question 28

How many joints/articulations are at each thoracic level?

Answer 28

12
4 facet joints
2 IVD articulations
4 costovertebral
2 costotransverse

Question 29

Define Murphy sign:

Answer 29

With pt in supine; palpation of the R subcostal margin while pt is inspiring - wincing = potential gallbladder inflammation

Question 30

Where is a common referral site for pancreatitis?

Answer 30

TL junction

Question 31

What are four common/key factors regarding a diagnosis of ankylosing spondylitis?

Answer 31

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

Question 32

What is an objective finding of the tspine that may contribute to anklylosing spondylitis diagnosis?

Answer 32

Limited chest expansion - typically 5 cm noted at nipple line - less than 2.5 cm is abnormal

Question 33

What gender, age group is most often affected by ankylosing spondylitis?

Answer 33

Men, 15-40 y.o

Question 34

What eye condition is associated with anklylosing spondylitis?

Answer 34

Uveitis - acute eye pain, sensitive to light

Question 35

What are 7 associated risk factors for developing osteoporosis?

Answer 35

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

Question 36

When analyzing Cobb angles, what value is considered hyperkyphotic?

Answer 36

> 50 degrees

Question 37

How is the first rib assessed for mobility?

Answer 37

Seated cervical rotation, lateral flexion test - indicates opposite rib involvement