TEST 3: Thoracic and Rib SD Dx Flashcards Preview

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Flashcards in TEST 3: Thoracic and Rib SD Dx Deck (47)
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what is important to remember about the thoracic spine?

-it is interdependent on the cervical and lumbar spine, so you should tx accordingly
-heart and lungs in thoracic cage, so problems with thoracic cage can be life threatening


SNS and thoracic spine

-much of SNS outflow arises from the thoracic spine
-can mimic life threatening problems


thoracic anatomy

-12 vertebra
-12 ribs
-clavicle and scapula often involved in thoracic injuries and pain syndromes, but are considered upper extremity


3 parts of the sternum

-head/manubrium--articulates with clavicles
-body/gladiolus--joined to manubrium at sternal angle
-xiphoid--small portion at inferior aspect of sternum


Rule of 3's

-T1-3 has a SP at the same level as the TP of same numbered vertebra
-T4-6 has a SP halfway b/w TP of same numbered vertebra and the TP of vertebra one segment inferior
-T7-9 has a SP in the same plane as the TP of one segment inferior
-T10 like 7-9
-T11 like 4-6
-T12 like 1-3


visceral afferent neurons and thoracic spine

-usually these neurons are nociceptive and follow the same pathway as the sympathetics
-visceral disturbances cause increased MSK tension in somatic structures innervated from the corresponding spinal level
-OMT can reduce somatic afferent input which reduces somatosympathetic activity to the organ


inferior angle of scapula at...



functional divisions of the thoracic vertebrae**

-T1-4: sympathetics of head and neck
-T1-6 innervates heart and lungs
-T5-9 sympathetics to upper abdominal viscera
-stomach, duodenum, liver, gall bladder, pancreas, spleen
-T10-11 sympathetics to lower abdominal viscera
-rest of small intestines, kidney, ureters, gonads, R colon
-T12-L2 sympathetics to remainder of lower abdominal viscera
-L colon and pelvic organs


thoracic biomechanics

-motion capabilities in the thoracic spine is generally less than cervical and lumbar
-follows Fryette's principles
-costal cage mechanics affect all planes of motion
-general body shapes and movement also affected by growth, aging, and lifestyle factors
-adaptations to work, athletics, postural decompensation
-changes in one area affect motion in other areas


what kind of abnormalities affect motion?

-costal cage asymmetries--pectus excavatum/carinatum
-osteoarthritis or osteoporosis
-cardiopulm conditions increasing chest wall diameter
-postural problems
-cervical and shoulder influences


Wolff's Law

-bones and soft tissues deform (are strained) according to the stresses (forces applied to an area) that are placed on them
-scoliosis, kyphosis, arthritis, leg length inequalities


F/E and rotation and SB in thoracic spine

-F is greater than E
-due to normal kyphotic curvature and gravity
-rotation is greater in upper and middle portions (second only to AA joint)
-lower thoracic moves similar to lumbar
-SB is limited by rib cage


what kinds of abnormalities affect motion in the thoracic spine?

-scoliosis +/- kyphosis
-upper and lower motor neuron lesions
-repetitive motion activity effects
-tethering affect of myofascial tissues


small muscles of the back

-often involved in postural stress
-often responsible for maintaining non neutral and neutral SD of vertebral units
-includes rotatores (SP down 2 levels to TP), multifidus (from SP down 2-3 levels to TP), and intertransvereriae M (b/w each SP)


spinal SD can result from what?

-neurological pathological conditions
-visceral dz
-intrinsic mechanical asymmetries
-chronic asymmetric motions or activities


anatomy of the ribs

-12 sets of ribs correspond to thoracic vertebrae
-bony rib connected to thoracic vertebrae at costovertebral articulations
-2-9 articulate with vertebrae above and below
-1, 10-12 have unifacets that articulate with corresponding vertebra only


rib one landmarks

-anteriorly attaches inferior to clavicle
-posteriorly attaches cephalad to border of scapula


rib 2 landmarks

-anteriorly articulates with manubrium and body of sternum


rib 3 landmarks

-posteriorly at level of scapular spine


rib 7 landmarks

-anteriorly at xiphosternal joint
-posteriorly at level of inferior angle of scapula


rib 10 landmarks

-cartilage at lowest part of thoracic cage at midclavicular line


what are the typical ribs?



describe typical ribs

-head, neck, tubercle, body is thin and flat
-head has 2 facets (for body of same numbered and for body of one above)
-costovertebral articulation
-tubercle articulates with TP
-costotransverse articulation


rib one anatomy

-flattest, shortest, with greatest curvature
-subclavian groove on superior surface
-head articulates with T1 only


rib 10 anatomy

-articulates T10 only


rib 11 and 12 anatomy

-no neck or tubercles
-articulates with associated vertebrae
-12 has no costal groove


costovertebral joint

-vertebral body (same level and one above)
-vertebral disc (annulus fibrosis)
-ligaments--radiate and interosseous


costotransverse joint

-tubercle and TP
-superior, lateral, inter transverse, and costotransverse
-superior ligament connects TP to next lower rib


muscles of inhalation

-intercostals (external mostly)
-crura anchor at L1-3
-attachments to lower ribs and sternum


muscles of exhalation

-rectus abdominus
-internal and external obliques
-transverse abdominus