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MSK 2 > Unit 2 Week 5 Thoracic > Flashcards

Unit 2 Week 5 Thoracic Flashcards

1
Q

what are the functions of the thoracic spine?

A

protects vital organs (heart and lungs)
transitional zone: transfers load to/from the lower and upper halves of the body
posture
bony stability
allow for limited mobility
respiration: mechanical bellows

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2
Q

what are the three functions of the rigidity of the thorax?

A

stable base
protection
mechanical bellows (respiratory function)

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3
Q

which layers of the posterior trunk muscles are “extrinsic”?

A

superficial and intermediate

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4
Q

which layers of the posterior trunk muscles are “intrinsic”?

A

deep

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5
Q

what is the primary muscle for inspiration?

A

diaphragm

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6
Q

which muscles oppose the diaphragm during inspiration?

A

scalenes

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7
Q

what do the intercostal muscles do for respiration?

A

collapse the rib cage, give rigidity to the rib cage to oppose the diaphragm

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8
Q

what are the norms for thoracic and lumbar flexion? arthrokinematics?

A

thoracic: 35
lumbar: 50
sliding up/anterior

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9
Q

what are the norms for thoracic and lumbar extension? arthrokinematics?

A

thoracic: 20
lumbar: 35
sliding down/posterior

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10
Q

what are the norms for thoracic and lumbar lateral flexion? arthrokinematics?

A

thoracic: 25
lumbar: 20
slide contralateral

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11
Q

what are the norms for thoracic and lumbar axial rotation? arthrokinematics?

A

thoracic: 35
lumbar: 5
slide contralateral

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12
Q

what are the arthrokinematics of the ribs?

A

upper segments (pump): in sagittal plane
middle to lower: (bucket) flare outwards
11-12: (calipers) spread laterally

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13
Q

what would be considered a yellow flag vs a red flag for thoracic pain?

A

yellow: fear avoiding behavior
red: history of cancer

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14
Q

what should you screen when performing a thoracic examination?

A

always shoulder
symptoms location above inferior angle: include c-spine
below inferior angle: include l-spine

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15
Q

what extra questions should be asked in a history of the thoracic spine?

A

pain radiating or occurring anywhere else?
symptom relationship to: breathing, cough, sneeze, eating or certain foods, CV exertion
recent stressful life events or changes?

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16
Q

what are the 4 components of a metastatic cancer screening?

A
  1. history of non-skin cancer
  2. failure of conservative management in past month
  3. > 50 years age
  4. unexplained weight loss more than 4.5kg in past 6 months
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17
Q

what are the 5 risk factors included in a thoracic fracture screening?

A
  1. age > 50 years
  2. female
  3. major trauma
  4. pain and tenderness
  5. distracting painful injury
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18
Q

what is the difference between structural and non-structural scoliosis?

A

structural: may be genetic, idiopathic, or caused by some congenital problem such as wedge vertebrae, hemivertebra, or failure of vertebral segment

non-structural: relatively easily correctable. poor posture, psychosocial, nerve root irritation, inflammation in spine, leg length discrepancy, or hip contracture

19
Q

how is scoliosis named?

A

named for the part of the spine and where the apex of the curve occurs

20
Q

where does a rib hump appear with scoliosis? depression?

A

rib hump: on the side of thoracic convexity
depression: on the side of concavity

21
Q

what are the three chest variations? describe each.

A
  1. pectus carinatum (pigeon): sternum forward and downward. restricts ventilation
  2. pectus excavatum (funnel): sternum posteriorly by overgrowth of the ribs. hyperkyphotic compensation
  3. barrel chest: acquired. sternum forward and upward. emphysema
22
Q

what is the difference between quiet and active breathing?

A

quiet: relies on diaphragm to pull air in and elastic recoil to get air out
active: pulls in more muscles causing accessory use during activity

23
Q

how would you measure thoracic motion vs thoracolumbar motion?

A

thoracolumbar: standing
thoracic: seated (takes hips out)

24
Q

what is the difference between upper thoracic and lower thoracic PIVMs?

A

lower cervical and upper thoracic: C5-T3 just move head
middle to lower thoracic: T3-T11 heads behind head move body

25
Q

what specific MMTs are pertinent in a thoracic examination?

A

middle trap
rhomboids
lower trap
lats
lumbar, cervical, and shoulder as needed

26
Q

what is the rule of 3s?

A

T1-T4, T9: up 1
T5-T8: up 2
T9-T11: at base of spinous process

27
Q

what are the common thoracic trigger points?

A

serratus anterior
pectoralis major
sternalis
external oblique

28
Q

what are the thee t-spine mobility relationships to the head, neck, and shoulder?

A
  1. neck and shoulder pain more common with hypomobility at C7-T1
  2. C7-T1 and T1-T2 hypomobility is a predictor of neck-shoulder pain and hand weakness
  3. C7-T1 and T3-T4 hypomobility predict headaches
29
Q

what should be assessed in an AP thoracic spine radiograph?

A

vertebral body alignment, pedicles equidistant, spinous processes at equal intervals, rib joints

30
Q

what is the most common spinal injury detectable on a radiograph in all age groups? what is the MOI?

A

anterior compression fractures
MOI: flexion, MVA or falls from heights, older adults with osteoporosis

31
Q

what are the 3 radiographs used in an assessment for scoliosis?

A

erect AP, erect lateral, erect AP sidebending R and L

32
Q

what is the pedicle method when looking at a radiograph of scoliosis?

A

gives value for axial rotation that has occurred in combination with the lateral curve

0 = normal/no rotation
1+ = pedicle moved 1/3 of the way toward midline
2+ = 2/3
3+ = when the pedicle is midline on the image of the vertebral body
4+ = pedicle has rotated beyond midline

33
Q

what are the three radiologic indicators of bone age?

A
  1. PA view of left hand
  2. fusion of vertebral rig apophyses
  3. Risser’s sign: formation of the apophysis over the iliac crests
34
Q

what are some potential causes of t-spine pain?

A

pain from local thoracic structures
referral from c-spine, l-spine, shoulder or ribcage
visceral referral

35
Q

what are the 4 syndromes that fall under the thoracic outlet syndrome umbrella?

A

scalene syndrome
cervical rib syndrome
costoclavicular syndrome
hyperabduction syndrome

36
Q

what is the etiology of scalene syndrome? what is being compressed?

A

etiology: scalene tightness, fibrous bands (congenital or scar), accessory scalene muscle, enlarged C7 TP, cervical rib syndrome

subclavian artery and nerve roots C5-T1

37
Q

what is cervical rib syndrome?

A

rudimentary cervical rib
elongated C7 TP

38
Q

what causes costoclavicular syndrome?

A

elevated first rib
clavicle fracture or callus
subclavius muscle disorder or morphological abnormality

39
Q

what causes hyperabduction syndrom?

A

tight pectoralis minor
expansion of fascia
prolonged arm elevation

40
Q

what should you look out for in a history that could hint towards thoracic outlet syndrome?

A

general ache neck to shoulder
non-specific paresthesia
heaviness of extremity
fatigue
worse sustained overhead or arm movements

41
Q

what interventions should be used for thoracic outlet syndrome?

A

posture/work education
treat impairments
1st rib mobilization
flexibility of pectoralis minor and scalene
neural mobility
surgical (if not responding)

42
Q

what are some clues that TOS is indeed a relevant diagnosis?

A

neural and/or vascular extremity symptoms produced with sustained arm positions
cervical radiculopathy usually is reduced with arm overhead
vascular

43
Q

what are some red flags/risks when thinking of using thrust techniques?

A

myelopathy
cancer
upper cervical ligamentous instability
vertebral artery insufficiency
inflammation or systemic disease

44
Q

what are some yellow flags/precautions when thinking of using thrust techniques?

A

factors that increase risk of developing or perpetuating long term disability and work loss associated with low back pain

MSK 2 (8 decks)

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