Thoracic

Question 1

Biomechanics - the thoracic vertebrae are wider in what direction

Answer 1

wider ant-post than med-lat

Question 2

Biomechanics - facets

Answer 2

Complete facets T1, T10-T12

Demifacets T2-T9

Question 3

Articular processes - facet/zygagpophyseal joints are what

Answer 3

pedicle to lamina junction

Question 4

Articular processes - motion at thoracic spine because of capsule

Answer 4

Flex is limited

Minimal axial rotation and LF

Question 5

TP - what happens to shape throughout

Answer 5

TP length dec from T1-T12

these are where ribs attach

Question 6

SP - what happened to orientation throughout

Answer 6

Upper - aligned horizontally
Middle - post and inf
Lower - short and projects posterior

Question 7

Sternum - landmarks

Answer 7

Sternal notch at T3 body

Body at T5-T9 levels

Question 8

Supporting structures - anterior instability

Answer 8

PLL
interspinous ligament
supraspinous ligament
post disc
issue with those that limit flexion

Question 9

Supporting structures - posterior instability

Answer 9

ALL
ant disc
issue with those that limit extension

Question 10

Costovertebral and Costotransverse are what type of joinrs

Answer 10

Gliding

Question 11

Ribs to sternum - attachments

Answer 11

1st to manubrium
2nd to junction
3-7 to body
8-10 to cartilage of 7th rib

Question 12

Thoracic spine - sagittal, forntal, transverse plan ROM throughout

Answer 12

Sagittal (flex/ext) - inc from sup to inf
Frontal (lateral) - same
Transverse (rot) - decreases from sup to inf

Question 13

Rib motion - sagittal plane

Answer 13

pump handle motion

Question 14

Rib motion - frontal plane

Answer 14

bucket handle motion

Question 15

With thoracic flex - what is rib motion

Answer 15

rib depression

Question 16

With thoracic ext - what is rib motion

Answer 16

rib elevation

Question 17

With thoracic rot what is rib motion

Answer 17

ipsilateral TP moves post pulling the rib and inc rib curvature
So if rot R, R closed, L is open
turning L, pushes ribs right (bone to bone) and pulls ribs left (ligaments)

Question 18

With thoracic lateral flexion, what is rib motion

Answer 18

Ipsilateral will have rib approximation

Contralateral will have rib separation

Question 19

Superincumbent weight exerts what type of moment on the thoracic spine

Answer 19

flexion
Moment inc from T1-T4 and then dec again
Greater kyphosis = greater flexion moment

Question 20

Forward bending - what are the mechanics and muscles activated throughout

Answer 20

0 (standing straight) - less ES activity, Inc while bend forward
30 flex - ES stops firing, stretch will suspend body without contracting mm
90 flex - moment arm dec, ligaments not stretched as much, increase strain, dec stress, mm are silent

Question 21

Thoracic - joints are designed for

Answer 21

compression, not shear! Kyphotic posture inc shear by 2.5x in standing!

Question 22

S/S of facet dysfunction

Answer 22

Local sharp pain!

Question 23

SP of thoracic spine - rules of

Answer 23

3s!
T1-T3 = in line with VB of same level
T4-T6 = in line with IVD of inf level
T7-T9 = in line with VB of inf level
T10 = inf body
T11 = inf IVD
T12 = same body

Question 24

Articulations - Manubriosternal, Xiphisternal

Answer 24

Synchondrosis
Ossifies in older adults
Manubrial rotation occurs with shoulder flexion

Question 25

Articulation - costovertebral

Answer 25

synovial joint

Question 26

Articulation - costotransverse

Answer 26

synovial

Question 27

Coupled movement

Answer 27

``` Upper = like cervical = LF and Rot SAME direction Lower = like lumbar = LF and Rot OPP direction ```

Question 28

If rib dysfunction and thoracic what tx first

Answer 28

Tx thoracic first!

Question 29

Pump handle action

Answer 29

during inspiration ribs 1-6 pull up and forward | manubrium elevation

Question 30

Bucket handle action

Answer 30

ribs 7-10 move up, backward, and medial to increase lateral dimension

Question 31

Caliper action

Answer 31

ribs 8-12 move laterally to increase lateral diameter | posterior and lateral during inhale

Question 32

Bucket bail lesion is what

Answer 32

bucket handle position is displaced more than pump handle because of its lateral position usually from trauma

Question 33

Disc pathology in T spine

Answer 33

less common to be herniation | more commonly degeneration

Question 34

Scheuermann's disease is what

Answer 34

Common in lower thoracic - related to schmorles nodes vertical disc herniation into vertebral body, causes achiness and stiffnes excessive kyphisis, loss of flex/ext

Question 35

Spinal tumors

Answer 35

MOST COMMON IN T SPINE! Back pain will be primary sx with it being worst at night Red flag if s/s cannot be reproduced with mvmnt

Question 36

Benign spinal tumors include

Answer 36

``` Osteochrondroma Osteoid osteoma Osteoblastoma Giant cell tumor Hemangioma Eosinophilic granuloma ```

Question 37

Malignant spinal tumors include

Answer 37

``` Plasmacytoma Ewings sarcoma Lymphoma Osteosarcoma Chondrosarcoma Chondroma ```

Question 38

Ankylosing spondylitis is what

Answer 38

chronic inflammatory arthropathy, stiffening or fusion of spine and SI joints More common and more severe in men 2nd most common in T SPINE

Question 39

Scoliosis - non structural

Answer 39

poor posture nerve root irritation leg length discrepancy

Question 40

Scoliosis - structural

Answer 40

genetic idiopathic wedge/hemi vertebrae contributes to rotation

Question 41

Scoliosis - curve pattern is named according to

Answer 41

apex of the curve and direction of the convexity | vertebral body rotates toward the convexity, rib post which is why we see rib hump with forward flexion

Question 42

Pectus carinatum

Answer 42

pigeon chest sternum projects forward and downward inc ant-post dimension of chest

Question 43

Pectus excavatum

Answer 43

funnel chest sternum pushed post by overgrowth of ribs and-post chest dimension dec

Question 44

Barrel chest

Answer 44

sternum projects forward and up ant-post dimension inc seen with emphysema

Question 45

Normal motion with breathing assessment

Answer 45

abdomen rises, lateral expansion, upper chest/accessory mm

Question 46

Rib motion with breathing assessment

Answer 46

supine | feel for ant/post motion during inhale/exhale

Question 47

Depressed rib - breathing assessment

Answer 47

will stop moving relative to others on inhale

Question 48

Elevated rib - breathing assessment

Answer 48

will stop moving relative to others on exhale

Question 49

Diaphragm attaches to

Answer 49

internal part of xiphoid process (sternal portion) inner surface of lower ribs (costal portion) L1-L3 (lumbar portion)

Question 50

Shoulder flexion can be used to assess

Answer 50

the upper 7 ribs

Question 51

Shoulder abduction can be used to assess

Answer 51

the lower ribs

Question 52

With right cervical rotation the R rib moves ____ and the L rib moves ___

Answer 52

R moves anteromedially | L moves posterolaterally

Question 53

With unilateral shoulder flexion you will get

Answer 53

thoracic rotation

Question 54

With bilateral shoulder flexion you will get

Answer 54

thoracic extension