Thoracic Spine and Rib Cage [Guest Lecture] Flashcards
(42 cards)
Describe the rule of 3
T1-3: TP at same level as spinous process
T4-6: TP 1/2 level above spinous process
T7-9: TP 1 level above spinous process
T10-12: TP at same level as spinous process
Describe the shape of the thoracic vertebrae
The AP and Transverse dimensions of the bodies are a uniform ratio
The body is slightly higher posteriorly
Describe the ratio of disk height to vertebral body through the spine and what this can implicate
C: 2:5 (largest)
T: 1:5 (smallest)
L: 1:3 (close 2nd largest)
A bulging disc is more likely to occur in a larger disc, thus bulges are less common in the T-spine
Describe the impact of dysfunctional T-spine muscles
If the origin within the T-spine is moving (i.e. mm attached to instable TP) then less force can be produced by the mm
Describe the critical zone
From T4-9 where the spinal canal is narrowed, which is supplied by only the anterior spinal artery — recall T6 = tension point
Area more prone to disc herniation and injury
Condition: Sudden chest pain, radiationg to back that is unrelenting (emergency situation)
Dissecting thoracic aneurism
List the 5 parts of the coronary artery disease CPR
F > 65; M > 55
Known vascular disease
Pain worse during exercise
Pain not reproduced w/palpation
Pt. feels that it is cardiac in nature
Condition: boring pain to mid T-spine after eating
Peptic Ulcer
Condition:
- Hx of cancer
- 50+ yo
- Failure of conservative tx
- Unexplained wt loss
Cancer
Condition:
- Stiffness > 30 min
- Back pain improved w/exercise NOT rest
- Awakening during 2nd half of night due to back pain
- Alternating butt pain
- Less than 2.5 cm of chest expansion
Ankylosing Spondylitis
Describe the motion of the ribs with flexion
- Superior vertebral body anteriorly translates and rotates
- Posterior rib translates superior
- Anterior rib translates inferior
- Anterior rotation of rib
Opposite for EXTENSION
Describe the motion of the ribs with rotation
- Ipsilateral rib translates inferior, rotates posterior
- Contralateral rib translates superior, rotates anterior
Describe the motion of the ribs with side bending
- Ipsilateral rib moves inferior and rotates posterior
- Ipsilateral facet extends, glides inferiolaterally
- Contralateral rib moves superior and rotates anterior
- Contralateral facet flexes, glides anteriomedially
Describe the amount of flex/ext, SB, and rotation in the upper vs. lower T-spine
Flex/Ext = motion increases as you move down the T-spine
SB = limited in upper, increased in lower segments
Rot = greatest in upper, significantly reduced in lower
Describe the 3 types of rib motion with respiration
Rib 1-6 = pump handle motion
Rib 7-10 = bucket handle motion
Rib 11&12 = caliper motion
Descirbe coupled motion throughout the T-spine
C7-T2 = SAME
T11-L1 = OPPOSITE
Mid = variable, follows which region it is closest to
Describe what occurs in T2-7 with full elevation of the arm
Extension, rotaiton, and SB of the segments to the ipsilateral side
Condition:
- Stiffness
- Headache
- Neck pain
- UE pain
- B “stocking glove” paresthesias
T4 Syndrome
Condition:
- Upper T-spin (T3-7)
- Flat or Reduced thoracic kyphosis
Flexion movement impairment
Condition:
- C/T junction or high T-spine segments
- Excessive kyphosis
- vertebral bodies may become wedge shaped
Extension movement impairment
Condition:
- First rib
- Limited painful caudal glide
Superior subluxation
Condition:
- 50 + yo
- Kyphotic position
- Extension activities reduc stress on vertebral body
Thoracic Vertebral Fracture
Condition:
- Lateral curve w/o rotational component
- Can lead to mm spasm, inflammation, injury
- Can be corrects with position changes
- Tx underlying cause and it will resolve
Functional Scoliosis
Condition:
- Lateral curve w/rotational component
- Can be congential/idiopathic
- Can’t be corrected by positioning
- Can cause wedge shaped vertebra
Structural Scoliosis
