Thoracic Flashcards
(200 cards)
1
Q
Patient’s primary musculoskeletal symptom(s) may be directly or indirectly related or influenced by impairments from various body regions and systems regardless of proximity to the primary symptoms (true/false)
A
true
2
Q
Restricted mobility in upper thoracic spine can affect cervical spine motion, as well as overall motion of thorax (true/false)
A
true
3
Q
What effects can be seen in the sympathetic nervous system with thoracic mobilization?
A
increase blood flow in hands
4
Q
The thoracic spine is very mobile (true/false)
A
false
second least mobile
5
Q
Decreased mobility is due to
A
ribcage and low ratio of IVD height to vertebral body height
6
Q
Where do ribs attach?
A
costovertebral and costotransverse joints
7
Q
Facets favor which motion?
a. flexion
b. extension
c. side bending
d. rotation
A
rotation
8
Q
the t-spine is vulnerable to
A
growth related deformities
age-related osteoporosis
flexion-compression fractures
9
Q
height of body is slightly higher _ which contributes to normal kyphosis
A
posterior
10
Q
each body has paired demi-facets posterio-laterally except _ _ _
A
T10, 11, and 12
11
Q
Pedicles protrude directly
a. anterior
b. lateral
c. medial
d. posterior
A
posterior
12
Q
(superior/inferior) facet slightly convex and posteriorly oriented
A
superior
13
Q
(superior/inferior) facet slightly concave and face anteriorly, slightly inferiorly and medially
A
inferior
14
Q
What structure resists buckling of vertical trabeculae under axial load?
A
transverse trabeculae
15
Q
transverse processes project
A
laterally and slightly posteriorly
16
Q
Which vertebrae level are considered typical thoracic vertebrae?
A
T4-T9
17
Q
Which vertebrae levels are considered transitions?
A
T10, T11, T12
18
Q
Spinous processes project
A
posteriorly and inferiorly
19
Q
heads of 2nd to 10th ribs each articulate with (one/two) vertebral bodies
A
two
20
Q
heads of 1st, 11th and 12th ribs each articulate with (one/two) vertebral bodies
A
one
21
Q
costal cartilages of first 7 pairs attach to the
A
sternum
22
Q
The head and tubercle of each rib articulate with the
A
vertebral body
transverse process of each side
23
Q
Rib articulates with upper and lower _
A
facet
24
Q
What does the rib articulate with?
a. Transverse process
b. Upper facet
c. Lower facet
d. Upper and lower facet
A
upper and lower facet
25
What is the ratio disc: body height in the t-spine?
a. 2:5
b. 1:3
c. 1:5
d. 2:3
1:5
26
The annulus is (stronger/weaker) in the thoracic spine
stronger
27
Why is the annulus in the thoracic spine stronger?
a. To load bear more weight
b. Support the rib cage
c. Because of the size of the vertebrae
d. To resist rotational stress
to resist rotational stress
28
What areas of cervicothoracic junction degenerate?
a. C7-T1
b. T1-T2
c. C6-7
d. C5-T2
C6-7
29
The upper t-spine costovertebral joint is designed to
a. Slide
b. Depress
c. Rotate
d. Glide
rotate
30
The lower t-spine and ribs form the costovertebral joint to
a. Rotate
b. Slide
c. Glide
d. None of the above
slide
31
What can be a primary site of sprain or irritation?
a. Costochondral junction
b. Costovertebral joint
c. Facet joint
d. Ribs
costochondral junction
32
Secondary pain caused by rib dysfunction will show
pain in the front
33
The ligaments for vertebrae and ribs positioned can be described as
Continuous ligamentous stocking
34
Which ligaments unite as a single unit?
Ligamentum flavum, interspinous ligament, supraspinous ligament, intertransverse ligament
35
Which ligament is a bridge between neural arch ligaments and those of the vertebral body?
a. ALL
b. Ligamentum flavum
c. Capsular ligament
d. Supraspinous ligament
ligamentum flavum
36
The capsule is reinforced dorsally by multifidus and ventrally by
a. Ligamentum flavum
b. Interspinous ligament
c. Supraspinous ligament
d. Capsular ligament
ligamentum flavum
37
Which motion does the thoracic spine mainly do?
a. Flexion
b. Rotation
c. Extension
d. Side bending
rotation
38
How does the vertebra move with flexion?
a. Posterior translation
b. Anterior translation
c. Rotates
d. None of the above
anterior translation
39
How do the ribs move with thoracic flexion?
a. Rotate backwards
b. Rotate sideways
c. Translate
d. Rotate forward
rotate forward
40
How does the vertebrae move with extension?
a. Posterior translation
b. Anterior translation
c. Rotation
d. None of the above
posterior translation
41
How do the ribs move with extension?
a. Rotate sideways
b. Rotate forward
c. Rotate backward
d. Translation
rotate backward
42
How does the vertebrae move with lateral flexion?
a. Translate anteriorly
b. Translate posteriorly
c. Translate in the direction side flexing
d. Rotates in the direction side flexing
Translate in the direction side flexing
43
How do the ribs move with lateral flexion?
a. Translate and rotate
b. Tip forward
c. Tip backward
d. Translate and tip to the same side lateral flexion
Translate and tip to the same side lateral flexion
44
What limits side flexion and stops motion?
ribs
45
With side bending to the right, the right rib (anterior/posteriorly) rotates and the left rib (anteriorly/posteriorly) rotates
anterior
| posterior
46
What happens to the vertebrae with rotation?
Coupling of rotation with contralateral translation and ipsilateral lateral flexion
47
How do the ribs move with rotation?
a. Anteriorly rotate to the side rotating and posteriorly rotate to opposite side
b. Posteriorly rotate to the side rotating and anteriorly rotate to opposite side
Posteriorly rotate to the side rotating and anteriorly rotate to opposite side
48
Which areas function as part of the lower c-spine and upper t-spine?
a. T1-T4
b. T1-T2
c. T1-T3
d. T1-T5
T1-2
49
Which areas function as the true t-spine?
a. T9-T10
b. T11-12
c. T4-T9
d. T3-T10
T4-T9
50
Which areas function as part of the upper L spine and lower t-spine?
a. T8-T12
b. T10-12
c. T9-11
d. T10-11
T10-12
51
Load on the t-spine increases
a. In upper levels
b. In mid thoracic
c. In lower areas
in lower areas
52
Lower t-spine load transferred through _ _
posterior column
53
The lower angle of scapulae is aligned with
a. T1
b. T4
c. T7
d. T9
T7
54
What is designed to handle increased load demand?
Vertebral body height
End plate cross sectional area
Bone content
55
In the upper spine the load is transferred through the
Vertebral body/disc complex
56
How does the load distribution across end plate change outside the neutral position?
Becomes asymmetrical
57
Mid-thoracic pain can be associated with what type of postures
sustained loading postures
58
How does mechanics of shoulder and c-spine affect the t-spine?
may restrict functional motion
59
How does kyphosis change mechanics of the arm?
Limits ability for arm elevation
60
Risk with red flags increases with indication of
Age under 20 or over 50
Family history
Past personal history
Sudden, unexpected weight loss/gain
61
Which structure leads to endplate concavity?
a. Annulus fibrosis
b. Vertebral bodies
c. Trabeculae
d. Vertebral end plates
vertebral end plates
62
What leads to a collapse of load bearing of the spine?
a. Vertebral end plate fracture
b. Vertebral bodies lose bone trabeculae
c. Rib arthritis
d. Decrease bone density
Vertebral bodies lose bone trabeculae
63
The thoracic spine is (more/less) likely to become arthritic
Less
| Because of rib cage protection
64
Height loss in females is due to
Compression of vertebrae
65
Vertebral body fracture twice as common as hip fracture (true/false)
true
66
Osteophytes of the t-spine is common which aging (true/false)
true
67
A patient has a sudden onset of symptoms aggravated by breathing and coughing on one side posteriorly, this could suggest
a. Facet joint dysfunction
b. Hypomobility
c. Hypermobility
d. Radiculopathy
hypomobility
68
(Hypomobility/hypermobility) is common in the thoracic spine
hypomobility
69
In which motion are vertebrae more commonly injured with trauma?
a. Extension
b. Rotation
c. Flexion or axial compression
d. Side flexion or axial compression unilaterally
Flexion or axial compression
70
Which type of traumatic injury is the most severe?
a. Bone bruising
b. Wedge compression
c. Endplate fracture
d. Burst fracture
burst fracture
71
In the upper t-spine _ causes more injury with thoracic facet injuries
a. Flexion
b. Extension
c. Axial compression
d. Rotation
extension
72
Which type of injury is common in the upper t-spine with MVC?
a. End plate fracture
b. Vertebral body injuries
c. Compression fracture
d. Bone bruising
vertebral body injuries
73
Which area is most frequently injured in a MVC?
a. Transitional zone
b. Upper t-spine
c. Lower t-spine
d. Mid thoracic
transitional zone
74
Falls and sudden flexion can cause
Sudden forceful flexion
Slipping
Sudden load onto the spine
75
Which levels are the highest at risk for a compression fracture?
a. T1,2,3
b. T5,6,7
c. T9,10,11
d. T11, 12, L1
T11, 12, L1
76
What is the risk with kyphoplasty?
high incidence of fractures
77
Ribs attach to _ _ which is related a higher incidence of _ _
Annulus fibers
| Disc lesion
78
What potential causes of disc lesion injury?
High viscosity of IVD
| Asymmetrical loading
79
Disc lesions are most commonly in what areas of the thoracic spine
lower t-spine
| thoracolumbar junction
80
Patient presents with pain in blobs and patches, unilateral, deep ache. What could this suggest?
a. Radiculopathy
b. Facet joint injury
c. Costochondral injury
d. Disc lesion
disc lesion
81
Patients pain is distal and has severe pain
a. Radiculopathy
b. Facet joint injury
c. Costochondral injury
d. Disc lesion
radiculopathy
82
Radiculopathy in the thoracic spine can be due to
Disc lesion
Facet injury
Osteophytes
Scarring
83
_ can closely stimulate thoracic nerve root symptoms
costochondritis
84
The upper t-spine will refer symptoms into _ with radiculopathy
UE
85
Patient presents with localized sharp pain unilaterally and is aggravated by extension
a. Radiculopathy
b. Facet joint injury
c. Costochondral injury
d. Disc lesion
facet joint injury
86
Facet joint dysfunction causes neurological symptoms (true/false)
false
87
Pain with coughing and sneezing is common in the (acute/chronic) phase with facet joint dysfunction
acute
88
Dull and aching pain related to facet joint dysfunction is common in the (acute/chronic) phase
chronic
89
Small ligaments in the t-spine can cause
sprain
90
Pain is vague, ill defined, spread around the area but no pain distally or neurological symptoms
a. Rib cage injury
b. Facet joint injury
c. Disc lesion
d. Ligamentous injury
ligamentous injury
91
Both ALL and PLL are innervated by _ nerve
sinuvertebral
92
Breathing causes pain, tender to palpation with severe pain
a. Muscle injury
b. T4 syndrome
c. Ligament injury
d. Rib cage injury
rib cage injury
93
Spasms are common in the _ area
a. Lower thoracic
b. Thoracolumbar junction
c. Upper thoracic
d. None of the above
upper thoracic
94
Dull aching symptoms covering the whole hand with pins and needles, unilateral
a. Muscle injury
b. T4 syndrome
c. Ligament injury
d. Rib cage injury
T4 syndrome
95
T4 syndrome is commonly a (UE/LE) problem
UE
96
T4 syndrome is a problem involving which structure
facet joints
97
Lower t-spine and T/L junction refers to the
low back
| hip
98
MSK and visceral conditions can be aggravated or alleviated with positional change (true/false)
true
99
With MVC (upper/lower) t-spine usually injure facet joints
upper
100
With MVC (upper/lower) t-spine usually injure vertebral bodies and disc
lower
101
Schmorls nodes are related to pain (True/false)
false
102
Scheurmanns Disease is associated with schmorls nodes (true/false)
true
103
Patient with thoracic dural attachment problems will present with _ in response to test flexion of spine in seated slump
headache
104
If a patients condition doesn’t change within _ visits, be suspicious and consider reexamination
6
105
The spinal cord unfolds with _
flexion
106
Which structure can facilitate trigger points?
posterior primary rami
107
What type of dysfunction can happen to the posterior primary rami?
entrapment
myelin removal
source of sensitization
facilitation of trigger points
108
Which tests can be done to see if the posterior primary rami is causing the problem?
slump longsit and add side flexion of the c-spine
109
What can cause a decrease in BF, ischemia, pH levels to drop?
prolonged posture
110
prolonged posture causing ischemia and scapular pain can be caused by
posterior primary rami
111
What contributes to pain caused by a rib fracture?
intercostal nerves
removal of myelin
scar tissue
112
Which test should be used to check T1, T2 nerve root and axilla?
ULNT3
113
Which structure is adjacent to costovertebral joint that can cause pain?
sympathetic ganglions
114
The path of the SNS gets altered due to
bone formation
| thickening of ligaments
115
Increased stress on SNS tracks can be caused by
posture
aging
scoliosis
kyphosis
116
The sympathetic chain sits (anterior/posterior) to the c-spine and (anterior/posterior) to the t-spine
anterior
| posterior
117
Extra load is added to the SNS with what type of postures
thoracic kyphosis
| cervical extension
118
Where is the sympathetic chain located in the spinal area?
on the side of vertebral bodies
119
This is described as pain, paresthesia, weakness or discomfort in the upper limb and is aggravated by elevation of the arms or by exaggerated movements of the head and neck
a. kyphosis
b. thoracic outlet syndrome
c. T4 syndrome
d. rib injury
thoracic outlet syndrome
120
This diagnosis is the most underrated, overlooked and misdiagnosed peripheral nerve compression in the UE
a. radiculopathy
b. thoracic outlet syndrome
c. T4 syndrome
d. posterior primary rami injury
thoracic outlet syndrome
121
Pain and discomfort of TOS are caused by compression of the
subclavian artery
| lower trunk of brachial plexus
122
Compression between anterior and middle scalene
a. site A
b. site B
c. site C
d. none of the above
site A
123
Compression between first rib and clavicle
a. site A
b. site B
c. site C
d. none of the above
site B
124
Compression under the pec minor attaching to the coracoid process
a. site A
b. site B
c. site C
d. none of the above
site C
125
What are the possible causes of TOS?
congential
traumatic
medical
posture
126
What soft tissue pathologies can cause TOS?
anterior scalene muscle hypertrophy
muscle fiber type adaptive transformation
spasm
excessive contraction post cervical trauma
127
How does posture cause TOS?
lowering the anterior chest wall with drooping shoulders and holding the head in a forward position
128
How can a trauma cause TOS?
bone remodeling after fracture of clavicle or first rib or posterior sublux of AC joint
129
What are the two types of TOS?
neurogenic
| vascualr
130
Most patients with TOS fall into which category?
neurogenic TOS (nTOS)
131
What symptoms are important to diagnose with TOS?
postural exacerbation
132
A patient has neurological symptoms in their upper limb, changes in skin temp, pain with sustained shoulder elevation. This could suggest
a. TOS
b. T4 syndrome
c. rib injury
d. neurodynamic issues
TOS
133
A patient has swelling, pain in prolonged postures and pain when they hold a backpack on their side, this could suggest
a. TOS
b. T4 syndrome
c. rib injury
d. neurodynamic issues
TOS
134
What are typical aggs of TOS
```
sustained shoulder elevation
suspensory holding activities
lying on the arm
carrying a backpack
prolonged postures
repetitive use of upper limb and hand dexterity
```
135
A patient with TOS will only have motor symptoms (true/false)
false
| mixed spinal nerve
136
A patient with TOS will have restrictions with _ ROM
glenohumeral joint
137
in a patient with TOS, check the _ joint for instability
glenohumeral joint
138
Which motion can cause TOS?
repeated overuse in overhead position
139
with TOS, muscle weakness will be in _ _ muscle groups
C5, 6
| C8, T1
140
a patient with TOS will have weak _ _
grip strength
141
Which ULNT test should be done for a patient that might have TOS?
a. UNLT 1
b. ULNT 2
c. ULNT 3
ULNT1
142
TOS screening tests are reliable (true/false)
false
143
Which type of scoliosis is the most common?
adolescent idiopathic scoliosis
144
What are the three classifications of scoliosis?
failure of formation
failure of segmentation
combination
145
This stage of scoliosis has spontaneous healing or surgery
a. infant
b. juvenile
c. adolescent
d. adult
infant
146
This stage of scoliosis has a poor prognosis and will grow
a. infant
b. juvenile
c. adolescent
d. adult
juvenile
147
This stage of scoliosis girls are diagnosed more than boys
a. infant
b. juvenile
c. adolescent
d. adult
adolescent
148
With this stage of scoliosis, there is spinal and joint degeneration
a. infant
b. juvenile
c. adolescent
d. adult
adult
149
Mild scoliosis is
a. 10-20 degrees
b. 10-25 degrees
c. 25-50 degrees
d. > 50 degrees
10-25 degrees
150
Moderate scoliosis is
a. 15-25 degrees
b. 25-40 degrees
c. 25-50 degrees
d. > 50 degrees
25-50 degrees
151
Severe scoliosis is
a. > 40 degrees
b. > 50 degrees
c. > 60 degrees
d. > 55 degrees
> 50 degrees
152
How does the curve progress with scoliosis?
torsion with eccentric loading of the spine and vertebral growth modulation
153
in scoliosis the rib is pushed (anteriorly/posteriorly) and the cage is (widened/narrowed)
posteriorly
| narrowed
154
vertebral body in scoliosis distorted toward the (concave/convex) side
convex
155
The vertebral canal is narrower in scoliosis on the (convex/concave) side
convex
156
In scoliosis the spinous process deviates to the (convex/concave) side
concave
157
In scoliosis the rib is pushed laterally and anteriorly to the (concave/convex) side
concave
158
What happens to the muscles with scoliosis?
weakness
hypertrophy
muscle imbalances
trigger points
159
A passive neck flexion test will be positive in patients with scoliosis (true/false)
true
160
How does flexion change in a patient with scoliosis?
curve enlarges
161
How does extension change in a patient with scoliosis?
limited movement
162
How does side flexion and rotation change in a patient with scoliosis?
asymmetry
163
What exercise treatment should be considered for the upper t-spine?
cervical spine exercises
164
What exercise treatment should be considered for the true t-spine?
thoracic exercises
AP and PA
Ribs: rotation
165
What exercise treatment should be considered for lower t-spine?
spinal stabilization
load attenuation
weight bearing
166
Which area responds favorably to PA and AP movements?
mid-thoracic spine
167
What can produce a pain pattern that may mimic Cloward and cervical joint referral?
a. impaired posture
b. posterior primary rami
c. costochondritis
d. annulus
posterior primary rami
168
What other structures have the same pain pattern as posterior primary rami?
cloward areas
cervical facet joints
thoracic facet
169
What is the structural differentiator for the longsit slump test?
knee flexion
170
Which joint deteriorates very fast?
costovertebral
171
Which two ribs have no costotransverse joints?
the lowest 2
172
Which are the floating ribs?
11 and 12
173
This joint is described as the head of rib connecting to the lateral side of the vertebral body
costovertebral joint
174
This joint is of the articular facet on the rib tubercle to the anterior aspect of the transverse process
costotransverse joint
175
The costovertebral and costotransverse joint provide
stability
176
What are the two tests for restricted first rib?
cervical rotation lateral flexion
| first rib spring test
177
This test is when the PT checks the pulse then the patient puts their arms in >90 degree abduction and ER, they hold then check for a pulse again
a. roos
b. wright
c. hyperabduction
d. adsons
hyperabduction
178
A positive hyperabduction test is indicated by
change in pulse, diminished or gone
179
This test is when the PT checks the pulse then the patient puts their arms in abduction and turn their head away from side testing and hold
a. roos
b. wright
c. hyperabduction
d. adsons
wright
180
This test is when the PT checks the pulse then the patient puts their arms in abduction and clasps their hands
a. roos
b. wright
c. hyperabduction
d. adsons
roos
181
A positive wright test is indicated by
change in pulse or paresthesia
182
This test is when the pt puts their arms at 15 degrees abduction and hold their breath, check pulse and rotate head towards that side
a. roos
b. wright
c. hyperabduction
d. adsons
adsons test
183
A positive adsons test is indicated by
a diminished pulse or goes away, paresthesia
184
the height of the body is projected posteriorly to contribute to which type of posturing
kyphosis
185
for safe thoracic manipulation be cautious to
a. decrease load
b. avoid doing them at all
c. decrease peak force
d. put them in the right position
decrease peak force
186
The thoracic spine has a (high/low) ratio of IVD height to vertebral body height
low
187
The laminae is designed to limit which motion
a. flexion
b. extension
c. rotation
d. side bending
extension
188
the facet joint is what type of joint
synovial
189
This ligament grouping is a bridge between neural arch ligaments and those of the vertebral body
capsular ligaments
190
_ reinforced dorsally by multifidus and ventrally by ligamentum flavum
a. neural arch ligaments
b. supraspinous ligament
c. ventral ligaments
d. capsule
capsule
191
What part of the rib articulates with the vertebral body and TP?
head and tubercle
192
Which nerve innervates the ALL and PLL which can be a source of pain?
sinuvertebral nerve
193
Which treatment is good for thoracic dura mater?
a. spinal stabilization
b. c-spine exercises
c. traction
d. manual therapy
manual therapy
194
Which neurodynamic tests should be done with a patient who has scoliosis?
passive neck flexion
slump
slump longsit
straight leg raise
195
T4 syndrome symptoms are (unilateral/bilateral)
unilateral
196
Which vertebral bodies are most frequently injured with MVC?
a. C7, T1
b. C6, T7
c. T12, L1
d. T11, T12
T12, L1
197
Spinous process alignment in the thoracic spine has (good/poor) reliability
poor
198
cervical rotation flexion test is testing the (same/opposite) side
opposite
199
What type of symptoms do patients with TOS complain of?
pain
paresthesia
weakness
200
Posterior subluxation of the AC joint can cause TOS (true/false)
true
