Thoracic spine and ribs

Question 1

Thoracic Structures

Answer 1

a. 12 thoracic vertebra
b. 24 apophyseal joints
c. Vertebral body & TP have costal articulating surfaces
d. 12 ribs

Question 2

Functions:

Answer 2

i. Provide stability
ii. Protect organs
iii. Ventilation

Question 3

a. Transitional vertebrae

i. T1

Answer 3

1. Similar to c-spine
2. Body transverse diameter is 2x size of AP diameter
3. SP long & prominent

Question 4

Typical vertebrae

Answer 4

i. Body equal in transverse & AP diameters stability
ii. Bodies are wedge shaped
1. Posterior height greater than anterior height kyphosis
iii. Width increases caudally
iv. SP’s angle inferiorly
v. TP’s angle posteriorly
vi. Smallest disc to body height ratio less mobility

Question 5

a. Apophyseal joints

Answer 5

i. 20° off frontal plane
ii. Flat
iii. Superior facets
1. Face posteriorly, slightly superiolaterally
iv. Inferior facets
1. Face anteriorly, slightly medially
v. Orientation changes (T10-11) to sagittal plane

Question 6

a. Flexion

Answer 6

i. Superior anterior slide of the inferior facet of the superior vertebrae on superior facet of the vertebrae belowi.

ii. Limited by tension in connective tissues on posterior aspect
iii. 30-40°

Question 7

Extension

Answer 7

i. Posterior inferior slide of the inferior facet of the superior vertebrae on superior facet of the vertebrae below
ii. Limited by tension in anterior connective tissues & posterior bony structures
iii. 20-25°

Question 8

Rotation

Answer 8

i. Inferior articular facet of superior vertebrae slides against superior facet below
ii. Thoracolumbar rotation = 40°

Question 9

a. Lateral Flexion

Answer 9

i. Inferior facet on the IPSILATERAL side slides inferiorly
ii. Inferior facet on the CONTRALATERAL side slides superiorly
iii. Thoracolumbar motion = 45°

Question 10

a. Range of Motion

Answer 10

Increases as we near lumbar region.

Learn ROM chart

Question 11

i. 1-7: True Ribs

Answer 11

1. Articulate directly with sternum thru chondrosternal joints

Question 12

i. 8-10: False Ribs

Answer 12

1. Indirect articulation with sternum thru costal cartilages of the adjacent superior rib at the interchondral joints

Question 13

i. 11-12: Floating Ribs

Answer 13

1. No anterior attachment

Question 14

Head of rib: attach to body @

Answer 14

1. costovertebral joint

Question 15

Head of rib:

Answer 15

a. 2 demifacets with crest between them
b. Convex head of rib articulates with 2 adjacent vertebral bodies (concave vertebral facets) & IV disc
c. Ribs attach to lower part of vertebral body

Question 16

Neck

Answer 16

distal to head

Question 17

Tubercle location?

Answer 17

distal to neck

Question 18

Tubercle

Answer 18

a. Articulates with TP costotransverse joint
i. 10 pairs of joints T1-T10
ii. Convex rib tubercle T1-T6
iii. Concave facet on TP
1. T1-T6: slight rotation
2. T7-T10: articular surfaces are flat permits gliding

Question 19

Rib angle

Answer 19

1. 2-3 thumb widths lateral to SP

Question 20

Ligaments

Answer 20

a. Costovertebral ligament:
i. Interosseous (capsular lig)
1. Crest of rib head IV disc
ii. Radiate ligament

Question 21

i. Atypical Rib Articulations

Answer 21

1. T1 and T10-T12 and Ribs 1, 10-12
   a. T1: full costal facet superiorly
   i. Accepts the entire head of 1st rib
   ii. Demifacet inferiorly to accept part of head of 2nd rib
   b. T10-T12: may have full costal facet, but typically lack costotransverse joints

Question 22

i. Rib Movement

1. Flexion

Answer 22

a. Osteokinematics: anterior rotation T3-T7

b. Arthrokinematics: superior glide with anterior roll

Question 23

i. Rib Movement

1. Extension

Answer 23

a. Osteokinematics: posterior rotation T3-T7

b. Arthrokinematics: inferior glide with posterior roll

Question 24

I. Role of T-Spine & Ribs During Respiration
a. Kinematics
i. Upper Ribs (2-7)
Inspiration?

Answer 24

a. Upper ribs & sternum increase the AP diameter of the thorax
b. Pump-handle motion (upward and forward)
c. Ribs at vertebral articulations glide inferiorly

Question 25

I. Role of T-Spine & Ribs During Respiration a. Kinematics i. Lower Ribs (8-10)

Answer 25

1. Motion occurs in frontal plane 2. Increased downward obliquity & indirect attachment to sternum 3. Inspiration a. Lower ribs increase transverse diameter of thorax b. Bucket-handle (downward, forward, & laterally) c. Ribs at vertebral articulations glide inferiorly

Question 26

a. Respiration | i. Inspiration

Answer 26

1. Diaphragm descends 2. Sternum moves anteriorly 3. Ribs 1-7 glide inferiorly 4. Ribs 8-10 glide anterior-lateral-inferior 5. Ribs 6-12 posteriorly rotate 6. Ribs 11-12 remain stationary

Question 27

1. Muscles involved: in respiration?

Answer 27

a. Primary: Diaphragm, intercostals, scalenes | b. Forced inspiration: serratus posterior, SCM, lats, iliocostalis, pecs, QL

Question 28

Muscles involved in expiration?

Answer 28

a. Abs (recuts, external, internal, TrA), internal intercostals

Question 29

Respiration: expiration?

Answer 29

1. Quiet expiration is passive a. Elastic recoil of thorax, lungs, diaphragm 2. Forced expiration a. Activate abdominals & intercostal mm 3. Ribs 1-7 glide superiorly 4. Ribs 8-10 glide posterior-medial-superior 5. Ribs 11-12 relatively stationary