Thoracic Spine/Ribs

Question 1

What makes ribs T1, T10-12 atypical?

Answer 1

Full costal facets (1 rib per vertebra)

Question 2

What is the structural makeup of a typical thoracic vertebrae?

Answer 2

1. Body - greater stability/decrease mobility
2. Intervertebral Disc - smallest ratio of disc height to vert height
3. Pedicles - face posterior to narrow vert canal - less motion
4. Articular pillar (facets) - coronal for lateral flexion and rotation
5. Spinous process - tip at level of caudal vertebra
6. Joint capsule - taut

Question 3

Where is the costovertebral joints?

Typical -

Answer 3

• 2-9

- head of rib, 2 adjacent vert bodies and intervertebral disc

Question 4

Where is the costovertebral joints?

Atypical -

Answer 4

• 1, 10-12

- Head of rib, one vert body (more mobile)

Question 5

Describe articulation of costotransverse joints?
Promotes what movement?
T1-T6

Answer 5

• Concave transverse process and convex costal tubercle

- Promotes rotation

Question 6

Describe articulation of costotransverse joints?
Promotes what movement?
T7-T10

Answer 6

• Flat

- Promotes gliding

Question 7

Describe articulation of costotransverse joints?
Promotes what movement?
T11-T12

Answer 7

Do not articulate at costotransverse

Question 8

Describe the structure of costochondral and chonrdosternal joints.

Answer 8

-Costochondral (rib with cartilage) - synchondrosis, no ligament support
-Chondrosternal (cartialge with sternum)
1: synchondrosis
2-5: synovial
6-7:synchondrosis or synovial

Question 9

Describe the available osteokinematics at the thoracic spine.

Answer 9

• Flex/Ext
• Lateral flex/sidebending
• Rotation

Question 10

What limits the motion in the flexion?

Answer 10

Limited by tension in PLL, ligamentum flavum, interspinous ligaments and capsule of facet joints

Question 11

What limits the motion in the extension?

Answer 11

Limited by contact of spinous processes, laminae, facet joints and tension from ALL, facet joint capsule and abdominal muscles

Question 12

What limits the motion in the lateral flexion?

Answer 12

Limited by facets and ribs

Question 13

What limits the motion in the rotation?

Answer 13

Rib cage

Question 14

Describe the arthrokinematics at the interbody joints and facet joints for Flex/ext

Answer 14

Flex - facet glides superior and anterior
Ext - facet glides inferior and posterior
*T1-T6 limited flex/ext
*Lower thoracic facet joints have more sagittal orientation

Question 15

Describe the arthrokinematics at the interbody joints and facet joints for sidebending

Answer 15

• Superior glide in facet contralateral to side bend
• Inferior glide in facet ipsilateral to side bend
• coupling relationship = rotate slight posterior ipsilateral and anterior contralateral

Question 16

Describe the arthrokinematics at the interbody joints and facet joints for rotation

Answer 16

-Anterior glide in facet contralateral to rotation
-Posterior glide in facet ipsilateral to rotation
Coupling = slight inferior glide ipsilateral and superior contralateral

Question 17

What is the arthrokinematic coupling relationship in the upper thoracic spine?

Answer 17

Upper = rotation and side bending coupled in same direction

Question 18

What is the arthrokinematic coupling relationship in the lower thoracic spine?

Answer 18

Lower = rotation and side bending coupled in opposite direction

Question 19

Describe the motions that occur at the ribs during breathing in upper ribs

Answer 19

• Diameter changes occur anterior/posterior (sagittal plane)

- Pump handle motion

Question 20

Describe the motions that occur at the ribs during breathing in lower ribs

Answer 20

• Diameter changes occur medial/lateral

- Bucket handle motion

Question 21

Describe the muscle activation that occurs when I am doing diagonal sit-up.

Answer 21

• External oblique on one side acts synergistically with internal oblique on the other side
• Transversus abdominus acts as a stabilizer for the obliques

Question 22

What are the primary axial rotators?

Answer 22

External and Internal obliques

Question 23

What are the secondary axial rotators?

Answer 23

Ipsilateral lats, iliocostalis lumborum

Contralateral transversospinal muscles

Question 24

What muscles crucial for extension stability in lumbar region during axial rotation?

Answer 24

Multifidi

-Loss may also result in visualization of flexion bias of unopposed oblique muscles (excessive movement in lumbar spine)

Question 25

What are the overall functions of the thoracic spine and ribs?

Answer 25

1. Less flexible and more stable
2. Motion is limited
3. Stable base for muscles
4. Protection for the thoracic organs

Question 26

Describe scoliosis

Answer 26

• Most often involves thoracic spine
• May be single curve or 2 (compensatory) curve
• Rib hump associated on convex side

Question 27

Functional therapy vs structural

Answer 27

Functional - strengthen muscles to move out

Structural - bones crate scoliosis and can’t be moved out

Question 28

Describe hyperkyphosis

May be due to what?

Answer 28

• Excessive thoracic kyphosis

- May be due to trauma, abnormal growth/development of vert, severe osteoporosis

Question 29

True/False: hyperkyphosis will not increase inter body joint compression and will not result in fracture

Answer 29

False will increase inter body joint compression and may result in fracture