thoracic spine Flashcards
1
Q
T/S spinous process
rule of 3s
A
- T 1-3 are in line with own TP
- T4-6 SP runs 1/2 way down to TP of vertebra below
- T7-9 SP runs down to TP of vertebrae below
Last 3:
- T 10 SP runs down to TP of vertebra below
- T 11 SP runs 1/2 down to TP vertebra below
- T12 SP in line with own TP
2
Q
articulations of the TS vertebrae
A
- 4 facet joints: superior and inferior each side and oriented from 60-90
- 2 costotransverse joints 1 on each side
- longer slender TP
- 2 disc vertebral body articulations above and below
- 4 costovertebral joints 2 on each side for rib heads
3
Q
rib joint articulations
A
- costo-transverse jt
- costoverebral joints: superior costal facet of vertebrae inferior costal facet of vertebrae above
execptions:
- rib 1 articulates with T1 only
- ribs 11 and 12 articulate with their respective verebral bodies
4
Q
rib motions
A
- upper ribs to T5 move upward, forward in a pump handle motion
- lower ribs move upward, laterally in a bucket handle motion
5
Q
Thoracic discs
A
- thinner in T/S
- less incidence of disc pathology (herniation)
- but if herniated, discs can cause thoarcic symptoms
- NR/radicular pain follows ribs from posterior to anteiror alone dermatome
6
Q
T/S arthrokinetmatics
flexion and extension
A
- T/S vert tilt anterior
- facets slide foward and anterior
- disc compressed anterior
- rib rotates anterior
- oppositie for extension
7
Q
side bending arthrokinematics for T/S
A
- Ribs gap contralaterally
- ribs approximate ipslaterally
- relative anterior rib rotation isplaterally and facet goes down
- contralateral rib rotates posterior and facet slides up
8
Q
T/S arthrokinetmatics for rotation
A
- facets gap on side vertebra bodies are rotating to
- facets approximate on opposite side
right rotation - R ribs move backward sequentially on one another
- L ribs move forward sequentially on one another
9
Q
Mid and lower T/S SB and rotation athrokinematics
A
- occur in opposite directions
- however when in some flexion of spine (functional SB) SB and rotation occur to the same side
10
Q
Common conditions of T/S
Compression fractures of T/S
A
- commonly seen in T/S
- osteoporosis W>M
- vertebral body collagpses anterior
- anterior wedging
- hyperkyphotic posture
11
Q
Common conditions of T/S
MOI: compression fracture
A
- forced spine flexion
- axial load to spine
- fall on buttock
- sneeze/cough if severe osteoporosis
12
Q
Common conditions of T/S
medical treatment for compression fractures
A
- to stabilize collapsed vertebral body
- guided by fluoroscopic technique
percutaneous vertebroplasty
- injection of bone cement into vertebral body
Kyphoplasty:
- ballon first inserted and inflated to expand collapsed vertebral body
- bone cement then inserted
- studies show no difference in pain and outcome with above techniques vs placebo
13
Q
bracing for compression fractures
A
- extension (jewtt) brace - 3 points system to avoid flexion
- unload fractured vertebral body
- allow healing
- prevent kyphotic deformtiy
- once healed: PT ROM and core strength
- careful with early flexion activites that load vertebral body
14
Q
Common conditions of T/S
Sheuermann’s disease
(osteochondrosis)
A
- anterior wedging of T/S vertebral bodies
- unknown cause
- first seen in 8-12 year olds
- hyperkyphosis
- angulation at apex of kyphosis
- deformtiy remains in prone
- bracing effective if done early
- stops progressing with skeletal maturity
15
Q
Common conditions of T/S
Schmorl’s nodes
A
- herniation of disc thru vertebral end plate “modic disc”
- more common in males
- MOI: trauma, lifting, falling on buttock
- discitis from infection - need antibiotics