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tspine ah Flashcards

1
Q

T spine vertebrae

A

12

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2
Q

size progression t spine vertebrae

A

increase size

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3
Q

diamter t spine verterpae

A

transvese = A/P

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4
Q

height t spine vertebrae

A

higher posteriorly than anterior forms kyphosis

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5
Q

Costal facets of t spine

which
function

A

ON SIDE OF BODY
superior = WB
Inferior= demi facet placeholder

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6
Q

t spine vertebral foramen

A

small

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7
Q

lamina t spine

A

short and thivk

overlap eachother

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8
Q

SP t spine

A

POSTERIOR and INFERIOR

overlap

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9
Q

articular process t spine

A

SUPERIOR process:
posterior , superior and Lateral
convex

iINFERIOR:
inferior, medial and anterior
concave

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10
Q

facet jt t spine

A

60 degrees

*rotation limit by ribs

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11
Q

TP of t spine

A

LATERAL and POSTERIOR

bulbous tp

OVAL FACETS FOR ARTICULATION WITH TUBERCLES OF CORRESPONDING RIBS

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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

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13
Q

T9-does it articulate with rib 10?

A

no

absent demi facets

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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

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15
Q

T11 -what it holds

do TP have articular facets?

A

holds all weight of rib 11

no

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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

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17
Q

which ribs attach manubrium or body of sternum?

A

1-7

TRUE RIBS

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18
Q

which ribs attach to bottom of superior rib?

A

8-10

FALSE RIBS

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19
Q

which ribs floaters?

A

11-12

FLOATING RIBS

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20
Q

3 rib functions

A
  1. stiffen and strengthen thoracic spine
  2. protect cavity for heart, lungs, and great vessels
  3. provide attachment for muscles needed for posture, respiration, UE function
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21
Q

rib head

how many facets and ridge?

A

2 articular facets

ridge = called a crest of the head

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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
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23
Q

facets on the rib

which correspons with corrresponding vertebrae?

A

2

the inferior facet of the rib with the same number vertebae

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24
Q

does superior articular facet correspond to vertebrae above or below?

A

ABOVE (to the placeholder)

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25
Q

where is angle of rib?

A

go out 5-6cm

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26
Q

where does rib articulate with TP?

A

anterior to TPof same # vertebae

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27
Q

tubercle of rib

medial

lateral

A

medial: smooth convex articulate with same # TP
lateral: rough non articular for lateral costal transverse ligament

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28
Q

body /shaft of rib

A

5-6cm beyond tubercle

point of most change in curvature is the angle of the rib

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29
Q

what attach angle of rib

A

iliocostalis muscle

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30
Q

where on rib spot for nerve and artery and vein?

A

costal groove

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31
Q

rib 1

A

MOST CURVED
SHORTEST
BROADEST

NO ANGLE OR COSTAL GROOVE

-muscles attach

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32
Q

rib 2

A

THINNER AND 2X LONGER THAN 1ST RIB

muscles attach

barely rib angle

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33
Q

rib 10

A

ONE articular facet -goes to T 10

34
Q

rib 11 and 12

A

short

can be assymetircal

single facet on head

no neck or tubercle

only articulate w the body of VB not TP

35
Q

ratio of disc height to VB in t spine

A

1:5

biggest is cervical (2/5)-> then lumbar (1/3) –> then thoracic (1/5

36
Q

position of xyphoid

A

DOWN and FORWARD

convex anterior
concave posterior

longer in males (17cm)

manubrium, body, xyphoid

37
Q

which rib at sternal angle btwn manubrium and body

A

rib 2

38
Q

which rib on xyphoid

A

some of rib ten (rest is on body)

39
Q

6 joints t spine

A 
1. facet
2, costovertebral
3 . costotransverse
4. sternocostal
5. costochondral
6. interchondral
40
Q

DF at facet joit

A

3

flex/extend
latreral flex
rotate

41
Q

costovertebral jt motion

motions
facts

A

elevation
depression
some rotation

SYNOVIAL **btwn rib and VB with IV discs in btwn

42
Q

costotransverse jt

job

A

control elevation
depression
rotation of costovertebral jt

  • -synovial joint
  • -located btwn ribs and reciprocal facet on TP of same # vertebrae
43
Q

do ribs 11 and 12 have costotransverse joints?

A

no

44
Q

sternocostal joint

A

btwn costal cartilage and sternum

1 costal cartilage united to manubrium by SYNCHONDROSIS

2-7 = synovial w lateral border sternum

45
Q

Costochondral joint

A

btwn rib and costal cartilage

no ligament

46
Q

interchondral jt

A

synovial

btwn ribs 6-8

may become fibrous later in life

47
Q

T spine flexion:

A

**exhale helps

top vertebrae: inferior articular process ANTERIOR and SUPERIOR over the bottom one

OPENEING
nuclear material posterior

posterior ligaments taut
ALL relaxed

48
Q

T spine extension

A

*inhale helps

top vertebrae slides inferior and posterior

CLOSE facets

nuclear posterior

ALL taut

49
Q

T spine lateral flexion

A

ipsilateral: close
contralateral: opn
nuclear: contralateral

limits: intertransverse lig, ligamentum flavum, articular proceses

COUPLED WITH ROTATION

50
Q

T spine rotation

A

inferior facet of top slides on superior facet of bottom

disc twists

ROTATION COUPLED WITH LATERAL FLEXION

51
Q

t spine coupled movements

ERECT

A

sidebend and rotation to opposite direction (like in lumbar = Fryette’s First Law: Neutral Mechanics or Type I Mechanic)

52
Q

t spine coupled movements

engaged

A

Side-bending and rotation occur to the same side

Fryette’s Second Law: Non-Neutral Mechanics or Type II Mechanics:

53
Q

t spine coupled movements

greenman about when engaged

A

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
Q

which ribs dominate which motions and what direction of expansion

A

PUMP HANDLE = a/p expansion = top ribs

BUCKET HANDLE = middle ribs = swing out and in

CALIPER = lower ribs = open like tongs = lateral

55
Q

where is rib motion

A

costocondral junction and

where articulate TP + rib

56
Q

each rib may be regarded as a lever with its fulcrum situated at the ___

A

costotransverse joint

when rib shaft is elevated the neck is depressed

when rib shaft is depressed the neck is elevated

57
Q

All ribs have both pump handle and pump motions

where each dominate?

A

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
Q

where is the axis of rib motion more transverse?

A

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
Q

UPPER RIBS PUMP AXIS

A

transverse

60
Q

Lower Ribs Bucket axis

A

a/p

61
Q

Caliper Motion

where

inhale
exhale

A

ribs 11 and 12

INHALE: posterior and lateral

Exhale: anterior and medial

62
Q

MOTION at

costovertebral joint

A

minimal glide and rotation

bc
RADIATE LIGAMENT
COSTOTRANSVERES LIGAMENT

63
Q

MOTION at

costotransverse joint

A

1-6 ROTATION

7-10: glide

64
Q

MOTION at

Sternocostal joint

A

2-7

= glide to assiste respiration

65
Q

Where can we get impingement in TOS? 3

A

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
Q

Adson

A

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
Q

Costoclavicular maneuver

A

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
Q

Hyperabduction Maneuver

A

= 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
Q

Roos East Test

A

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
Q

Disc Herniation

A

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
Q

Schuermann’s Disease

A

= 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
Q

Scoliosis

A

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
Q

Nonstructural scoliosis

A

Nonstructural scoliosis also called functional or reversible lateral curve without rotation (look this up)

74
Q

Structural scoliosis

A

Structural scoliosis is a fixed lateral curve with a rotational component

75
Q

Cervical Point of the back

A

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
Q

T4 Syndrome

A

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
Q

Thoracic Hypomobility

A

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
Q

Thoracic Facet Dysfunction

A

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

  1. Symptoms with respiration
  2. Quicker and more robust movements to the ribs ie on a jog feel the pain in addition to the impact by loading the joint
  3. Pain may be present in anterior chest wall
  4. Pain may refer around the rib to sternalcostal junction or costochondral junction may be tender as well

Treat with mobilizations

79
Q

Ankylosing Spondylitis

A
  1. Low back and thoracic pain
  2. Everything stiffens up
  3. Collagen issue
  4. Not relieved with lying supine
  5. Worse with rest, better with activity
  6. Morning stiffness
  7. History of collagen disease in family
  8. Age of onset
80
Q

Treat TOS

A

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.

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