Tx Flashcards
Thoracic spine 4 regions
- Vertebromanubrial region
- C7,T1 & T2, ribs 1&2, and the manubrium - Vertebrosternal region
- T3-T7, ribs 3-7, and the sternum - Vertebrochondral region
- T8-T10, and the 8,9,10th ribs - Thoracolumbar junction
- T11 and T12, and the 11&12th ribs
Lower cervical spine
• Painreferral
– Commonly felt between and/or above scapulae
– Less common = anterior chest wall
• Can be episodic or related to exertion • May mimic angina
cervico-thoracic region
- Mobile region becomes interdependent with a rigid area
- Junctional region therefore developmentally “restless”
- Marked decrease in sagittal movement from C6/7 to C7/T1
- Soft tissue, connective tissue and neurovascular structures cross the area
cervical ribs
- Unilateral or bilateral(rare)
- True ribs articulate with transverse processes or vertebral bodies. False ribs have ligamentous connections
- Vary from small beak like processes to full articulation
- Not always symptomatic
- Present in only about 1 in 500(0.2%)of people
- Children born with cervical ribs develop early childhood cancer at a rate 125 times higher than the general population!
Thoraco-lumbar junction
• Upper Zjointsthoracicinorientation • LowerZjointslumbarinorientation • Mayoccurat.. – T12/L1 – T10/11 – T11/12 • Tropismmayoccur – orientation differs more than 5-7°
Thoracic articulations
At each vertebral level – 2 x interbody joints – 4 x Z-joints – 2 x costo-transverse joints – 4 x costo-vertebral joints (level dependent) – 2 x sterno-costal joints
Thoracic mobility and stability
Stability of the thoracic spine is
substantially enhanced by the ribs,
sternum and associated ligaments (Panjab et al 1981, Oda et al 1996, Berg 1993, Jiang et al 1994, Singer 1989)
Mobility of the thoracic spine is dependent on the relationship between the height and cross
sectional area of discs (Kapadji 1978, Reuben et al 1979) as well as the facet joint orientation (White 1969)
Consensus is lacking on the nature of coupled movements of the thoracic spine
Mid thoracic region flexion
• Flexion
– Osteokinematic motion
• Vertebral body = ant translation, ant sagittal rotation, slight
distraction
• Ribs = anterior rotation (relative mobility is age dependant)
– Arthrokinematic motion
• Inferior facet of the superior vertebrae glides supero-anteriorly
• Rib = superior glide of the tubercle
mid thoracic region extension
• Extension
– Osteokinematic motion
• Vertebral body = post translation, post sagittal rotation, slight
distraction
• Ribs = posterior rotation (relative mobility is age dependant)
– Arthrokinematic motion
• Inferior facet of the superior vertebrae glides infero-posteriorly
• Rib = inferior glide of the tubercle
Mid thoracic region side region
• Sideflexion
– Osteokinematic motion
• Vert body = ipsilateral translation, ipsilateral rotation in ‘x’ axis,
contralateral rotation about the ‘y’ axis
• Ribs = contra rib posteriorly rotates, ipsilateral rib anteriorly rotates
– Clinical hypothesis
• are hypothesized to support the osteokinematic motion
mid thoracic region rotation
– Osteokinematic motion
• Vert body = contralateral rotation about the ‘z’ axis, ipsilateral translation in the ‘x’ axis
• Clinically rotation is coupled with ipsilateral rotation about the ‘z’ axis, and contralateral translation in the ‘x’ axis
• Ribs = contra rib posteriorly rotates, ipsilateral rib anteriorly rotates
– Clinical hypothesis
• Inferior facet of the superior vertebrae glides inferoposteriorly • Rib = inferior glide of the tubercle
lower thoracic region
• Flexion/extension
– Flexion is accompanied by anterior translation of the superior vertebra, extension the opposite occurs
– Superior facet glides superiorly with flexion and inferiorly with extension
– The ribs are less firmly attached or do not have costovertebral articulations
• Sideflexion
– Apex location dependant (greater trochanter vs. within
thorax i.e. T8) • Rotation
– Coronally orientated facets do not dictate direction of side flexion coupling
Mechanical structures that can be sources of thoracic pain
- thoracic vertebrae
- dura mater
- Intervertebral discs
- longitudinal ligaments
- posterior thoracic muscles
- costotransverse joint
- zygoapophyseal joints
Possible sources of pain - trauma
– Fracture of rib, spinous process, transverse process, vertebral arch or vertebral body
– Fracture dislocation
– Compression fractures
• A1- Wedge compression • A2- Split fracture
• A3- Burst fracture
Degeneration IVD
– Degeneration of the intervertebral disc
• Discs degenerate earlier than all other musculoskeletal tissues
• First appearance at 11–16 years
• About 20% of people in their teens have discs with mild signs of degeneration
• degeneration increases steeply with age, particularly in males,
• 10% of 50-year-old discs and 60% of 70-year-old discs are
severely degenerate
