TS Anatomy Flashcards
1
Q
Unique features of thorax - in one typical vertebra (T2-T9) there will be 12 separate articulations for what structures?
A
- superior articular processes (2) for facet joints above
- inferior articular processes (2) for facets joints below
- superior demi-facets (2) for costovertebral joints
- inferior demi-facets (2) for costovertebral joints
- transverse process facet (2) for costotransverse joints
- intervertebral joints (2)
2
Q
Relative stability of the TS compared to the LS & CS is due to:
A
- rib cage (increase stability of unit nearly 3x & greatly decrease mobility)
- attachment of rib head to intervertebral disc
- angulation of facets & decreased disk height
3
Q
T/F: any movement occurring at any joint of each ring (costovertebral, costotransverse, sternocostal or facet joint) can potentially influence motions at the other joints within the ring or adjacent segments.
A
True
4
Q
Why is the integrity of the thoracic ring important?
A
-it is critical to the stability of the thorax
5
Q
Which other musculoskeletal dysfunctions can the thoracic spine contribute to?
A
- shoulder
- AC/SC
- neck
- lumbar
6
Q
What are the functional regions of the thoracic spine?
A
- cervicothoracic junction (CT junction)
- middle thoracic spine
- thoracolumbar (TL) junction
7
Q
What are the segments that make up the cervicothoracic (CT junction)?
A
-C7 through T3
8
Q
What are the segments that make up the middle thoracic spine?
A
-T4 through T9
9
Q
What are the segments that make up the thoracolumbar (TL) junction
A
-T10 through L1
10
Q
Anatomy of the vertebromanubrial region (classified by Diane Lee)
A
-upper thorax, T1-2 + Rib 1-Rib 2 + manubrium
11
Q
Anatomy of the vertebrosternal region (classified by Diane Lee)
A
-middle thorax, T3-T7 + Rib 3-Rib 7 + sternum
12
Q
Anatomy of the vertebrochondral region (classified by Diane Lee)
A
-middle/lower thorax, T8-T10 + Rib 8 - Rib 10
13
Q
Anatomy of the thoracolumbar region (classified by Diane Lee)
A
-lower thorax, T11-12 + Rib 11 - Rib 12
14
Q
Anatomical orientation of the vertebral bodies and intervertebral discs in the thoracic spine?
A
-vertebral bodies & intervertebral discs are higher posteriorly than anteriorly
15
Q
How does the anatomical orientation of the vertebral bodies and intervertebral discs affect the load on the vertebral body in the TS?
A
-since both structures are higher posteriorly than anteriorly, there is increased load ventrally on the vertebral body
16
Q
How do the vertebral bodies in the TS compare to the vertebral bodies in the LS?
A
-TS vertebral bodies are more wedge-shaped
17
Q
Which thoracic vertebrae are considered typical in reference to their morphology?
A
T2-T9
18
Q
Which thoracic vertebrae are considered atypical in reference to their morphology?
A
T1, T10, T11, T12
19
Q
Which structures form the costovertebral joint (CVJ)?
A
-formed by the articulation between the head of the rib, the intervertebral disc and the vertebral body at the same level and the level above
20
Q
Anatomical variations in T1?
A
-two ovoid facets for articulation with Rib 1 with two small demi-facets on the inferior aspect of the body for articulation with Rib 2
21
Q
Anatomical variations in T9 and T10?
A
- T9 has two demi-facets for articulation with rib 9 & often, there is a small articulation between the superior aspect of the head of the 10th rib & the inferior aspect of the vertebral body of T9.
- occasionally, the 10th rib will articulate only with T10
22
Q
Anatomical variations in T11 and T12?
A
-rib 11 and rib 12 articulate only with the vertebral body at the same level
23
Q
Disc height ratio comparison between TS, CS and LS?
A
TS = 1:5 CS = 2:5 LS = 1:3
24
Q
Why is it typical to see central disc protrusions of the annular type and not nuclear?
A
-the nucleus in the TS is so small
25
Schmorl's nodes
-herniation of disc substance through cartilaginous plate of disc into the body of the adjacent vertebra
26
Why does a patient complain of band of pain with damage to the outer annulus of the intervertebral disc?
-poly-segmental innervation (patient will complain of band of pain)
27
Why does a patient complain of thumbprint pain with damage to the inner annulus of the intervertebral disc?
-mono-segmental innervations (thumbprint pain)
28
How does the ALL differ in the TS compared with the CS & LS?
-the TS ALL is narrower but thicker relative to CS & LS
29
TS anterior compartment structures?
1. vertebral bodies
2. intervertebral discs
3. ligaments (ALL)
30
What structures form the vertebral arches in the TS?
-the lamina & pedicles
31
Function of the vertebral arch?
-protects spinal cord
32
Where is the spinal canal smallest?
-middle thoracic segments (T4-T9)
33
What junctions have large spinal canals?
1. cervico-thoracic junction
| 2. thoraco-lumbar junction
34
TS lamina
-when disc protrudes dorsally there is no chance for other structures to move out of the way. a very small protrusion of the disc can cause immediate dural irritation
35
TS pedicle
-located cranial, short & thick
36
T/F - it is common to have facet orientation asymmetry in the TS
true
37
Upper facet segments orientation:
-45-60 degrees from horizontal in the coronal plane
38
Middle facet segments orientation:
-50-60 degrees from the horizontal in the coronal plane (or 20 deg. in the transverse plane)
39
Lower facet segments orientation:
-inferior facets of T11 and T12 can resemble lumbar Z joint (in sagittal plane) changing by 90 degrees
40
Convex/concave rule for TS facet joints
-superior facets are slightly convex & inferior facets are slightly concave
41
Facet joints innervation for TS?
-medial branch of dorsal rams, supplied by axons from 1 to 2 adjacent root levels above, the same level & 1-2 levels below
42
Description of spinous processes?
-long (5-6 cm), slender & triangular shape
43
Function of spinous processes?
-increase inferior angulation
44
Location of transverse process in relation to spinous process for T1-T3?
-TP is directly lateral to the SP
45
Location of transverse process in relation to spinous process for T4-T9?
-TP is superior to the SP (as many as 3 fingers)
46
Location of transverse process in relation to spinous process for T10-T12?
-gradual transition of TP lateral to SP
47
What forms a costotransverse joint (CTJ)?
-formed when the ribs attach to the transverse process via the costotransverse ligament
48
PLL of TS?
- thicker in thoracic region
| - wider at disk level & narrower at vertebral body
49
Ossification of PLL & Ligamentum Flavum
-middle & low back pain, difficulty with balance, progressive gait disturbance, onset of bladder retention, MRI & CT sensitive
50
Rx for ossification of PLL & Ligamentum Flavum?
-a decompressive laminectomy
51
What motion does the facet capsule limit?
-TS flexion
52
intertransverse ligament
-attach TP to TP
53
costotransverse ligament
-in costotransverse foramen (interval between neck of rib & anterior surface of associated transverse process; attach rib to TP
54
lateral costotransverse ligament
- short & thick
| - apex of transverse process to non-articulating portion of tubercle of adjacent rib
55
superior costotransverse ligament
-anteriorly between neck of rib & lower aspect of superior transverse process; laterally continuous with intercostals membrane, posteriorly attaches to posterior aspect of neck of rib & transverse process
56
intra-articular costovertebral joint
-from head of rib between facets to the disc in the CVJ; divides joint into 2 cavities
57
radiate ligament of costovertebral joint
-attaches the head of the rib to the disc
58
True ribs
ribs 1-7
| considered true ribs because their cartilage attaches directly to the manubrium or sternum
59
How do the true ribs affection motion in the thoracic spine?
- increases flexion/extension stiffness
| - no change in rotation
60
Rib 1
- atypical
| - shortest of the 12 ribs; articulates with the manubrium; the sternochondral joint is fibrous rather than synovial
61
Rib 2
- atypical
| - articulates with manubrium & sternum at manubriosternal symphysis (synovial joint)
62
Rib 3-6
- typical
| - the sternum has 8 full concave facets for articulation with the costocartilage of rib 3-rib 6 (synovial joints)
63
Rib 7
- typical
| - articulates with sternum & xiphoid process
64
False ribs
- ribs 8-10
- articulate indirectly with the sternum by blending with the seventh costocartilage through the chostochondral cartilage of their superior neighbor
65
How do the false ribs influence motion at the thoracic spine?
-increase stiffness with rotation with more ability to move in flexion & extension
66
Ribs 8-9
-typical
67
Rib 10
- atypical
| - articulates with corresponding vertebral level, articulation to TP is variable
68
Ribs 11-12
- atypical
| - no sternal attachment, articulate with corresponding vertebral level but not to the TP of that level
69
Movement of ribs during breathing?
- upper: pump
- lower: bucket
- ribs 1-2: don't move as much
- ribs 3-6: move more in A-P direction (pump)
- ribs 7-10: move more in lateral direction (bucket)
70
Ribs 1-4 elasticity
-stiff, strong, rigid, relative immobility
71
Ribs 5-12 elasticity
-greater elasticity, fracture potential
72
Definition of "typical" ribs?
- Ribs 3-9
- posterior end has a head, neck & tubercle. The head has two articular facets (superior costal facet for articulation with vertebral body above & inferior costal facet for articulation with vertebral body below)
73
Definition of "atypical" ribs?
- Ribs 1, 10, 11, 12
| - they only articulate with their own vertebrae via one full facet
74
Thoracic spine biomechanics general concepts?
-when compared to other regions of the spine, literature regarding the biomechanics of the thoracic spine has not been extensively published. much of the available research is based on observation & empirical data rather than on laboratory studies
75
TS sagittal plane physiological movement?
- 20-45 degrees of flexion
| - 15-20 degrees of extension
76
TS frontal plane physiological movement?
-24-45 degrees of total SB movement
77
TS transverse plane physiological movement?
-35-50 degrees of total rotation movement
78
Upper TS facet joint orientation?
-45-60 degrees to coronal plane
79
Middle TS facet joint orientation?
-90 degrees to coronal plane/20 degrees to transverse plane
80
Lower TS facet joint orientation?
-0 degree to coronal plane (starts to change from coronal to sagittal plane)
81
How does movement in the C-spine cause movement up/down the kinematic chain?
-causes movement down to T3-4
82
How does movement in the UE cause movement up/down the kinematic chain?
-causes movement down to T5-6
83
How does movement in the LE cause movement up/down the kinematic chain?
-causes movement down to T7-8
84
How does movement in the UE/LE (during gait) cause movement up/down the kinematic chain?
-causes movement down to T6-8
85
TS disc mechanics?
- primarily controls rotation & extension
| - minor control of flexion & SB
86
Flexion osteokinematics in a mobile thorax?
-anterior translation coupled with forward sagittal rotation induces anterior rotation of the ribs
87
Flexion arthrokinematics of the vertebra in a mobile thorax?
-interior facet of the superior vertebra glides superior-anteriorly at the facet joints
88
Flexion arthrokinematics of the rib in a mobile thorax?
-convex tubercle of the rib glides superiorly on the concave transverse process of T3-T7 in response to the anterior rotation of the rib - convex on concave
89
Flexion osteokinematics in a stiff thorax?
-ribs are less mobile
90
Flexion arthrokinematics of the vertebrae in a stiff thorax?
-the arthrokinematics are the same as a mobile thorax with the exception that the degree of anterior translation is less
91
Flexion arthrokinematics of the ribs in a stiff thorax?
-ribs are less mobile, during forward bend the anterior aspect of the rib travels inferiorly while the posterior aspect travels superiorly. once the mobility of the rib cage is exhausted, the thoracic vertebrae continue to flex on the stationary ribs
92
Flexion osteokinematics of a rigid thorax?
-the relative flexibility between the vertebral column & the rib cage is the same, no palpable movement between the thoracic vertebrae & the ribs
93
Flexion arthrokinematics change in the vertebrae of a rigid thorax?
-some superior gliding but little anterior translation
94
Limiters of TS flexion?
- posterior ligaments
- posterior 1/2 of disc
- facet joints & CVJ
95
Extension osteokinematics in a mobile thorax?
- posterior translation coupled with backward sagittal rotation
- induces posterior rotation of ribs
96
Extension arthrokinematics of the vertebrae in a mobile thorax?
-inferior facet of superior vertebra glides infero-posteriorly at the facet joints
97
Extension arthrokinematics of the ribs in a mobile thorax?
-convex tubercle of the rib of T3-T7 glides inferiorly on the concave transverse process of T3-T7 in response to the posterior rotation of the rib
98
Extension osteokinematics of a stiffer thorax?
-ribs are less mobile
99
Extension arthrokinematics of the vertebrae in a stiff thorax?
-same as in a mobile thorax BUT degree of posterior translation is less
100
Extension arthrokinematics of the ribs in a stiff thorax?
-ribs are less mobile, during backward bend the anterior aspect of the rib travels superiorly while the posterior aspect travels inferiorly. once the mobility of the rib cage is exhausted, the thoracic vertebrae continue to extend on the stationary ribs
101
Extension osteokinematics in a rigid thorax?
-the relative flexibility between the vertebral column & the rib cage is the same, no palpable movement between the thoracic vertebrae & the ribs
102
Extension arthrokinematics changes in the vertebrae in a rigid thorax?
-some inferior gliding but little posterior translation
103
Limiters of TS extension?
- ALL
- anterior 1/2 of disc becomes taught
- compression of the posterior disc & PLL
- contact by either the SP or the facets
104
Biomechanics of side bending in the cervicothoracic region (up to T2)?
-side bending is accompanied by rotation to the same side
105
Osteokinematics of side bending in the TS?
-in both the mobile & stiff thorax the ribs stop moving before the thoracic vertebrae
106
Arthrokinematics of the facets during side bending?
-whichever side the TS is bending to (right side, for example), the right inferior articular process of the superior vertebra glides inferiorly & the L glides superiorly
107
Silent zone (described by Diane Lee) for side bending?
-coupling pattern is not always contralateral & can be ipsilateral. careful examination of 3D movements & PPIVM testing will help guide the clinician in determining the coupling pattern for individual patients
108
Thoracolumbar side bending biomechanics?
-differing reports: side bending is accompanied by rotation to the opposite side vs. Diane Lee reports that pure SB occurs at the TLJ
109
Limiters of TS side bending?
- soft tissue
- ribs
- ipsilateral facet approximation
110
TS side bending influence with breathing?
-active SB towards the pain: increased pain with inspiration: ribs
111
Osteokinematics of rotation in thoracic spine?
-coupled with ipsilateral SB
112
Arthrokinematics of rotation (described for right rotation)?
-R inferior aspect of superior facet joint moves infero-medially & L moves supero-laterally
113
Limiters of TS rotation?
- anterior chest
- stable disc
- rib cage
114
Anterior thoracic spine muscles
1. scalene
2. abdominals
3. serratus anterior
4. pectorals (all attach to ribs)
115
Posterior superficial thoracic spine muscles?
1. spinalis thoracis
2. longissimus thoracis
3. iliocostalis thoracis
4. quadratus lumborum
5. multifidus
116
Posterior deep thoracic spine muscles?
1. rotators
| 2. multifidus
