tspine ah Flashcards
1
Q
T spine vertebrae
A
12
2
Q
size progression t spine vertebrae
A
increase size
3
Q
diamter t spine verterpae
A
transvese = A/P
4
Q
height t spine vertebrae
A
higher posteriorly than anterior forms kyphosis
5
Q
Costal facets of t spine
which
function
A
ON SIDE OF BODY
superior = WB
Inferior= demi facet placeholder
6
Q
t spine vertebral foramen
A
small
7
Q
lamina t spine
A
short and thivk
overlap eachother
8
Q
SP t spine
A
POSTERIOR and INFERIOR
overlap
9
Q
articular process t spine
A
SUPERIOR process:
posterior , superior and Lateral
convex
iINFERIOR:
inferior, medial and anterior
concave
10
Q
facet jt t spine
A
60 degrees
*rotation limit by ribs
11
Q
TP of t spine
A
LATERAL and POSTERIOR
bulbous tp
OVAL FACETS FOR ARTICULATION WITH TUBERCLES OF CORRESPONDING RIBS
12
Q
WHY issues with rib 1
A
1st vertebrae of t spine holds it all by itself
2 circular facet e side instead of superior and inferior
*superior facet faces up and back
***SP is thick and long and horizontal
LONGEST TP in THORACIC SPINE
13
Q
T9-does it articulate with rib 10?
A
no
absent demi facets
14
Q
T10 -what it holds
does it touch rib 11?
A
takes all the weight of rib 10
doesnt articulate rib 11
**NO INFERIOR COSTAL FACET
15
Q
T11 -what it holds
do TP have articular facets?
A
holds all weight of rib 11
no
16
Q
T12
what it hold
special function
A
all weight of rib 12
2 costal facets for rib 12
bridge thoracic and lumabr vertebrae : superior facet like thoracic and inferior like lumbar
17
Q
which ribs attach manubrium or body of sternum?
A
1-7
TRUE RIBS
18
Q
which ribs attach to bottom of superior rib?
A
8-10
FALSE RIBS
19
Q
which ribs floaters?
A
11-12
FLOATING RIBS
20
Q
3 rib functions
A
- stiffen and strengthen thoracic spine
- protect cavity for heart, lungs, and great vessels
- provide attachment for muscles needed for posture, respiration, UE function
21
Q
rib head
how many facets and ridge?
A
2 articular facets
ridge = called a crest of the head
22
Q
crest of the rib
A
articulates with the IV discs by intra-articular ligament
- -attached by ligament to disc
- -crest is point of articulation w disc at motion segment
23
Q
facets on the rib
which correspons with corrresponding vertebrae?
A
2
the inferior facet of the rib with the same number vertebae
24
Q
does superior articular facet correspond to vertebrae above or below?
A
ABOVE (to the placeholder)
25
where is angle of rib?
go out 5-6cm
26
where does rib articulate with TP?
anterior to TPof same # vertebae
27
tubercle of rib
medial
lateral
medial: smooth convex articulate with same # TP
lateral: rough non articular for lateral costal transverse ligament
28
body /shaft of rib
5-6cm beyond tubercle
point of most change in curvature is the angle of the rib
29
what attach angle of rib
iliocostalis muscle
30
where on rib spot for nerve and artery and vein?
costal groove
31
rib 1
MOST CURVED
SHORTEST
BROADEST
NO ANGLE OR COSTAL GROOVE
-muscles attach
32
rib 2
THINNER AND 2X LONGER THAN 1ST RIB
muscles attach
barely rib angle
33
rib 10
ONE articular facet -goes to T 10
34
rib 11 and 12
short
can be assymetircal
single facet on head
no neck or tubercle
only articulate w the body of VB not TP
35
ratio of disc height to VB in t spine
1:5
| biggest is cervical (2/5)-> then lumbar (1/3) --> then thoracic (1/5
36
position of xyphoid
DOWN and FORWARD
convex anterior
concave posterior
longer in males (17cm)
manubrium, body, xyphoid
37
which rib at sternal angle btwn manubrium and body
rib 2
38
which rib on xyphoid
some of rib ten (rest is on body)
39
6 joints t spine
```
1. facet
2, costovertebral
3 . costotransverse
4. sternocostal
5. costochondral
6. interchondral
```
40
DF at facet joit
3
flex/extend
latreral flex
rotate
41
costovertebral jt motion
motions
facts
elevation
depression
some rotation
SYNOVIAL **btwn rib and VB with IV discs in btwn
42
costotransverse jt
job
control elevation
depression
rotation of costovertebral jt
- -synovial joint
- -located btwn ribs and reciprocal facet on TP of same # vertebrae
43
do ribs 11 and 12 have costotransverse joints?
no
44
sternocostal joint
btwn costal cartilage and sternum
1 costal cartilage united to manubrium by SYNCHONDROSIS
2-7 = synovial w lateral border sternum
45
Costochondral joint
btwn rib and costal cartilage
no ligament
46
interchondral jt
synovial
btwn ribs 6-8
may become fibrous later in life
47
T spine flexion:
**exhale helps
top vertebrae: inferior articular process ANTERIOR and SUPERIOR over the bottom one
OPENEING
nuclear material posterior
posterior ligaments taut
ALL relaxed
48
T spine extension
*inhale helps
top vertebrae slides inferior and posterior
CLOSE facets
nuclear posterior
ALL taut
49
T spine lateral flexion
ipsilateral: close
contralateral: opn
nuclear: contralateral
limits: intertransverse lig, ligamentum flavum, articular proceses
COUPLED WITH ROTATION
50
T spine rotation
inferior facet of top slides on superior facet of bottom
disc twists
ROTATION COUPLED WITH LATERAL FLEXION
51
t spine coupled movements
ERECT
sidebend and rotation to opposite direction (like in lumbar = Fryette’s First Law: Neutral Mechanics or Type I Mechanic)
52
t spine coupled movements
engaged
Side-bending and rotation occur to the same side
Fryette’s Second Law: Non-Neutral Mechanics or Type II Mechanics:
53
t spine coupled movements
greenman about when engaged
T4-T8
if rotate first then rotation and sidebending happen together same side
(if sidebend first then opposite side from rotation)
(T1-T4 same as fyettte = engaged same side)
54
which ribs dominate which motions and what direction of expansion
PUMP HANDLE = a/p expansion = top ribs
BUCKET HANDLE = middle ribs = swing out and in
CALIPER = lower ribs = open like tongs = lateral
55
where is rib motion
costocondral junction and
| where articulate TP + rib
56
each rib may be regarded as a lever with its fulcrum situated at the ___
costotransverse joint
when rib shaft is elevated the neck is depressed
when rib shaft is depressed the neck is elevated
57
All ribs have both pump handle and pump motions
where each dominate?
upper ribs--more pump handle (AP)
lower ribs-more bucker handle -lateral aspect of rib move superiorly
THIS IS DUE TO THE AXIS OF THE COSTOVERTEBRAL TO THE COSTOTRANSVERSE ARTICULATION
58
where is the axis of rib motion more transverse?
UPPER RIBS
PUMP HANDLE
Transverse
LOWER RIBS
BUCKET HANDLE
A/P Axis
CALIPER
ribs 11 and 12
Inhalation = posterior and lateral
Exhalation = anterior and medial
59
UPPER RIBS PUMP AXIS
transverse
60
Lower Ribs Bucket axis
a/p
61
Caliper Motion
where
inhale
exhale
ribs 11 and 12
INHALE: posterior and lateral
Exhale: anterior and medial
62
MOTION at
costovertebral joint
minimal glide and rotation
bc
RADIATE LIGAMENT
COSTOTRANSVERES LIGAMENT
63
MOTION at
costotransverse joint
1-6 ROTATION
| 7-10: glide
64
MOTION at
Sternocostal joint
2-7
= glide to assiste respiration
65
Where can we get impingement in TOS? 3
Interscalene triangle: anterior and medial scalene and rib 1 (ADSON)
Costoclavicular space: clavicle and rib 1 (COSTOCLAVICULAR MANEUVER)
Neurovascular bundle passes beneath coracoid process and tendon of pec minor (HYPERABDUCTION MANEUVER)
66
Adson
for TOS
narrow Interscalene triangle: anterior and medial scalene and rib 1
1) monitor pulse
2) extend and ER UE passively (hand is in tennis forearm position )
3) pt looks at hand
4) deep breath
record sx and change in pulse
also turn head other way
67
Costoclavicular maneuver
TOS
Costoclavicular space: clavicle and rib 1
- pt sit
- arms at side
- monitor radial pulse
- shoulder retracted and depressed + position exagerated military posture
record change and reproduce sx
68
Hyperabduction Maneuver
= wrights maneuver
compress'Neurovascular bundle passes beneath coracoid process and tendon of PEC minor
1. pt seated
2. monitor radial pulse
3. pt arms at 145 degrees abduction withs slight extension
4. record pulse change and sx
69
Roos East Test
elevated arm stress test
test for VASCULAR INSUFFICIENCY
pt seated
abduct arms to 90 degrees
externally rotate shoulders and flex elbows to 90 degrees
pt open and close hands slowly 3 minutes
+ = ischemic pain, heavy arms, numb and tingle hands
70
Disc Herniation
be traumatic or degenerative
asymptomatic people have thoracic disc protrusion: so interpret MRI results guardedly
Dural stretch may be positive—positive kerning if high enough, positive slump test
get rid of inflammation as much as can, then decrease symptoms as can ie extension or flexion or sideglide as in McKenzie technique
Incidence : T7/T8 --> T6/T7 --> T8/T9
Symptoms:
1. Anterior chest pain
2. Interscapular, epigastric and LE pain
3. Pain may increase with deep breathing and coughing /pain with valsalva
4. Muscle spasms, muscle weakness, decrease ROM
(There may be guarding
71
Schuermann’s Disease
= vertebral osteochondritis or juvenile kyphosis
Degeneration of bone resulting in structural sagittal plane kyphosis in thoracic or thoracolumbar spine
growth spurt in adolescents age 12-16 years
Excessive thoracic kyphosis with wedging of 5 degrees or more in at least three adjacent vertebrae with vertebral end plate irregularities
X-ray findings: All of these things mess up the mechanics of the joint
1. Anterior wedging VB
2. Irregularities of vertebral end plates
3. Schmorl’s nodes
a. See it on the xray
Decreased IV disc space heights
72
Scoliosis
Name the curve by the side of the convexity: Forward bending test because the spinous process will go to the side of the concavity and bodies to side of convexity, push ribs backwards so on visual view as person bends down see a rib hump.
Structural scoliosis is a fixed lateral curve with a rotational component
* *common structural scoliosis is called idiopathic
* *congenital anomalies, neuromuscular, disease, trauma
Nonstructural scoliosis also called functional or reversible lateral curve without rotation (look this up)
**poor posture or compensation to musculoskeletal imbalances
1. May develop cardiopulmonary symptoms (curves greater than 40 degrees) with reduced vital capacity and decreased pulmonary function
73
Nonstructural scoliosis
Nonstructural scoliosis also called functional or reversible lateral curve without rotation (look this up)
74
Structural scoliosis
Structural scoliosis is a fixed lateral curve with a rotational component
75
Cervical Point of the back
localized area of tenderness T5/T6 (2cm from line of spinous process)
Referred from C5/C6, C6/C7 or C7/T1
Presents as thoracic pain of postural origin
Feel better when they lie down, when correct their posture
1. Facets usually tender on same side as thoracic pain
Treat cervical spine !!
76
T4 Syndrome
Decreased mobility of upper thoracic segments, especially T4 = Decreased mobility of upper thoracic segments, especially T4
1. Glove paresthesia (long or short)
It doesn’t match dermatome, it is from the sympathetic
2. May have vascular symptoms like hot or cold hands, swelling
3. Non-dermatomal patterns of pain in UE: sympathetic nerve involvement
4. Neck, upper thoracic pain, headache in cap of head
5. Symptoms start in the morning and get worse, especially with poor posture
6. Symptoms may interrupt sleep
**1. Positive neurodynamic tests
1. Treatment of choice is to mobilize the affected segment (T4) followed by posture and movement reeducation
77
Thoracic Hypomobility
a. stiffness in thoracic spine ie MVA, hit with football, a fall and hit head and back: decreased mobility and PIVM, postural changes, look and see if ribs changes as well
1. Onset secondary to trauma, degenerative joint changes, decreased movement thoracic cage, or immobility
1. decreased mobility with AROM and or PIVMT
2. Postural Changes
3. Decreased Chest expansion: rib changes
4. General loss of extension and rotation
Tight/painful paravertebral muscles in affected area
78
Thoracic Facet Dysfunction
a. impaired mobility, it will make sense if facet affected, decreased mobility at specific segment, ribs may also be affected and must be assessed in addition to assessing the facet joints
1. Relatively common
2. Associated with rib dysfunction
3. Localized symptoms
4. Movement impairments
5. Decreased joint play facet and rib
6. Symptoms with respiration
1. Quicker and more robust movements to the ribs ie on a jog feel the pain in addition to the impact by loading the joint
7. Pain may be present in anterior chest wall
1. Pain may refer around the rib to sternalcostal junction or costochondral junction may be tender as well
Treat with mobilizations
79
Ankylosing Spondylitis
1. Low back and thoracic pain
1. Everything stiffens up
2. Collagen issue
2. Not relieved with lying supine
3. Worse with rest, better with activity
4. Morning stiffness
5. History of collagen disease in family
6. Age of onset
80
Treat TOS
cannot just be the opposite of the test because we need to respect the nerve and the musculature
1. Adson positive: (scalene) Soft tissue work to get the muscles more elastic (stretching increases the symptoms)
2. Costoclavicular Maneuver positive: (rib 1 and clavicle) Mobilize rib #1, mobilize SC and AC joints, exercises, deep breathing so upper rib cage is mobilizing, soft tissue work and open up area around scalene as well
3. Hyperabduction test positive: (pectoralis minor) soft tissue work of pec major and pec minor, get under there, clear the landmarks going around the border of the pec minor and get through tissue deeply get into region and mobilize, can move the middle ribs where pec minor fibers attach ie big breathes. Later can do stretches for better flow to the extremity.
