thoracic biomechanics

Question 1

What is the main source of support in the thoracic area

Answer 1

Ligamentous support

Question 2

What type of joint is the zygapophyseal joint?

Answer 2

gliding synovial joints

Question 3

What directions do the superior facets face?

Answer 3

posteriorly, superiorly and laterally

Question 4

What directions do the interior facets face?

Answer 4

anteriorly, inferiorly, and medially

Question 5

What is the intervertebral joint?

Answer 5

articulation between each vertebra with an intervertebral disc

Question 6

Which capsule is tighter between the cervical and thoracic spine?

Answer 6

thoracic spine

Question 7

Is a disc herniation common in the thoracic spine?

Answer 7

no, they are rare

Question 8

What joints make up the thoracic spine (other than the ones that are the same as all others)?

Answer 8

• costovertebral
• costotransverse
• costochondral
• interchondral
• chondrosternal
• xiphisternal
• manubriosternal

Question 9

What articulations make up the costovertebral joint?

Answer 9

• head of rib articulates with 2 adjacent vertebral bodies and the IVD
• vertebral bodies of T2-T9

Question 10

How is the costovertebral joint reinforced?

Answer 10

intra-articular ligament

absent in atypical joints

Question 11

how is the costovertebral capsule supported?

Answer 11

radiate ligament

Question 12

What articulations make up the costotransverse joint?

Answer 12

• articulation of the transverse process and the rib

- TP of T1-T10

Question 13

How is the costotransverse joint and joint capsule reinforced?

Answer 13

• lateral costotransverse ligament
• costotransverse ligament
• superior costotransverse ligament

Question 14

What articulations make up the costochondral joint?

Answer 14

• articulation of the 1st-10th ribs anterolaterally with the costal cartilages
• direct attachment of the rib

Question 15

What ligaments support the costochondral joint?

Answer 15

none-lacks true ligamentous support

Question 16

What articulations make up the interchondral joint?

Answer 16

• synovial articulation between corresponding ribs

- costal cartilages of ribs 7-10 articulate with cartilage immediately above

Question 17

What is the only connection between the sternum and ribs 8-10?

Answer 17

interchondral joint

Question 18

How is the interchondral joint supported?

Answer 18

• a capsule and interchondral ligament

Question 19

What articulations make up the chondrosternal joint?

Answer 19

• articulation of costal cartilages of ribs 1-7 anteriorly with the sternum
• continues with sternum

Question 20

What articulations make up the xiphisternal joint?

Answer 20

-articulation between the main body of the sternum ad xiphoid process

Question 21

Is the xiphisternal always cartilaginous?

Answer 21

no, it is cartilaginous during childhood but ossifies in adulthood

Question 22

What ligaments support the xiphisternal joint?

Answer 22

none-no direct ligamentous support

Question 23

What articulations make up the manubriosternal joint?

Answer 23

articulations between the most superior portion of the sternum (manubrium) and the largest portion of the sternum (sternal body)

Question 24

What ligaments support the manubriosternal joint?

Answer 24

none-no direct ligamentous support

Question 25

What structures in the thoracic spine reduce thoracic mobility?

Answer 25

- decreased IVD height - rib articulation with thoracic spine - facet joint orientation

Question 26

How many degrees of freedom does the thoracic spine have? And what are they?

Answer 26

Sagittal: flexion/extension Transverse: Axial rotation Frontal: side bending

Question 27

Arthokinematics: flexion at thoracic spine and ribcage

Answer 27

T-spine: anterior and superior translation-anterior rotation | Ribcage: rolls superiorly on the transverse process

Question 28

Arthokinematics: extension at thoracic spine and ribcage

Answer 28

T-spine: posterior rotation and posterior translation | Ribcage: posterior roll

Question 29

Arthokinematics: rotation at thoracic spine and ribcage

Answer 29

BOTH: -ipsilateral posterior medial glide | -contralateral anterior lateral glide

Question 30

Arthokinematics: side bending at thoracic spine and ribcage

Answer 30

BOTH: - ipsilateral superior facet inferior glide and approximation - contralateral facet superior glide and gapping

Question 31

What are vertical changes in the interthoracic volume with inspiration and expiration?

Answer 31

- Diaphragm contracts and lowers increasing negative pressure for inspiration - diaphragm relaxes and raises for quiet expiration

Question 32

How does elevation of the ribs affect inter thoracic volume?

Answer 32

Elevation of ribs produces an increase in anterioposterior and mediolateral distances increasing interthoracic volume during inspiration -bucket handle/pump handle motion

Question 33

How does depression affect interthoracic volume

Answer 33

Depression of ribs produces a decrease anterioposterior and mediolateral distances decreasing interthoracic volume during expiration -bucket handle/pump handle motion

Question 34

Arthrokinematics: respiration at ribs 1-6 | Inspiration and expiration

Answer 34

Primary movement is rotation Inspiration: anterior portion moves superior, posterior portion moves inferior Expiration: posterior portion moves superior, anterior portion moves inferior Pump handle

Question 35

Arthrokinematics: Respiration ribs 7-10 | Inspiration and expiration

Answer 35

Inspiration: superior, anterior, and lateral Expiration: inferior, posterior, and medial Bucket handle

Question 36

Explain "bucket-handle" in simple terms for inspiration and expiration

Answer 36

Inspiration : ribs rotate upward and outward Expiration: ribs rotate down and in

Question 37

What occurs during forced inspiration?

Answer 37

The movement of the ribs is combined with slight thoracic extension

Question 38

Thoracic muscles

Answer 38

``` Last Erector spinal Traps Rhomboid minor and major External oblique Rectus abdominis Pec major and minor ```

Question 39

Primary muscles of respiration

Answer 39

Diaphragm Sternocostal Intercostal All act on the rib cage to promote inspiration

Question 40

Diaphragm

Answer 40

-Most important muscle of inspiration: increases intrathoracic volume -Dome shaped -separates thoracic cavity from abdominal cavity -connected by the central tendon -innervated by the phrenic nerve Drops during inspiration; elevates during expiration

Question 41

What are the three intercostal muscles and what part of respiration are they active during

Answer 41

External intercostals: pull the lower rib toward the upper rib in inspiration Internal intercostals: pulls the upper rib down during expiration Sternocostals: active during inspiration

Question 42

Secondary muscles of respiration

Answer 42

``` Anterior and middle scalenes Serratus posterior Pec maj and min Last Traps SCM ``` Assist with inspiration and expiration during activity, stress, or illness

Question 43

Clinical implications: posture

Answer 43

Changes in posture affect muscle length Affects respiration Important to monitor progression during therapeutic exercise

Question 44

Clinical implication: rib dysfunction

Answer 44

A rib that does not coordinate its movements with the other ribs -pain, muscle spasms, difficulty breathing Wide variety of causes - posture, trauma, rotational strains, forceful compression, coughing attack

Question 45

Clinical implications: scoliosis

Answer 45

Frontal and transverse plane deviation of the normal alignment of the spinal curve Named by the shape, spine location, and the side of convexity Functional or structural Rib hump is always present in structural scoliosis Varying degrees of severity: Cobb angle

Question 46

Open, closed and Capsular pattern in thoracic

Answer 46

Open:midway between flex and extended Closed:full extension Capsular pattern:extension, side bending, rotation>flexion