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MS II > Thoracic > Flashcards

Thoracic Flashcards

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

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2
Q

Restricted mobility in upper thoracic spine can affect cervical spine motion, as well as overall motion of thorax (true/false)

A

true

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3
Q

What effects can be seen in the sympathetic nervous system with thoracic mobilization?

A

increase blood flow in hands

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4
Q

The thoracic spine is very mobile (true/false)

A

false

second least mobile

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5
Q

Decreased mobility is due to

A

ribcage and low ratio of IVD height to vertebral body height

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6
Q

Where do ribs attach?

A

costovertebral and costotransverse joints

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7
Q

Facets favor which motion?

a. flexion
b. extension
c. side bending
d. rotation

A

rotation

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8
Q

the t-spine is vulnerable to

A

growth related deformities
age-related osteoporosis
flexion-compression fractures

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9
Q

height of body is slightly higher _ which contributes to normal kyphosis

A

posterior

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10
Q

each body has paired demi-facets posterio-laterally except _ _ _

A

T10, 11, and 12

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11
Q

Pedicles protrude directly

a. anterior
b. lateral
c. medial
d. posterior

A

posterior

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12
Q

(superior/inferior) facet slightly convex and posteriorly oriented

A

superior

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13
Q

(superior/inferior) facet slightly concave and face anteriorly, slightly inferiorly and medially

A

inferior

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14
Q

What structure resists buckling of vertical trabeculae under axial load?

A

transverse trabeculae

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15
Q

transverse processes project

A

laterally and slightly posteriorly

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16
Q

Which vertebrae level are considered typical thoracic vertebrae?

A

T4-T9

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17
Q

Which vertebrae levels are considered transitions?

A

T10, T11, T12

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18
Q

Spinous processes project

A

posteriorly and inferiorly

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19
Q

heads of 2nd to 10th ribs each articulate with (one/two) vertebral bodies

A

two

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20
Q

heads of 1st, 11th and 12th ribs each articulate with (one/two) vertebral bodies

A

one

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21
Q

costal cartilages of first 7 pairs attach to the

A

sternum

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22
Q

The head and tubercle of each rib articulate with the

A

vertebral body

transverse process of each side

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23
Q

Rib articulates with upper and lower _

A

facet

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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

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25
Q

What is the ratio disc: body height in the t-spine?

a. 2:5
b. 1:3
c. 1:5
d. 2:3

A

1:5

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26
Q

The annulus is (stronger/weaker) in the thoracic spine

A

stronger

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27
Q

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

A

to resist rotational stress

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28
Q

What areas of cervicothoracic junction degenerate?

a. C7-T1
b. T1-T2
c. C6-7
d. C5-T2

A

C6-7

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29
Q

The upper t-spine costovertebral joint is designed to

a. Slide
b. Depress
c. Rotate
d. Glide

A

rotate

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30
Q

The lower t-spine and ribs form the costovertebral joint to

a. Rotate
b. Slide
c. Glide
d. None of the above

A

slide

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31
Q

What can be a primary site of sprain or irritation?

a. Costochondral junction
b. Costovertebral joint
c. Facet joint
d. Ribs

A

costochondral junction

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32
Q

Secondary pain caused by rib dysfunction will show

A

pain in the front

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33
Q

The ligaments for vertebrae and ribs positioned can be described as

A

Continuous ligamentous stocking

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34
Q

Which ligaments unite as a single unit?

A

Ligamentum flavum, interspinous ligament, supraspinous ligament, intertransverse ligament

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35
Q

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

A

ligamentum flavum

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36
Q

The capsule is reinforced dorsally by multifidus and ventrally by

a. Ligamentum flavum
b. Interspinous ligament
c. Supraspinous ligament
d. Capsular ligament

A

ligamentum flavum

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37
Q

Which motion does the thoracic spine mainly do?

a. Flexion
b. Rotation
c. Extension
d. Side bending

A

rotation

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38
Q

How does the vertebra move with flexion?

a. Posterior translation
b. Anterior translation
c. Rotates
d. None of the above

A

anterior translation

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39
Q

How do the ribs move with thoracic flexion?

a. Rotate backwards
b. Rotate sideways
c. Translate
d. Rotate forward

A

rotate forward

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40
Q

How does the vertebrae move with extension?

a. Posterior translation
b. Anterior translation
c. Rotation
d. None of the above

A

posterior translation

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41
Q

How do the ribs move with extension?

a. Rotate sideways
b. Rotate forward
c. Rotate backward
d. Translation

A

rotate backward

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42
Q

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

A

Translate in the direction side flexing

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43
Q

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

A

Translate and tip to the same side lateral flexion

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44
Q

What limits side flexion and stops motion?

A

ribs

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45
Q

With side bending to the right, the right rib (anterior/posteriorly) rotates and the left rib (anteriorly/posteriorly) rotates

A

anterior

posterior

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46
Q

What happens to the vertebrae with rotation?

A

Coupling of rotation with contralateral translation and ipsilateral lateral flexion

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47
Q

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

A

Posteriorly rotate to the side rotating and anteriorly rotate to opposite side

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48
Q

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

A

T1-2

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49
Q

Which areas function as the true t-spine?

a. T9-T10
b. T11-12
c. T4-T9
d. T3-T10

A

T4-T9

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50
Q

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

A

T10-12

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51
Q

Load on the t-spine increases

a. In upper levels
b. In mid thoracic
c. In lower areas

A

in lower areas

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52
Q

Lower t-spine load transferred through _ _

A

posterior column

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53
Q

The lower angle of scapulae is aligned with

a. T1
b. T4
c. T7
d. T9

A

T7

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54
Q

What is designed to handle increased load demand?

A

Vertebral body height
End plate cross sectional area
Bone content

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55
Q

In the upper spine the load is transferred through the

A

Vertebral body/disc complex

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56
Q

How does the load distribution across end plate change outside the neutral position?

A

Becomes asymmetrical

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57
Q

Mid-thoracic pain can be associated with what type of postures

A

sustained loading postures

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58
Q

How does mechanics of shoulder and c-spine affect the t-spine?

A

may restrict functional motion

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59
Q

How does kyphosis change mechanics of the arm?

A

Limits ability for arm elevation

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60
Q

Risk with red flags increases with indication of

A

Age under 20 or over 50
Family history
Past personal history
Sudden, unexpected weight loss/gain

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61
Q

Which structure leads to endplate concavity?

a. Annulus fibrosis
b. Vertebral bodies
c. Trabeculae
d. Vertebral end plates

A

vertebral end plates

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62
Q

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

A

Vertebral bodies lose bone trabeculae

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63
Q

The thoracic spine is (more/less) likely to become arthritic

A

Less

Because of rib cage protection

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64
Q

Height loss in females is due to

A

Compression of vertebrae

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65
Q

Vertebral body fracture twice as common as hip fracture (true/false)

A

true

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66
Q

Osteophytes of the t-spine is common which aging (true/false)

A

true

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67
Q

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

A

hypomobility

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68
Q

(Hypomobility/hypermobility) is common in the thoracic spine

A

hypomobility

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69
Q

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

A

Flexion or axial compression

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70
Q

Which type of traumatic injury is the most severe?

a. Bone bruising
b. Wedge compression
c. Endplate fracture
d. Burst fracture

A

burst fracture

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71
Q

In the upper t-spine _ causes more injury with thoracic facet injuries

a. Flexion
b. Extension
c. Axial compression
d. Rotation

A

extension

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72
Q

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

A

vertebral body injuries

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73
Q

Which area is most frequently injured in a MVC?

a. Transitional zone
b. Upper t-spine
c. Lower t-spine
d. Mid thoracic

A

transitional zone

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74
Q

Falls and sudden flexion can cause

A

Sudden forceful flexion
Slipping
Sudden load onto the spine

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75
Q

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

A

T11, 12, L1

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76
Q

What is the risk with kyphoplasty?

A

high incidence of fractures

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77
Q

Ribs attach to _ _ which is related a higher incidence of _ _

A

Annulus fibers

Disc lesion

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78
Q

What potential causes of disc lesion injury?

A

High viscosity of IVD

Asymmetrical loading

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79
Q

Disc lesions are most commonly in what areas of the thoracic spine

A

lower t-spine

thoracolumbar junction

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80
Q

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

A

disc lesion

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81
Q

Patients pain is distal and has severe pain

a. Radiculopathy
b. Facet joint injury
c. Costochondral injury
d. Disc lesion

A

radiculopathy

82
Q

Radiculopathy in the thoracic spine can be due to

A

Disc lesion
Facet injury
Osteophytes
Scarring

83
Q

_ can closely stimulate thoracic nerve root symptoms

A

costochondritis

84
Q

The upper t-spine will refer symptoms into _ with radiculopathy

A

UE

85
Q

Patient presents with localized sharp pain unilaterally and is aggravated by extension

a. Radiculopathy
b. Facet joint injury
c. Costochondral injury
d. Disc lesion

A

facet joint injury

86
Q

Facet joint dysfunction causes neurological symptoms (true/false)

A

false

87
Q

Pain with coughing and sneezing is common in the (acute/chronic) phase with facet joint dysfunction

A

acute

88
Q

Dull and aching pain related to facet joint dysfunction is common in the (acute/chronic) phase

A

chronic

89
Q

Small ligaments in the t-spine can cause

A

sprain

90
Q

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

A

ligamentous injury

91
Q

Both ALL and PLL are innervated by _ nerve

A

sinuvertebral

92
Q

Breathing causes pain, tender to palpation with severe pain

a. Muscle injury
b. T4 syndrome
c. Ligament injury
d. Rib cage injury

A

rib cage injury

93
Q

Spasms are common in the _ area

a. Lower thoracic
b. Thoracolumbar junction
c. Upper thoracic
d. None of the above

A

upper thoracic

94
Q

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

A

T4 syndrome

95
Q

T4 syndrome is commonly a (UE/LE) problem

A

UE

96
Q

T4 syndrome is a problem involving which structure

A

facet joints

97
Q

Lower t-spine and T/L junction refers to the

A

low back

hip

98
Q

MSK and visceral conditions can be aggravated or alleviated with positional change (true/false)

A

true

99
Q

With MVC (upper/lower) t-spine usually injure facet joints

A

upper

100
Q

With MVC (upper/lower) t-spine usually injure vertebral bodies and disc

A

lower

101
Q

Schmorls nodes are related to pain (True/false)

A

false

102
Q

Scheurmanns Disease is associated with schmorls nodes (true/false)

A

true

103
Q

Patient with thoracic dural attachment problems will present with _ in response to test flexion of spine in seated slump

A

headache

104
Q

If a patients condition doesn’t change within _ visits, be suspicious and consider reexamination

A

6

105
Q

The spinal cord unfolds with _

A

flexion

106
Q

Which structure can facilitate trigger points?

A

posterior primary rami

107
Q

What type of dysfunction can happen to the posterior primary rami?

A

entrapment
myelin removal
source of sensitization
facilitation of trigger points

108
Q

Which tests can be done to see if the posterior primary rami is causing the problem?

A

slump longsit and add side flexion of the c-spine

109
Q

What can cause a decrease in BF, ischemia, pH levels to drop?

A

prolonged posture

110
Q

prolonged posture causing ischemia and scapular pain can be caused by

A

posterior primary rami

111
Q

What contributes to pain caused by a rib fracture?

A

intercostal nerves
removal of myelin
scar tissue

112
Q

Which test should be used to check T1, T2 nerve root and axilla?

A

ULNT3

113
Q

Which structure is adjacent to costovertebral joint that can cause pain?

A

sympathetic ganglions

114
Q

The path of the SNS gets altered due to

A

bone formation

thickening of ligaments

115
Q

Increased stress on SNS tracks can be caused by

A

posture
aging
scoliosis
kyphosis

116
Q

The sympathetic chain sits (anterior/posterior) to the c-spine and (anterior/posterior) to the t-spine

A

anterior

posterior

117
Q

Extra load is added to the SNS with what type of postures

A

thoracic kyphosis

cervical extension

118
Q

Where is the sympathetic chain located in the spinal area?

A

on the side of vertebral bodies

119
Q

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

A

thoracic outlet syndrome

120
Q

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

A

thoracic outlet syndrome

121
Q

Pain and discomfort of TOS are caused by compression of the

A

subclavian artery

lower trunk of brachial plexus

122
Q

Compression between anterior and middle scalene

a. site A
b. site B
c. site C
d. none of the above

A

site A

123
Q

Compression between first rib and clavicle

a. site A
b. site B
c. site C
d. none of the above

A

site B

124
Q

Compression under the pec minor attaching to the coracoid process

a. site A
b. site B
c. site C
d. none of the above

A

site C

125
Q

What are the possible causes of TOS?

A

congential
traumatic
medical
posture

126
Q

What soft tissue pathologies can cause TOS?

A

anterior scalene muscle hypertrophy
muscle fiber type adaptive transformation
spasm
excessive contraction post cervical trauma

127
Q

How does posture cause TOS?

A

lowering the anterior chest wall with drooping shoulders and holding the head in a forward position

128
Q

How can a trauma cause TOS?

A

bone remodeling after fracture of clavicle or first rib or posterior sublux of AC joint

129
Q

What are the two types of TOS?

A

neurogenic

vascualr

130
Q

Most patients with TOS fall into which category?

A

neurogenic TOS (nTOS)

131
Q

What symptoms are important to diagnose with TOS?

A

postural exacerbation

132
Q

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

A

TOS

133
Q

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

A

TOS

134
Q

What are typical aggs of TOS

A 
sustained shoulder elevation
suspensory holding activities 
lying on the arm 
carrying a backpack
prolonged postures 
repetitive use of upper limb and hand dexterity
135
Q

A patient with TOS will only have motor symptoms (true/false)

A

false

mixed spinal nerve

136
Q

A patient with TOS will have restrictions with _ ROM

A

glenohumeral joint

137
Q

in a patient with TOS, check the _ joint for instability

A

glenohumeral joint

138
Q

Which motion can cause TOS?

A

repeated overuse in overhead position

139
Q

with TOS, muscle weakness will be in _ _ muscle groups

A

C5, 6

C8, T1

140
Q

a patient with TOS will have weak _ _

A

grip strength

141
Q

Which ULNT test should be done for a patient that might have TOS?

a. UNLT 1
b. ULNT 2
c. ULNT 3

A

ULNT1

142
Q

TOS screening tests are reliable (true/false)

A

false

143
Q

Which type of scoliosis is the most common?

A

adolescent idiopathic scoliosis

144
Q

What are the three classifications of scoliosis?

A

failure of formation
failure of segmentation
combination

145
Q

This stage of scoliosis has spontaneous healing or surgery

a. infant
b. juvenile
c. adolescent
d. adult

A

infant

146
Q

This stage of scoliosis has a poor prognosis and will grow

a. infant
b. juvenile
c. adolescent
d. adult

A

juvenile

147
Q

This stage of scoliosis girls are diagnosed more than boys

a. infant
b. juvenile
c. adolescent
d. adult

A

adolescent

148
Q

With this stage of scoliosis, there is spinal and joint degeneration

a. infant
b. juvenile
c. adolescent
d. adult

A

adult

149
Q

Mild scoliosis is

a. 10-20 degrees
b. 10-25 degrees
c. 25-50 degrees
d. > 50 degrees

A

10-25 degrees

150
Q

Moderate scoliosis is

a. 15-25 degrees
b. 25-40 degrees
c. 25-50 degrees
d. > 50 degrees

A

25-50 degrees

151
Q

Severe scoliosis is

a. > 40 degrees
b. > 50 degrees
c. > 60 degrees
d. > 55 degrees

A

> 50 degrees

152
Q

How does the curve progress with scoliosis?

A

torsion with eccentric loading of the spine and vertebral growth modulation

153
Q

in scoliosis the rib is pushed (anteriorly/posteriorly) and the cage is (widened/narrowed)

A

posteriorly

narrowed

154
Q

vertebral body in scoliosis distorted toward the (concave/convex) side

A

convex

155
Q

The vertebral canal is narrower in scoliosis on the (convex/concave) side

A

convex

156
Q

In scoliosis the spinous process deviates to the (convex/concave) side

A

concave

157
Q

In scoliosis the rib is pushed laterally and anteriorly to the (concave/convex) side

A

concave

158
Q

What happens to the muscles with scoliosis?

A

weakness
hypertrophy
muscle imbalances
trigger points

159
Q

A passive neck flexion test will be positive in patients with scoliosis (true/false)

A

true

160
Q

How does flexion change in a patient with scoliosis?

A

curve enlarges

161
Q

How does extension change in a patient with scoliosis?

A

limited movement

162
Q

How does side flexion and rotation change in a patient with scoliosis?

A

asymmetry

163
Q

What exercise treatment should be considered for the upper t-spine?

A

cervical spine exercises

164
Q

What exercise treatment should be considered for the true t-spine?

A

thoracic exercises
AP and PA
Ribs: rotation

165
Q

What exercise treatment should be considered for lower t-spine?

A

spinal stabilization
load attenuation
weight bearing

166
Q

Which area responds favorably to PA and AP movements?

A

mid-thoracic spine

167
Q

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

A

posterior primary rami

168
Q

What other structures have the same pain pattern as posterior primary rami?

A

cloward areas
cervical facet joints
thoracic facet

169
Q

What is the structural differentiator for the longsit slump test?

A

knee flexion

170
Q

Which joint deteriorates very fast?

A

costovertebral

171
Q

Which two ribs have no costotransverse joints?

A

the lowest 2

172
Q

Which are the floating ribs?

A

11 and 12

173
Q

This joint is described as the head of rib connecting to the lateral side of the vertebral body

A

costovertebral joint

174
Q

This joint is of the articular facet on the rib tubercle to the anterior aspect of the transverse process

A

costotransverse joint

175
Q

The costovertebral and costotransverse joint provide

A

stability

176
Q

What are the two tests for restricted first rib?

A

cervical rotation lateral flexion

first rib spring test

177
Q

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

A

hyperabduction

178
Q

A positive hyperabduction test is indicated by

A

change in pulse, diminished or gone

179
Q

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

A

wright

180
Q

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

A

roos

181
Q

A positive wright test is indicated by

A

change in pulse or paresthesia

182
Q

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

A

adsons test

183
Q

A positive adsons test is indicated by

A

a diminished pulse or goes away, paresthesia

184
Q

the height of the body is projected posteriorly to contribute to which type of posturing

A

kyphosis

185
Q

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

A

decrease peak force

186
Q

The thoracic spine has a (high/low) ratio of IVD height to vertebral body height

A

low

187
Q

The laminae is designed to limit which motion

a. flexion
b. extension
c. rotation
d. side bending

A

extension

188
Q

the facet joint is what type of joint

A

synovial

189
Q

This ligament grouping is a bridge between neural arch ligaments and those of the vertebral body

A

capsular ligaments

190
Q

_ reinforced dorsally by multifidus and ventrally by ligamentum flavum

a. neural arch ligaments
b. supraspinous ligament
c. ventral ligaments
d. capsule

A

capsule

191
Q

What part of the rib articulates with the vertebral body and TP?

A

head and tubercle

192
Q

Which nerve innervates the ALL and PLL which can be a source of pain?

A

sinuvertebral nerve

193
Q

Which treatment is good for thoracic dura mater?

a. spinal stabilization
b. c-spine exercises
c. traction
d. manual therapy

A

manual therapy

194
Q

Which neurodynamic tests should be done with a patient who has scoliosis?

A

passive neck flexion
slump
slump longsit
straight leg raise

195
Q

T4 syndrome symptoms are (unilateral/bilateral)

A

unilateral

196
Q

Which vertebral bodies are most frequently injured with MVC?

a. C7, T1
b. C6, T7
c. T12, L1
d. T11, T12

A

T12, L1

197
Q

Spinous process alignment in the thoracic spine has (good/poor) reliability

A

poor

198
Q

cervical rotation flexion test is testing the (same/opposite) side

A

opposite

199
Q

What type of symptoms do patients with TOS complain of?

A

pain
paresthesia
weakness

200
Q

Posterior subluxation of the AC joint can cause TOS (true/false)

A

true

MS II (17 decks)

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