Thoracic Flashcards
(18 cards)
Joints at the Thoracic Spx
Costovertebral
Costochondral
facet Joints
Transitional Vertebra
Motion of the Ribs
Pump handle - Inspiration ribs pulled up and forward : ribs 1-6
Buket Handle: With inspiration ribs move upwards laterally: ribs 7-10
Caliper action
- ribs move laterally
- 8-12
Where should the Line of Gravity go through
- external auditory meatus of ear
*Acromomion Process of scapula
*Greater trochanter of femur
Lie posterior to patella and anterior to lateral Malleolus of fibula
What are the 5 types of Kyphosis in Thoracic spx
- Round Back
- Scheurmann’s
- hump Back
- Flat Back
- Dowager’s Hump
Describe Round Back
- Decreased pelvic inclination (post pelvic tilt) with excess kyphosis
- often seen with forward cervical posture and rounded shoulders
SEEMS LIKE ENTIRE SPINE IS KYPHOSIS
Describe Scheurmanns Disease
- rare Congenital an/or degenerative weakening of vertebral end plate
MOST common in YOUNG ADOLESCENTS - structural kyphosis
- uneven growth of vertebrae in the saggital plane resulting in excessive wedge shape - leading to kyphosis
Seen typically between T10-12
Describe Hump Back
Gibbus (localized, sharp, posterior angulation) in the T-spx
- result of structural deformity - anterior wedging of the body of thoracic vertebrae –> due to fracture, tumor, or bone disease
May or may not have pelvic inclination
What is Flat back?
Decreased Pelvic Inclination (post.pelvic tilt 20 degrees) –> decreased curve through T-spx
T-spx becomes more mobile
Describe Dowagers HUmp
- Increased kyphosis typically seen in Older women with postmenopausal osteoporosis
- Anterior wedge fractures occuring at several vertebrae
- hump seen at upper or middle t-spx : due to compression fracture, osteoporosis
- contributes to decreased height
What Interventions can be given for Kyphotic deformities
- Posture education
- Extension approach (uncless flat back) –> Ext in prone
- Streching as needed
- Mobs as needed –> unless person is low bone density like Scheurmanns or OP (dowager)
Describe Compression Fracture
- Typically secondary to Osteoporosis
- Typically occurs in the sixth or seventh decade
- F>M (post menopausal)
- Typically anterior vertebral body - Flexion places compressive to anterior vertebral bodies - vertebral compression fracture (more common in thoracolumbar region)
- Common cause: falls, trauma, trunk flexion
- Patient may present with increased kyphosis = multiple fractures = Increased kyphosis
What is the intervention
- Posture education - prevent too much flexion
- Extension Approach
- Stabilization Exercises
- Scapular-stabilization exercises?
- Weight bearing activities - important for pts with low bone density
Light mobs as needed (with precaution)
Define Scoliosis
- Lateral curvature in the spine
- Curve patterns labelled in the direction of the convexity of the curve and the level of the apex of the curve (right thoracic curve has its convexity towards right and its apex in the thoracic spine)
- two of more curves get labelled “major” and “minor” - double major
Non-Structural Scoliosis
- Curve Disappears with forward flexion
- can be due to poor posture, muscle guarding or spasm, nerve root irritation, inflamm, LEG LENGTH DISCREPANCY
- FUNCTIONAL OR POSTURAL SCOLIOSIS
Structural Scoliosis
- Structural changes in the bone
- congenital or acquired
- in severe cases the Cobbs angle is >60 degrees
- irreversible curvature with fixed rotation of the vertebrae
- vertebral bodies rotate to the side of the convexity
In thoracic - vertebral body rotation will cause the ribs on the convex side to become more prominent posteriroly “rib hump”
- Visible with forward flexion
- Severe rib hump = razor abck spine
- CURVE DOES NOT DISSAPEAR WITH FORWARD FLEXION (NEY ADAMS TEST)
Interventions for Scoliosis
- postural education - for structural scoliosis cannot fix the bones but can prevent further scoliosis - by addressing mm imbalances
–> visual cues like a mirror/line and tell them to stand straight
Strengthen side of convexity –> Rotation - R scoliosis vertebral body rotated to the right - for resisted exercise rotate to the left
- Single arm barbell row –> rotate to the left with barbell
- Stretch side of concavity
- Stabilization exercise
- Scapular stabilization
- Mobilization as needed
- Bracing as needed : Boston Brace - puts pressure on convexity
- Surgery as needed
Describe Herpes Zoster
- viral infection causing painful skin rash –> SHINGLES
- skin rash follows N. dermatomal pattern
- thoracic spx - stripe like dermatomal distribution on one side of body
- may be accompanied by a fever
Describe how leg-length discrepancy imapcts non-structural scoliosis
If the right leg is longer - pelvis becomes angled
- Sacrum angled to the left - lumbar spx attached to the sacrum so it goes to the left (tips)
- T-spx tries to compensate and come back to the otherside - to maintain CoG (towards direction of the long leg
