T-Spine Jawn part 1 Flashcards Preview

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Flashcards in T-Spine Jawn part 1 Deck (50):
1

Arthrokinematics of T-Spine in flexion

• Bilateral upslides of the facets
• Bilateral ribs rotate anteriorly at
costovertebral joint

2

Arthrokinematics of T-Spine in extension

• Bilateral facets downslide
• Bilateral ribs rotate posteriorly
at costovertebral joint

3

Arthrokinematics of T-Spine in sidebending / lateral flexion

• Ipsilateral facet downslides
• Contralateral feet upslides
• Ipsilateral ribs approximate
• Contralateral ribs separate

4

Arthrokinematics of T-Spine in rotation

• Ipsilateral facet distracts
(opens)
• Contralateral facet compresses
(closes)
• Ipsilateral rib rotates posteriorly
• Contralateral rib rotates anteriorly

5

Coupled motions of T-spine when in flexion

◦ Occur to same side
◦ I.e. right SB coupled with right rotation

6

Coupled motions of T-spine when in extension

◦ Occur to opposite sides
◦ I.e. right SB coupled with left rotation

7

Non-MS Causes of Thoracic Pain

• Metastases: breast, lung, or colon CA
• Primary Thoracic Spine Tumors
• Infection
◦ Osteomyelitis, diskitis, epidural infections
• Inflammatory disorders
◦ Ankylosing Spondylitis
• Fracture

8

Visceral Sources or Thoracic Pain

◦ Dissecting aortic aneurysm- MEDICAL EMERGENCY ◦ Myocardial ischemia
‣ Stable angina- related to exertion
‣ Unstable angina ◦ Peptic ulcer
◦ Pyelonephritis

9

Quadrant Testing

Combines motion in multiple planes to assess for symptomatic response

10

Where can facets refer pain to in the T-Spine?

Facets can refer unilateral pain to 2 segments lower, along border of scapula, and inter scapular
area

11

Ribs pain can refer to what?

around the thorax

12

The Rule of 3's T1-T3:

SP same level as TPs

13

The Rule of 3's T4-T6:

SP 1/2 level inferior to TPs

14

The Rule of 3's T7-T9:

SP 1 level inferior to TPs

15

The Rule of 3's T10:

SP 1 level inferior to TPs

16

The Rule of 3's T11:

SP 1/2 level inferior to TPs

17

The Rule of 3's T12:

SP same level as TPs

18

What is a positive sign for Cervical Rotation Lateral Flexion Test

Restricted or blocked motion (+) for elevated 1st rib

19

Thoracic Manipulation: Contraindications and Precautions

• Osteoporosis
• Joint ankylosis- ankylosing spondylitis
• Possibility of metastasis
• Suspected fx
• Suspected infection
• Instability and spondylolisthesis
• Severe scoliosis
• Long-term use of corticosteroids
• Neurological signs
• Suspected cord compression
• Pt unable to relax/tolerate
• Lack of informed consent

20

What is the primary function of the T-Spine?

protection of viscera, provides stability, limited mobility

21

Muscles of inspiration accessory

SCM (elevates sternum)
Scalenes (elevates upper ribs)
Pec minor

22

Muscles of inspiration Principles

External intercostals Internchondral part of internal intercostals,

Diaphgram

23

Muscles of expiration (quiet breathing)

Expiration from passive, elastic recoil of lungs and dib cage

24

Muscles of expiration (active breathing)

internal intercostals pull ribs down

abs pull ribs down and push diaphragm up

QL pull ribs down

25

Pump handle

upper ribs

26

Bucket handle

Lower ribs

27

Dual Energy X-Ray Absorptiometry is gold standard for

Osteoprosis

28

For osteoporotic compression fractures what would you use

Radiographs, CT, MRI

29

What is the clinical presentation of someone with traumatic vertebral fractures?

Severe pain, onset associated with traumatic incident (MVA, fall on butt or from height), muscle guarding around spine

30

What happens during a chance fracture?

Seatbeat in flexion/distraction injury, can be unstable, 2-3 colmns involved, anterior compressed and middle/posterior under tension

31

What happens during a Burst fracture?

High energy compression axial loading, associated with hindfoot fractures

32

Burst fracture are most common where?

T9-L5

33

TLSO bracing does what?

restrict motion and unload anterior vertebral bodies

34

Jewett Brace what does it do and indications?

Prevents flexion, permits extension

 Stable Compression Fracture
 Post-op surgery of anterior vertebral
bodies
 Kyphotic posture

35

What is scheuermann's kyphosis?

wedged shaped vertebra, deficient growth anteriorly and normal posture, mimics wedge fx,

36

Proper brace for scheuermann's kyphosis?

Any TLSO to limit spinal flexion

37

What is structural scoliosis?

inflexible curvature, unchanged with lat flex to convex side, 85% idiopathic

38

What is functional scoliosis ?

flexible curve, curve reveres or straightens with lat flex toward convexity

39

What is a Cobb Angle?

>10 degree is considered for scoliosis

40

what are possible Scoliosis intervention?

 Curves 25-40 ̊ and progressing
 Bracing
 Physical therapy

 Curves 40-50 ̊
 Surgical intervention

41

In scoliosis what would you do to the convex side?

Strengthening of muscles

42

In scoliosis what would you do to the concave side?

Stretching, joint mobilizations

43

Who would you prescribe a milwaukee brace?

Indications:
Thoracic scoliosis
Scheuermann’s disease
 Control curve
 Prevent progression

44

Who would you prescribe a Boston brace?

Indications:
 Moderate curves in thoracic & lumbar spine

45

Who would you prescribe a rigo system cheneau brace?

utilized in conjunction with schroth method of therapy

46

What are is a barrel chest?

lungs remain inflated, thorax expanded

47

Ankylosing Spondylitis

Effect costotransverse and costovertebral joint, limit chest expansion

48

What happens to the thoracic outlet syndrome to the specific structures?

 Brachial Plexus: compression
 Subclavian Vein: engorgement
 Subclavian Artery: insufficiency

49

What are neurologic symptoms for someone with TOS?

pain in neck, shoulder, arm, hand.

Parasthesias along C8 and T1 dermatomes

weakness and atrophy for gripping muscles, thenar muscles

Decreased hand dexterity

50

What are vascular symptoms for someone with TOS?

 Heaviness/fatigue
 Especially with overhead activity (i.e. blow drying hair)
 Cramping with activity
 Cold intolerance
 Arterial: pallor, decreased pulses, ischemia
 Venous: engorgement, edema