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Flashcards in thoracic Deck (37):
1

Rules of 3s

-T1-3 SP at same level
-T4-6 SP 1/2 level below
-T7-9 SP 1 full level below
-T10 1 full level below
-T11 1/2 level below
-T12 at same level

2

Ligamenta Flava

-Assists in resuming posture after flexion
-Can cause stenosis

3

Radiate Ligament

-Connect anterior head of each rib with bodies of 2 vert and intervertebral fibrocartilage
-Triradiate (above, at level, below) except 1, 10, 11, 12 (biradiate - above and at level)

4

Multifidi: Jull, Hodges, Hides

-Between TP and SP, sacrum to C2
-stabilize vertebral column
-pain inhibits

5

Critical Zone: artery of adamkiewicz

-T4-9 has 3mm of redundancy, watershead vascularization

6

Typical Ribs

-Ribs 3-10
-Attached above and below and to intervertebral disc

7

Atypical ribs

-Ribs 1, 2, 11, 12
-Ribs 1, 11, 12 to T1, 11, 12 with unifacet
-Rib 2 to T1 with 2 demifacets

8

Respiratory motion with thoracic flexion

Rib internal torsion

9

Respiratory motion with thoracic extension

Rib external torsion

10

Physiological motion of costal cage

-Pump handle: upper/mid
-Bucket handle: mid to inf ribs
-Calipers: ribs 11-12
-Torsional motion: internal/external, mid to lower ribs

11

Structural dysfunction: superior subluxation

First rib: exhalation dysfunction

12

Structural dysfunction: anterior/posterior subluxation

circumferential pain = sympathetic facilitation, traumatic force.
asymmetry of boney landmarks of UE

13

Structural dysfunction: internal or external torsion

rib stuck with dysfunctional vertebrae or chronic myofascial restrictions.
-circumferential tenderness, hypertonicity of ipsilat intercostals
-Inf edge post: internal torsion
-Sup edge post: external torsion

14

Structural dysfunction: inhalation and exhalation

Often asymptomatic, no asymmetries.
Less problematic

15

Thoracic Scan: Compression

seated, arms crossed. push down through shoulders
ID: fracture

16

Thoracic Scan: Traction

seated, arms crossed, lift up
ID: disc/ligament

17

Thoracic Scan: Breathing pattern

look at breathing, can put hands on ribs

18

Thoracic Scan: Manubrial compression

pain provication

19

Thoracic Scan: Upper sternal compression

pain provication

20

Thoracic Scan: Lower sternal compression

pain provication

21

Thoracic Scan: abdominal cutaneous relfex

pt in hooklying, drag sharp end of reflex hammer into belly button.
Look for asymmetry of inconsistency.
Upper: T6-10
Lower: T10-12

22

Thoracic Scan: Beevor's Sign

hooklying, pt lift head off pillow, look for deviation (will deviate away from dysfunction)

23

Thoracic Scan: Aortic pulse

larger than 3 finger width, lack of normal lub-dub

24

Thoracic Scan: Abdominal quadrant palpation

looking for rebound or pain

25

Thoracic Scan: Sprin test

-PA of SP pt in prone
-Rib spring PA, pt in prone

26

Thoracic Scan: Soft tissue spring

due to segmental innervation soft tissue changes will be along same level of dysfunction. "idiot light"

27

Thoracic Tests: AROM

-Flexion, ext, rotation, SB
-in sitting, prone, prone pressup, arch/sag

28

Thoracic Tests: Positional/motion testing

-Hands on TPs, pt flex/ext

29

Thoracic tests: PIVM

-Flexion, extension, rot, SB

30

Thoracic Test: PAIVM

combined motions: quadrants

31

Thoracic Tests: Anterior translation

-Pt prone
-Stabilize inferior vert
-Cranial hand on TP give P>A force to superior vert.
-Positive = excessive translation, clunk, crepitus

32

Thoracic Tests: Rotational stability

-Pt prone
-Stabilize inf vert at TP
-Sprint opposite side of TP of superior vert to rotate the superior vert on inferior.

33

Thoracic Tests: Posterior translation

-Pt sitting
-P>A vert inferior to one being tested, block ribcage
-essentially an A>P of sup vert

34

Thoracic Tests: Lateral stress test

-pt sitting
-Palpate SP of inf vert, shear trunk toward PT

35

Costal Cage Assessment: Key Rib

-Rib within a group of ribs that is limiting respiration of others
-Will have both structural and respiratory rib dysfunction
-Inhalation: key rib above
-Exhalation: key rib below

36

Costal Cage Assessment: Bony landmarks

Look for asymmetries

37

Costal Cage Assessment: Passive overpressure

-Spring into internal torsion (flexion)
-Spring into external torsion (extension)