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Flashcards in Thoracic Spine - Review Deck (87):
1

What structures provide strengthening and stabilizing forces to, and affect the motion of the T-spine?

- The ribs

2

Do inter-rib motions, or intervetebral motions stop first?

- Inter-rib stops first

3

What arthrokinematic motion occurs in the T-spine at the end range of osteokinematic motions?

- Motion of transverse process on a fixed rib

4

What type are the arthrokinematics relationships of the joint surfaces of the costotransverse joints?

- Convex rib on concave transverse process for ribs 1 - 7/8
- Planar surfaces for ribs 8 - 10

5

What is the ROM for T-spine flexion? (goniometry and tape changes)

- 0 - 25/45 degrees
- ~ 2.7 cm

6

What 4 structures limit an opening semental motion of the T-spine?

- Supraspinatus
- Infraspinatus
- Capsular ligaments
- Posterior longitudinal ligament

7

What type of force is produced on the nucleus pulposis during T-spine flexion?

Posteriorly directed

8

At what 3 joints does motion occur during flexion of the T-spine?

- Costovertebral
- Sternocostal
- Costochondral

9

What is the ROM for T-spine extension? (goniometry and tape changes)

- 0 - 25/45 degrees
- ~ 2.5 cm

10

What limits segmental T-spine extension/ closing?

- Approximation of spinous processes

11

What type of force is produced on the nucleus pulposis during T-spine extension?

- Anterior force

12

At what 3 joints does motion occur during extension of the T-spine?

- Costovertebral
- Sternocostal
- Costochondral

13

What is normal ROM lateral flexion of the T-spine? (goniometry only)

- 0 - 20/40 degrees

14

What type of force is produced on the nucleus pulposis during lateral flexion of the T-spine?

- Lateral force

15

What type of motion occurs at the intercostal spaces during lateral motion on the convex and on the concave side?

Convex: Widen, enlarging rib cage
Concave: Close, shrinking rib cage

16

What is the normal ROM of rotation of the T-spine? (goniometry only)

- 0 - 35/50 degrees

17

What limits the opening and closing motions of the T-spine during rotation?

- Rib cage deformations

18

Through what structures of the T-spine does the axis of rotation pass?

- The bodies of the vertebrae

19

What motion occurs at the disc during T-spine rotation? What effect does this have in comparison with the L-spine?

- Disc twists and rotates as opposed to shearing in the lumbar spine allowing for greater rotation ROM per segment

20

How much rotation is allowed per segment in the T-spine? The L-spine?

T-spine: 3 degrees
L-spine: 1 degree

21

What are the joint surfaces of the costovertebral joint?

- Convex rib on both vertebral bodies, and the annulus of the disc

22

What structure divides the inside of the joint capsule of the costovertebral joint into 2 sections?

- An interosseus ligament

23

What ligament reinforces the joint capsule of the costovertebral joint?

- Annular ligament

24

What are the joint surfaces of the costotransverse joints?

1 - 7/8: convex rib tubercle on concave transverse process
8 - 10: Transverse surfaces

25

What 3 ligaments stabilize ribs 8 - 10?

- Interosseus
- Posterior costotransverse
- Superior costotransvserse

26

Through what joints does rib motion occur?

- Costotranverse
- Costovertebral

27

Describe the 4 planes of motion of the ribs?

Upper ribs: In sagittal plane (raises sternum and expands AP dimension of rib cage
Middle ribs: 45 degrees to frontal plane
Lower ribs: In frontal plane (Medial lateral expansion of the rib cage )

28

What type of motion occurs at the Lower ribs?

Bucket handle

29

What type of motion occurs in the inferior ribs?

Caliper motion

30

What type of motion occurs in the upper ribs?

- Pump handle

31

What type of motion occurs in the middle ribs?

- Combination of pump and bucket handle

32

What 3 muscles are found in the superficial layer of the posterior T-spine?

- Trapezius muscles
- Rhomboids
- Latissimus dorsi

33

What 2 muscles are found in the 2nd layer of the posterior T-spine?

- Splenius
- Serratus posterior

34

What 3 muscles are found in the 3rd layer of the posterior T-spine?

- Iliocostalis
- Longissimus
- Semispinalis

35

What 5 muscles are found in the 4th layer of the posterior T-spine?

- Levator costorum
- Interspinalis
- Intertransversarii
- Multifidii
- Rotatores

36

What are the 5 muscles of the ribs?

- External intercostals
- Internal intercostals
- Levator costae
- Sternocostalis
- Diaphragm

37

Which intercostal assists in inhalation? Which assists in exhalation?

Inhalation: External
Exhalation: Internal

38

What is the function of the levator costae?

- Elevates ribs

39

Where is the sternocostalis located? What is its function?

- Retrosternal location
- Exhalation muscle

40

What is the function of the diaphragm?

- Increases all 3 dimensions of the ribs
- Inhalation

41

What are the 5 impairment-based classifications of the T_spine?

- Thoracic hypomobility
- T-Spine hypomobility with UE referred pain
- T-Spine hypomobility with neck pain
- T-Spine hypomobility with LBP
- Thoracic clinical instability

(see Olsen 204 for more)

42

What type of intervention shows promise in the literature for T-Spine ROM increases and pain relief?

- Manipulation

43

How is T-spine hypomobility differentiated from rib hypomobility?

- Perform PA over spine
- Perform PA over rib

44

Which is treated first if T-spine and rib hypomobility occur concurrently?

- T-spine first
- Then address lingering rib hypomobility

45

What is another name for T-spine hypomobility with Upper Extremity referred pain?

- T4 syndrome

46

What is T-Spine hypomobility with UE Referred pain/ T-4 Syndrome? What are its 4 clinical symptoms?

- UE extremity paresthesias/ pain
- Cervical spine pain (may or may not be present)
- T4 region stiffness
- (+) ULTT (Usually median, but not always)

47

What condition is T4 syndrome often misdiagnosed as?

- Carpal tunnel

48

What is the theory behind T4 syndrome?

- Irritated nerve root ganglion

49

What 3 areas may symptoms be referred to in T4 syndrome?

- C-spine
- Head
- Upper extremities

50

What level of evidence shows success for T4 syndrome with upper T-Spine manips?

Level 4/ case study

51

What are the 6 CPR for T-Spine manips for patients with C-spine pain?

- Symptoms < 30 days
- No symptoms distal to shoulders
- No increase in symptoms on looking up
- FABQ < 12 points
- Decreased upper T-spine kyphosis
- C-spine extension < 30 degrees

3/6 is an indication

52

What are the 3 components of an FABQ?

- Physical Activities
- Work Activities
- Smoke Screen

53

What are the 2 factors would be tested in a patient with suspected T-Spine Hypomobility with Shoulder Impairments classification?

- Passive Intervertebral movements of the T-spine
- Observation of the T-spine during active elevation; re-checked with manual retraction of the scapula

54

What 2 treatments should be used when treating a patient classified into the T-spine Hypomobility with Shoulder Impairments category?

- Mobilizations/ Manipulations
- Postural re-education

55

What shoulder structures are commonly affected by T-spine hypomobilitY?

- Rotator cuff (impingement)

56

What soft tissue links the T-spine and L-spine?

- Thoraco-lumbar fascia

57

Where is T-spine stiffness typically compensated for?

The L-spine

58

How can manipulation of the T-spine relieve symptoms in the L-spine?

- The manipulation may inhibit hyperactive musculature

59

If a patient's T-Spine stiffness is affecting their lower back, what impairment category are classified into?

T-Spine Hypomobility with LBP

60

Are hyper or hypomobile T-spines more common?

Hypomobile

61

What are some clinical signs for T-spine instability?

- Ache with sustained upright posture; relief with recumbent positions
- Aberrant movement with AROM
- Hypermobile passive intervertebral motion (especially flexion)

62

What are 4 possible precursors that are linked to Thoracic Clinical Instability?

- Systemic Hypermobility
- Severe postural deviations
- S/P trauma (MVA)
- S/P T-Spine surgery

63

What are 4 tests for systemic hypermobility?

- Thumb to forearm
- Hyper extension at elbows
- Hyper extension at knees
- Ability to palm floor

64

What are 6 cardiac symptoms that could be mistaken for T-spine pain?

- Chest pain
- Chest heaviness
- No mechanical link to pain
- Abdominal Pain
- Shortness of breath
- Cough

65

What are 7 clinical signs that your patient may have a malignancy, and not T-spine pain?

- History of malignancy
- Age > 50
- No improvement with Treatment
- Unexplained weight loss
- Pain at multiple sites
- Pain at rest
- PM pain

66

What is a sign from the history that the patient may have a fracture?

- Major trauma

67

What are 2 signs that a patient may have an infection instead of T-spine impairments?

- Fever
- Night seats

68

What is the most common reason for T-spine pain?

- Overuse/ postural deviations

69

What are 2 causes of sprains and strains of the T-spine?

- Overuse/ postural deviations
- Trauma

70

What are 2 causes of referred pain to the T-spine?

- C-spine pain
- Abdominal/ thoracic organs

71

What is a sign that the pain may be visceral and not musculoskeletal?

- Movement and pain are unrelated

72

What 2 pathologies does T-spine disc lesions mimic?

- Fractured ribs or chondral problems
- Visceral disease

73

How can a fractured rib/ chondral problem be distinguised from a disc lesion?

- AP pressure on the sternum does not provoke pain with a disc lesion

74

A fracture through which column of the T-spine tends to result in serious problems?

The middle

75

In which column of the T-spine is instability due to fracture not uncommon?

Posterior

76

Fracture through which column of the T-spine does not usually result in severe symptoms?

- Anterior

77

What is a Schmorl's node?

Protrusion of nucleus pulposis into vertebra

78

Are Schmoral's nodes typically symptomatic?

No.

79

What is the surgical intervention for instability/ hypermobility of the T-spine?

- Rods
- Plates
- Pedical screws

80

What is the conservative intervention for instability/ hypermobility of the T-spine?

- Stabilization exercises
- Orthsoes
- Corsets
- Strapping

81

What tissues are COMMONLY affected by rib fractures?

- The ribs themselves, and the costal cartilage

82

What needs to monitored with a rib fracture?

Need to avoid/ monitor pneumothorax

83

How are rib fractures typically treated?

Conservatively without immobilization

84

What is costochondritis?

- Painful swelling of the costochondral junction due to trauma or infection

85

What are 3 signs of costochondritis?

- Localized, palpable swelling
- Pressure on sternum or lateral borders of sternum elicits pain at the junction
- There is pain on deep breathing or coughing

86

What is the conservative treatment for costochondritis?

- NSAIDs
- Rest
- OCC injections

87

What are 2 proprioceptive techniques for posture correction of the T-spine?

- Corsets
- Taping