thoracic spine and rib cage

Question 1

rule of 3

Answer 1

SP T1-3 same level of TP
SP T4-6 1/2 level below level of TP
SP T7-9 1 level below TP
SP T10-12 same level

Question 2

Spinal canal is more narrow in mid-thoracic spine
decreased blood supply
disc herniation/injury can lead to central spinal cord compressionhere causing tension along the path of a nerve
T6=tension point

Answer 2

critical zone

Question 3

stiffness
look at chest expansion
improvement of back pain with exercise but not with rest
awakening because of back pain during second 1/2 of the night only
alternating buttock pain

Answer 3

ankylosing spondylitis

Question 4

motion in sagittal plane gradually increases from

Answer 4

top to bottom

Question 5

coupled SB in the TS

Answer 5

upper: ipsilateral
lower: contralateral

Question 6

sympathetic chain is tensioned during

Answer 6

flexion
contralateral rot
contralateral SB

Question 7

stiffness causing HA, neck pain, UE pain, B stocking glove paresthesias

Answer 7

T4 syndrome

Question 8

most common at fist rib
limit painful caudal glide
may progress to thoracic outlet syndrome if bad enough

Answer 8

superior subluxation

Question 9

traumatic blow to posterior chest wall

may be able to plapate prominence of rib anteriorly or a concavity posteriorly

Answer 9

anterior subluxation

Question 10

anterior chest wall trauma

most treatments are a mobilization or manipulation

Answer 10

posterior subluxation

Question 11

associated with osteioporosis or impact injuries
most frequent in 5th decade and after
tends to be in kyphotic position
extension activities may help reduce stress on vertebral body
treatment involves safely restoring func while preserving integrity of healing

Answer 11

TS vertebral fx

Question 12

lateral curvature w/o rotational component
can be lead to by mm spasm, inflammatory conditions, injuries
curvature can be corrected by changing patient postition
treat the underlying cause and the scoliosis will resolve

Answer 12

funcitonal scoliosis

Question 13

lateral curvature w rotational component
can be congenital, secondary to a neurological disorder, or idiopahtic
does not change with position
vertebral bodies can become wedge shaped in frontal plane
curves irreversible

Answer 13

structural scoliosis

Question 14

usually due to elevated or abnormal first rib after a traumatic injury or overuse of repetitive overhead activities
Nerves: vague aching radicular pain, N/T especially with shoulder elevation
Blood vessels: swelling and redness of arm/hands
difficulty with ovehead activities

Answer 14

TOS

Question 15

Tx of TOS

Answer 15

first rib mobs, scalene stretch, pec stretch, soft tissue mobs, strengthening mid and lower traps.

Question 16

due to increased tension int he nervous system, stiff sounding joints, natural posture
hx of MVA and shiplash
may lead to constant loading of joints and mid back pain
stiffness of CTJ and mid thoracic
flexion restriction

Answer 16

Flattened upper TS

Question 17

Flattened upper TS tx

Answer 17

unload joint, improve mobility, scapular and thoracic stability

Question 18

first rib test

Answer 18

stabilize first rib
rotate head to contralateral side
SB to ipsilateral side
pos: pain, decreased ROM, firm end-feel

Question 19

small herniation of disc material into the endplate of vertebral bodies

Answer 19

schmoral’s nodes

Question 20

sx: pain and stiffness, rigid curved spine
tx: cercise to improve mobility and back care, bracing, surgical intervention

Answer 20

scheuermanns and schmorals nodes