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T4 MSK > Topic 1 - Thoracic Spine & Rib Cage > Flashcards

Topic 1 - Thoracic Spine & Rib Cage Flashcards

1
Q

The thoracic spine region is the most _____ part of the spine because of the ribcage.

A

Rigid

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2
Q

There is a mild primary ________ curvature in the thoracic spine.

A

Kyphotic

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3
Q

The thoracic spine is the largest region of the vertebral column, making up ___% of the overall body length.

A

20%

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4
Q

The ______ is the site of global and local/intrinsic muscle attachments that are part of the shoulder girdle, cervical spine and pelvic girdle.

A

Thorax

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5
Q

T/F - Almost every task requires the transference of loads through the thorax and therefore needs control.

A

True

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6
Q

____________ dysfunction is thought to affect other regions and contribute to pain syndromes including:
- Faulty posture
- Glenohumeral impingement
- TMJ disorder

A

Mid-Thoracic

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7
Q

T/F - Low grade thoracic spine complaints are common, and often outweigh neck and low back problems.

A

False - Low grade thoracic spine complaints are common, BUT ARE often OVERSHADOWED BY neck and low back problems.

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8
Q

T/F - Nerve/intervertebral disc lesions and radicular pain are common due to the structural rigidity of the region.

A

False - Nerve/intervertebral disc lesions and radicular pain are RARE due to the structural rigidity of the region.

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9
Q

T/F - The upper thoracic spine is a common area for degenerative joint disease, osteoarthritis and rheumatoid arthritis.

A

True

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10
Q

____________ is the most common disease affecting the thoracic spine.

A

Osteoporosis

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11
Q

___________ fractures are common in the _____ thoracic spine and occur as a result of osteoporosis or trauma.

A

Compression
Lower

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12
Q

Conditions to ____ ___ in the thoracic spine include:
- Ankylosing spondylitis
- Nerve lesions (e.g. shingles, intercostal neuropathy)
- Visceral referral (consider somatic pain referral)
- Systemic diseases
- Cervicogenic dorsalgia

A

Rule Out

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13
Q

There are a total of ___ thoracic vertebrae and intervertebral discs. The vertebral bodies are _____ shaped and the intervertebral discs are flatter and more ______.

A

12
Heart
Narrow

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14
Q

Thoracic spinous processes are pointy, long and project __________ and ___________. They restrict _________ due to their orientation.

A

Inferiorly
Posteriorly
Extension

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15
Q

Thoracic facet surfaces tend to be ________ and occur along the coronal plane.

A

Vertical

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16
Q

T/F - There is more rotation available as you move down the thoracic spine.

A

False - There is LESS rotation available as you move down the thoracic spine.

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17
Q

The upper thoracic spine refers to ___ to ___ and the lower thoracic spine refers to ___ to ____.

A

T1-T2
T3-T12

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18
Q

T1 (_______________ junction) and T12 (_____________ junction) are considered ____________ vertebrae, therefore they can begin to move in unison with their articulating vertebrae.

A

Cervicothoracic
Thoracolumbar
Transitional

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19
Q

Fill in the blanks for the rule of three related to the thoracic spine:
1-3 TP and SP ____ level
4-6 TP ____ level above the SP
7-9 TP ___ level above the SP
10 TP ___ level above the SP
11 TP ____ level above the SP
12 TP and SP ____ level

A

1-3 TP and SP SAME level
4-6 TP HALF level above the SP
7-9 TP ONE level above the SP
10 TP ONE level above the SP
11 TP HALF level above the SP
12 TP and SP SAME level

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20
Q

Which of the following arthrokinematic movements of the thoracic spine is being described below?
“Inferior facets of the superior motion segment glide up and forward (open).”

A

Flexion

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21
Q

Which of the following arthrokinematic movements of the thoracic spine is being described below?
“Inferior facets of the superior motion segment glide down and back (close).”

A

Extension

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22
Q

T/F - With thoracic spine lateral flexion to the right, facets close on the right and open on the left.

A

True

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23
Q

T/F - With thoracic spine rotation to the left, facets close on the right and open on the left.

A

False - With thoracic spine rotation to the left, facets close on the LEFT and open on the RIGHT.

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24
Q

Match the following normal ranges of motion for the thoracic spine with the corresponding action.
1) 35-50 degrees
2) 20-40 degrees
3) 20-45 degrees
4) 25-45 degrees

A) Flexion
B) Extension
C) Lateral Flexion
D) Rotation

A

1) 35-50 degrees - D) Rotation
2) 20-40 degrees - C) Lateral Flexion
3) 20-45 degrees - A) Flexion
4) 25-45 degrees - B) Extension

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25
Q

The ____ contribute to spinal stability while restricting forward bending, side bending and rotation. They also protect _______.

A

Ribs
Viscera

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26
Q

________ ribs have the following characteristics:
- Articulate with 1 vertebral body
- Not united to a disc
- Articulate with the numerically corresponding vertebral body only

A

Atypical

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27
Q

T/F - Ribs 1, 2, 11 and 12 are classified as atypical ribs.

A

False - Ribs 1, 11 and 12 are classified as atypical ribs.

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28
Q

_______ ribs have the following characteristics:
- Articulate with 2 vertebral bodies
- Articulate with the numerically corresponding vertebral body and intervertebral disc, as well as the vertebral body above
- Head with 2 facets on either side of a tiny crest

A

Typical

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29
Q

Ribs 11 and 12 are considered ________ ribs.

A

Floating

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30
Q

Ribs 1 and 2 articulate with the _________ in the front. Ribs 3-7 articulate with the _______.

A

Manubrium
Sternum

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31
Q

Connection of the rib head to a thoracic vertebral body.

A

Costovertebral Joint (CVJ)

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32
Q

Connection of the facet of the tubercle of the rib and the adjacent transverse process of a thoracic vertebrae.

A

Costotransverse Joint (CTJ)

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33
Q

When the mid-thoracic spine ______, the ribs roll anteriorly and glide superiorly.

A

Flexes

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34
Q

When the mid-thoracic spine extends, the ribs roll ___________ and glide __________.

A

Posteriorly
Inferiorly

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35
Q

When the mid-thoracic spine laterally flexes, the ribs approximate _____________ and separate _______________.

A

Ipsilaterally
Contralaterally

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36
Q

When the mid-thoracic spine rotates, the ___________ rib will posteriorly rotate and the _____________ rib will anteriorly rotate.

A

Ipsilateral
Contralateral

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37
Q

Movement of the ribs with lower thoracic spine movement are quite different due to __________ differences in the vertebrae and rib connections.

A

Structural

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38
Q

How many joints are in the thorax?

A

136

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39
Q

T/F - There is a lot of movement in the thorax, even if each joint only moves a little bit.

A

True

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40
Q

We generate our core power with thoracopelvic ________.

A

Rotation

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41
Q

The ______ is the key contributor for trunk rotation.

A

Thorax

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42
Q

Thoracic mobility and control is essential for the trunk to act as spring during compressive _______.

A

Loading

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43
Q

The thorax adjusts for changes in center of mass over base of support, especially _______ shifts.

A

Lateral

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44
Q

Contains 2 ribs of the same number, the vertebrae to which they attach and the anterior coastal attachments to the sternum and manubrium.

A

Thoracic Ring

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45
Q

Which structures are included in the 4th thoracic ring?

A
  • Left and right 4th ribs
  • T3
  • T4
  • 4th costocartilages
  • Sternum
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46
Q

How many complete and incomplete thoracic rings are there?

A

10 complete (1-10)
2 incomplete (11-12)

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47
Q

T/F - The entire thoracic ring does not need to be intact for optimal biomechanics.

A

False - The entire thoracic ring NEEDS to be intact for optimal biomechanics.

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48
Q

During flexion of the trunk the thoracic rings __________ tilt, and conversely during extension the thoracic rings ___________ tilt.

A

Anteriorly
Posteriorly

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49
Q

T/F - During side bending of the trunk, the vertebrae side flex contralaterally, ribs approximate ipsilaterally and separate contralaterally.

A

False - During side bending of the trunk, the vertebrae side flex IPSILATERALLY, ribs approximate ipsilaterally and separate contralaterally.

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50
Q

During ________ of the trunk, the ipsilateral rib will posteriorly rotate, the contralateral rib will anteriorly rotate and the vertebra will shift to the _____________ side.

A

Rotation
Contralateral

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51
Q

During ___________, the _______ muscles of respiration include:
- Diaphragm
- Levator costorum
- External intercostals
- Internal intercostals (anterior)

A

Inspiration
Primary

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52
Q

During __________, the _______ muscles of respiration include:
- Internal obliques
- External obliques
- Rectus abdominus
- Transversus abdominus
- Transversus thoracis
- Transverse intercostals
- Internal intercostals (posterior)

A

Expiration
Primary

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53
Q

During ___________, the _________ muscles of respiration include:
- Scaleni
- SCM
- Trapezius
- Serratus anterior and posterior
- Pectoralis major and minor
- Subclavius
- Latissimus dorsi
- Serratus posterior superior
- Quadratus lumborum
- Iliocostalis lumborum

A

Inspiration
Secondary

54
Q

Primary muscle of respiration that is shaped like a large dome and divides the thorax from the abdomen.

A

Diaphragm

55
Q

T/F - The right side of the diaphragm is slightly higher than the left because of the presence of the liver just below it.

A

True

56
Q

The level of the top of the diaphragm varies from the ____ intercostal space (during expiration) to the ____ intercostal space (during inspiration).

A

4th
6th

57
Q

The diaphragm is innervated by ___, ___ and ___ (phrenic nerve).

A

C3, C4 & C5

58
Q

The ______ of the diaphragm is:
- Xiphoid process
- Lower 6 cartilages
- Lower 4 ribs interdigitating with transversus abdominus
- Upper lumbar vertebral bodies via two muscular cura
- Medial arcuate ligaments
- Lateral arcuate ligaments

A

Origin

59
Q

The insertion of the diaphragm is the non-contractile _______ ______ that is boomerang-shaped and forms a dome.

A

Central Tendon

60
Q

The central portion of the diaphragm fuses with the ___________.

A

Pericardium

61
Q

During inspiration, contraction of the diaphragm causes decent of the central tendon. The volume is _________ and pressure is _________ in the abdominal cavity. The volume is _________ and pressure is _________ in the thoracic cavity.

A

Decreased
Increased
Increased
Decreased

62
Q

What causes air to rush into the lungs?

A

Pressure difference between the atmosphere and lungs

63
Q

T/F - During expiration, the diaphragm relaxes (eccentrically contracts) and the dome descends.

A

False - During expiration, the diaphragm relaxes (eccentrically contracts) and the dome ASCENDS.

64
Q

When the upper ribs and sternum are elevated, the _______________ diameter of the thorax is increased.

A

Anteroposterior

65
Q

Which action is being described below?
“Movement at the costovertebral joint around the medial-lateral axis results in raising and lowering of the sternal end of the rib.”

A

Pump Handle

66
Q

The lower ribs move laterally when they are elevated, thereby increasing the __________ diameter of the thorax.

A

Transverse

67
Q

Which action is being described below?
“Movement at the costovertebral joint around an anterior-posterior axis leads to elevation of the middle of the rib.”

A

Bucket Handle

68
Q

T/F - The bucket handle movement takes place mainly at ribs 7 through 10.

A

True

69
Q

The lower ribs move laterally, in what is known as a _______ action, to increase the lateral diameter.

A

Caliper

70
Q

When we inhale, the spine _______, the ribs expand — they rotate posteriorly and glide __________ where they meet the spine.

A

Extends
Inferiorly

71
Q

When we exhale, the spine ______, the ribs rotate anteriorly and glide __________ where they meet the spine.

A

Flexes
Superiorly

72
Q

T/F - Vertebral compression fracture can occur anywhere along the spine, but is particularly common in the higher thoracic region.

A

False - Vertebral compression fracture can occur anywhere along the spine, but is particularly common in the LOWER thoracic region.

73
Q

Vertebral compression fractures occur in older patients with the main cause being ____________.

A

Osteoporosis

74
Q

With vertebral compression fractures, a _________ hump and a noticeable increase in ________ may be present as the anterior vertebral body collapses and tips forward.

A

Dowager’s
Kyphosis

75
Q

_______ causes spinal misalignment, where segments above will also begin to tip forward and eventually cause the spine to curve.

A

Tipping

76
Q

In younger patients, the cause of vertebral compression fractures will be ________ ______.

A

Physical Trauma

77
Q

Presentation in older people is sudden onset of acute pain after minor trauma, such as stepping off a curb, sudden movement or even sneezing.

A

Vertebral Compression Fracture

78
Q

If progression of the bony collapse is slow, these types of vertebral compression fractures can be “______” aka. ____________ and may present a mild pain when the break occurs.

A

“Silent”
Asymptomatic

79
Q

T/F - Increased exercise increases the risk of vertebral compression fractures, therefore light resistance and weight-bearing exercise are good preventative measures.

A

False - DECREASED exercise increases the risk of vertebral compression fractures, therefore light resistance and weight-bearing exercise are good preventative measures.

80
Q

T/F - Refer out if you suspect an undiagnosed vertebral compression fracture.

A

True

81
Q

Medical treatment for vertebral compression fractures range from ____ management and short-term modification of _____ to surgical intervention depending on presentation and severity.

A

Pain
ADLs

82
Q

A lateral curvature of the spine. Because the vertebral column cannot bend laterally without also rotating, _________ involves both lateral flexion and rotation.

A

Scoliosis

83
Q

Scoliosis affects __ to __% of the population, and 80% of these cases are __________.

A

2-4%
Idiopathic

84
Q

Onset of _________ is usually between ages 10-15 years in adolescents, where rapid growth spurts occur and spinal development is most relenting to ________ and environmental influences during this time.

A

Scoliosis
Genetics

85
Q

T/F - Scoliosis is most prevalent in adolescent males as they undergo puberty before musculoskeletal maturity.

A

False - Scoliosis is most prevalent in adolescent FEMALES as they undergo puberty before musculoskeletal maturity.

86
Q

T/F - Scoliosis usually involves the thoracic and lumbar regions.

A

True

87
Q

Signs and symptoms of _________ include:
- Typically asymptomatic
- Rib prominence, elevated shoulder and/or prominent shoulder blade
- Uneven hip, arm or leg lengths
- Uneven musculature, impaired mobility and muscle performance

A

Scoliosis

88
Q

T/F - Back pain is not usually considered a scoliosis symptom.

A

True

89
Q

Complications of _________ include:
- Pulmonary/cardiac risks due to compression of the ribcage
- Neurological complications
- Gastrointestinal disturbances
- Intermittent backache may occur

A

Scoliosis

90
Q

________ symptoms of scoliosis include:
- Radiating leg pain
- Night pain
- System complaints (e.g. bowel/bladder)

A

Abnormal

91
Q

Labelling of either a right or left curve with scoliosis is dictated by the ______ side.

A

Convex

92
Q

What are the 2 scoliosis curve shapes?

A

C-curve
S-curve

93
Q

The severity of major and minor curves with scoliosis are determined by the degrees of ________.

A

Rotation

94
Q

A labelling component of scoliosis is ____________ vertebra between the curves.

A

Transitional

95
Q

The anatomical start and end points of a curve.

A

Span

96
Q

The vertebra furthest from midline.

A

Apex

97
Q

Curve patterns are designated according to the level of the ____ of curve.

A

Apex

98
Q

Match the following Cobb angle ranges to the corresponding level of severity related to scoliosis.
1) 20-50 degrees
2) <10 degrees
3) 50 degrees
4) 10-20 degrees

A) Mild
B) Severe
C) Normal
D) Moderate

A

1) 20-50 degrees - D) Moderate
2) <10 degrees - C) Normal
3) 50 degrees - B) Severe
4) 10-20 degrees - A) Mild

99
Q

The vertebral bodies rotate to the _________ of the curve and become distorted. If this occurs in the thoracic spine, this rotation causes the ribs on the convex side of the curve to push ___________ causing a “___ ____” and a narrowing on the convex side.

A

Convexity
Posteriorly
“Rib Hump”

100
Q

The ribs on the concave side of the curve are pushed more __________ causing a “______” and a widening of the thoracic cage.

A

Anteriorly
“Hollow”

101
Q

T/F - The direction of vertebral body rotation would present to the same side as the thoracic spine lateral flexion.

A

False - The direction of vertebral body rotation would present OPPOSITE TO the thoracic spine lateral flexion.

102
Q

The vertebral body is always directed at the _________ side and the spinous process towards the _________ side.

A

Convexity
Concavity

103
Q

A reversible type of scoliosis that can be altered with forward or side bending and positional changes. Proper and consistent treatment may include therapeutic exercise, positional changes and correction of contributing causes.

A

Functional Scoliosis (aka. Postural Scoliosis, Non-Structural Scoliosis)

104
Q

T/F - Both functional and structural scoliosis are commonly caused by leg-length discrepancy.

A

True

105
Q

Other causes of __________ scoliosis include boney asymmetries, muscle guarding/spasm from a painful stimuli in the back or neck and habitual/aberrant postures (e.g. d/t occupational stresses).

A

Functional

106
Q

Functional scoliosis can be caused by altered soft tissue integrity, functional and adaptive changes (e.g. ____________ of muscle and/or fascia, trigger points).

A

Contracture

107
Q

Someone with functional scoliosis may adopt an ________ gait to minimize or avoid pain.

A

Antalgic

108
Q

What do we use to test for functional scoliosis?

A

Adam’s Forward Bend Test

109
Q

Which test is being described below?
“The spine needs to be visible. The patient bends forward at the waist until the back comes in the horizontal plane, with feet together, arms hanging and knees extended. The palms are held together. The examiner looks from behind, along the horizontal plane of the column vertebrae. The examiner looks for indicators of scoliosis.”

A

Adam’s Forward Bend Test

110
Q

The following are indicators of _________:
- Spinal asymmetry
- Unlevel shoulders
- Scapula asymmetry
- Unlevel hips
- Head does not line up with the pelvis
- Rib hump
- Increased/decreased lordosis/kyphosis

A

Scoliosis

111
Q

A type of scoliosis described as a fixed deformity (congenital or acquired) that does not correct with positional change. It is irreversible and further classified according to the cause.

A

Structural Scoliosis

112
Q

The most common type of scoliosis involving a structural spinal curve with no established cause.

A

Idiopathic Scoliosis

113
Q

Cause of __________ scoliosis is likely complex and multifactorial (e.g. genetics, tissue imbalances, hormonal and/or neurological components).

A

Idiopathic

114
Q

T/F - Idiopathic scoliosis does not occur in healthy, neurologically normal children and adolescents.

A

False - Idiopathic scoliosis OCCURS in healthy, neurologically normal children and adolescents.

115
Q

Name the 4 groups according to age of onset for idiopathic scoliosis:
1) _________ (birth - 3 years)
2) ________ (4 - 10 years)
3) __________ ( > 11 years)
4) ______ ( > 18 years)

A

1) Infantile (birth - 3 years)
2) Juvenile (4 - 10 years)
3) Adolescent ( > 11 years)
4) Adults ( > 18 years)

116
Q

Which age of onset for idiopathic scoliosis is the highest risk? Which is the most common?

A

Juvenile (4 - 10 years) = highest risk
Adolescent ( > 11 years) = most common

117
Q

T/F - Idiopathic scoliosis is progressive and cannot be “fixed” or “corrected,” however symptoms can be reduced and functionality may be improved.

A

True

118
Q

A type of scoliosis caused by disturbances in vertebral development. Involves failures of formation or failures of segmentation of the vertebral bodies.

A

Congenital Scoliosis

119
Q

Individuals with __________ scoliosis may present with neurological complications, but it is not common.

A

Congenital

120
Q

Congenital scoliosis usually occurs during the first __ weeks of embryonic formation.

A

6 weeks

121
Q

T/F - Congenital scoliosis is not a progressive disorder, and therefore does not usually involve surgical intervention.

A

False - Congenital scoliosis MAY BE a progressive disorder, and therefore USUALLY involves surgical intervention.

122
Q

A type of scoliosis often presenting as a long c-shape curve from the cervical to sacral region. Often associated with neuropathic disease (e.g. cerebral palsy, poliomyelitis), upper/lower motor neuron lesion, or myopathic disease.

A

Neuromuscular Scoliosis

123
Q

When muscle fibres do not function normally, resulting in severe muscle weakness. May be associated with muscle stiffness or spasms.

A

Myopathic Disease

124
Q

____ will be an important factor when considering intervention for scoliosis.

A

Age

125
Q

T/F - With scoliosis in children and adolescents, treatment usually focuses on relieving pain.

A

False - With scoliosis in ADULTS, treatment usually focuses on relieving pain.

126
Q

Consistent monitoring of the curve ___________ is a key component to the plan of care in children and adolescents.

A

Progression

127
Q

With _____ curve progression, bracing and surgical options are considered.

A

Rapid

128
Q

Forms of treatment and interventions are considered when the curve is between ___ to ___ degress.

A

20-30 degrees

129
Q

_______ is considered when the curve is between 30-40 degrees.

A

Bracing

130
Q

Surgical interventions are considered when the curve is between ___ to ___ degrees.

A

40-45 degrees

131
Q

_______ is used to prevent further progression of a scoliosis curve.

A

Bracing

132
Q

_______ is used to stop the progression of a scoliosis curve. It corrects the deformity in all three planes and _____ the spine.

A

Surgery
Fuses

T4 MSK (4 decks)

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