Thoracic Lumbar PBL

Question 1

What segments are help innervate between the mouth and the ligament of Treitz?

Answer 1

Upper GI (T5-T9)

Question 2

What segments innervate the Mid GI? (Ligament of Treitz to ileocecal valve)

Answer 2

T10-T11

Question 3

What segments innervate the lower GI? (Ileocecal valve to the anus)

Answer 3

T12-L2

Question 4

What segments innervate the upper GU? (Kidney to upper 1/3 of the ureter)

Answer 4

T10-T11

Question 5

What segments innervate the lower GU (lower 2/3 of the ureter, urethra)?

Answer 5

T12-L2

Question 6

What segments innervate the bladder?

Answer 6

T11-L2

Question 7

Where does the rib attach to?

Answer 7

To its own vertebral segment at the superior costal facet (as well as other attachment points)

Question 8

What motion do ribs 1, 2, and 8-10 have?

Answer 8

Bucket handle

Question 9

What motion do ribs 3-7 have?

Answer 9

Pump handle

Question 10

What motion do ribs 11-12 have?

Answer 10

Caliper

Question 11

How do ribs have torsional motion?

Answer 11

Due to the rotation of the thoracic spine

Question 12

What are non-physiologic motions of the ribs?

Answer 12

Anterior or posterior subluxation

Question 13

What is it called when there is a rib or group of ribs that ceases movemnet first during inhalation effort?

Answer 13

Inhalation restriction/dysfunction

Question 14

Which rib is the key rib in inhalation dysfunction?

Answer 14

If a group of ribs is found to have inhalation dysfunction, the bottom of the group is the key rib

Question 15

What motion is there for the floating ribs?

Answer 15

Caliper or pincer motion

Question 16

What is caliper/pincer motion?

Answer 16

Downward and posterior with inhalation

Upward and superior with exhalation

Question 17

What muscle do you treat for an exhalation restriction (inhalation dysfunction)?

Answer 17

Ribs 1-10: depress key rib with exhalation

Ribs 11-12: quadratus lumborum

Question 18

What muscle do you treat for inhalation restriction/exhalation dysfunction for rib 1?

Answer 18

Anterior/med scalene

Question 19

What muscle do you treat for inhalation restriction/exhalation dysfunction for rib 2?

Answer 19

Posterior scalene

Question 20

What muscle do you treat for inhalation restriction/exhalation dysfunction for ribs 3-5?

Answer 20

Pectoralis major

Question 21

What muscle do you treat for inhalation restriction/exhalation dysfunction for ribs 6-8?

Answer 21

Serratus anterior

Question 22

What muscle do you treat for inhalation restriction/exhalation dysfunction for ribs 9-10?

Answer 22

Latissimus Dorsi

Question 23

What muscle do you treat for inhalation restriction/exhalation dysfunction for ribs 11-12?

Answer 23

Quadratus lumborum

Question 24

What allows torsional movement to occur?

Answer 24

articulation at the inferior costal facet

Question 25

What factors contribute to an inhalation dysfunction?

Answer 25

Inhaled, inspired, moves inhaled, symmetrical in inhalation, doesn’t move in exhalation, elevated rib, restricted in exhalation, exhalation restriction

Question 26

What factors contribute to an exhalation dysfunction?

Answer 26

Exhaled, expired, moves exhaled, symmetrical in exhalation, doesn’t move in inhalation, depressed rib, restricted in inhalation, inhalation restriction

Question 27

What is seen in facet arthritis?

Answer 27

Localized to low back and buttocks Better with lying down or change of position Worse with spinal extension Typically chronic Work up: ap/lateral films, MRI

Question 28

What is expected with spondylolisthesis?

Answer 28

``` Leg pain, numbness, or weakness, stiff back, changes in posture or gait Grade I-II = stable Grade III- V = surgery “Step off” when palpating lumbar spine Usually chronic ``` Work up: ap/lateral films

Question 29

What is seen with radiculopathy?

Answer 29

Pain with dermatomal distribution Neurological function may be impaired Typically acute Work up: MRI

Question 30

What’s seen with spinal stenosis?

Answer 30

BLE pain Neurogenic claudication Neurological function may be impaired Typically chronic Work up: MRI

Question 31

What’s seen with cauda equina syndrome?

Answer 31

Impairied neurological function: saddle anesthesia, LE weakness, diminished reflexes, urinary retention Usually traumatic EMERGENCY Work up: MRI

Question 32

What diseases are considered to be seronegative spondyloarthropathy?

Answer 32

Psoriatic arthritis, ankylosing spondylitis, IBD, reiter syndrome Back and joint pain Typically chronic

Question 33

What direction does the superior facet face on cervical vertebrae?

Answer 33

BUM Backwards Upward Medial

Question 34

What direction does the superior facet face on the thoracic vertebrae?

Answer 34

BUL Backwards Upwards Lateral

Question 35

What direction does the superior facet face on the lumbar vertebrae?

Answer 35

BM Backwards Medial