Thoracic Spine Flashcards
Thoracic Rib Motion
(3)
Pump Handle Action
- W/ inspiration the ribs are pulled up & forward (anteriorly)
- Changes in anterior-posterior diameter
- Occurs at ribs 1-6
Bucket Handle Action
- W/ inspiration the ribs move upwards laterally
- Changes in medial-lateral (transverse) diameter
- Occurs primarily at ribs 7-10
Caliper Action:
- W/ inspiration the ribs more laterally
- Occurs at ribs 8-12
Ideal Alignment in Standing
(lateral view)
- Line of gravity should go through:
External auditory meatus of the ear
Acromion process of the scapula
Greater trochanter of femur - Line of gravity should lie posterior to the patella
- The line of gravity should lie anterior to the lateral malleolus of the fibula
Kyphosis Deformities: LIST
(5)
- Round Back
- Scheurmann’s Disease
- Hump Back
- Flat Back
- Dowager’s Hump
Kyphosis Deformities: Round Back
(3)
- Decreased pelvic inclination (~20) w/ throacolumbar or thoracic kyphosis
- Often associated with a forward head (cervical protraction) & rounded shoulders (scapular protraction)
- The appearance looks as though the entire spine is in kyphosis
Kyphosis Deformities: Scheuermann’s Disease
(4)
- Rare congenital &/or degenerative weakening of vertebral end-plate
-
Most common structural kyphosis in adolescents, usually seen in the second decade of life (teenage years)
May be mistaken for “growing pains” - Uneven growth of the vertebrae in the sagittal plane resulting in an excessive wedge shape leading to increased kyphosis
- Typically seen in T10-L2
Kyphosis Deformities: Hump Back
(3)
- Gibbus (localized, sharp, posterior angulation) in the thoracic spine
- Typically, a result of a structural deformity, susch as an anterior wedging of the body of a thoracic vertebrae d/t a fracture, tumor, or bone disease
Anterior wedging - compression or osteoporotic fracture - May or may not have normal pelvic inclination
Kyphosis Deformities: Flat Back
(2)
- A decreased pevlic inclination (~20) & a decreased curve through the thoacic spine
- Thoracic spine is mobile
Kyphosis Deformities: Dowager’s Hump
(5)
- INC kyphosis typically seen in older women w/ postmenopausal osteoporosis
- Due to anterior wedge fracture occurring at several vertebrea (compression #)
- Typically, as a result of tunk flexion
- Typically occurs in upper or middle thoracic spine
- Contributes to decreased height
More wedging = INC Dowager’s hump
Kyphosis Deformities: Interventions
(5)
- Posture Education
- Extension approach - for hyperkyphosis - EXTEND more (in prone)
Prone - be careful pt does not have CV/ pulmonary conditions - can be CONTRAindicated - Stabilization exercises
- Stretching as needed
- Mobilization as needed - precaution for some conditions
CONTRAindications: Joint manipulation & aggressive mobilization in Scheurmann’s disease & dowager’s hump
Compression Fracture
(7)
- Typically, secondary to osteoporosis
Low bone density - prone to these fractures - Typically occurs in the 6th or 7th decade of life
- F>M (post-menopausal)
- Typically, in anterior vertebral body - mechanism that caused it is FLEXION
- Vertebral compression fractures more common in the thoracolumbar region
- Common causes:
Falls
Traumas
Trunk flexion (more precautions w/ exercise - pallof press compared to a crunch - Patient may present w/ INC kyphosis (multiple fractures = INC kyphosis)
Compression Fractures: Interventions
(6)
- Posture education
- Extension approach - exercises
- Stabilization exercises
- Scapular stabilization exercises
- Weight-bearing activites & exercises
Lower load & progressively increase
Very important for pt w/ low bone density - Light mobilization as needed (with precaution)
Be mindful of medications & ADL requiring flexion
CONTRA-indications: Joint mobilizations & aggressove mobilization, trunk flexion exercises
Scoliosis
Description
Lateral curvature of the spine
- Curve patterns are labeled in the direction of the convexity of the curve & the level of the apex of the curve
Ex. A RT thoracic curve has its convexity towards the RT & it’s apex in the thoracic spine) - In cases where there is more than one curve = the greater of two curves is labeled “major” & the lesser of two curves is labelled “minor”
- Curves are equal = “double major”
COBB ANGLE
< 10 is not scolosis
> 10 is diagnostic of scolosis
Non-Structural Scoliosis =
Functional Scoliosis
(4)
Curve dissapears with forward flexion
- Relatively easy to correct once cause is found
- Can be d/t poor posture, mm guarding or spasm (injury - do not want to move to that side), nerve root irritation, inflammation, leg length discrepancy
- Also known as functional or postural scolosis
Structural Scolosis
Structual changes in bone
- May be congenital or acquired, but typically congenital
- Severe cases (Cob Angle > 60) may result in a compromised cardiovascular system
To much pressure restricting the lungs & mediastenum = RESTRICTIVE disease - Curve does not dissapear with forward flexion < Adams test (differentiate)
- Irreversible curvature w/ fixed rotation of the vertebrae
-
Vertebral bodies rotate to the side of the convexity
If scoliosis in T/S, vertebral body rotation will cause the ribs on the convex side to become more prominent posteriorly
This posterior rib prominence is known as a rib “hump” & is easily visible with forward flexion
Severe rib hump known as razor back spine
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Non-Structural Scoliosis =
Functional Scoliosis:
LLD
LLD causes many compensatory deficits
CoG shifts towards the short leg - going away from the long leg
Short leg - ABDucts
Long leg - ADDucts
- Can wear down the hip - compressive forces
T/S curve going to the side of the long leg to regain stability (higher up the chain)
