Flashcards in Thoracic Spine - Review Deck (87):
What structures provide strengthening and stabilizing forces to, and affect the motion of the T-spine?
- The ribs
Do inter-rib motions, or intervetebral motions stop first?
- Inter-rib stops first
What arthrokinematic motion occurs in the T-spine at the end range of osteokinematic motions?
- Motion of transverse process on a fixed rib
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
What is the ROM for T-spine flexion? (goniometry and tape changes)
- 0 - 25/45 degrees
- ~ 2.7 cm
What 4 structures limit an opening semental motion of the T-spine?
- Capsular ligaments
- Posterior longitudinal ligament
What type of force is produced on the nucleus pulposis during T-spine flexion?
At what 3 joints does motion occur during flexion of the T-spine?
What is the ROM for T-spine extension? (goniometry and tape changes)
- 0 - 25/45 degrees
- ~ 2.5 cm
What limits segmental T-spine extension/ closing?
- Approximation of spinous processes
What type of force is produced on the nucleus pulposis during T-spine extension?
- Anterior force
At what 3 joints does motion occur during extension of the T-spine?
What is normal ROM lateral flexion of the T-spine? (goniometry only)
- 0 - 20/40 degrees
What type of force is produced on the nucleus pulposis during lateral flexion of the T-spine?
- Lateral force
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
What is the normal ROM of rotation of the T-spine? (goniometry only)
- 0 - 35/50 degrees
What limits the opening and closing motions of the T-spine during rotation?
- Rib cage deformations
Through what structures of the T-spine does the axis of rotation pass?
- The bodies of the vertebrae
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
How much rotation is allowed per segment in the T-spine? The L-spine?
T-spine: 3 degrees
L-spine: 1 degree
What are the joint surfaces of the costovertebral joint?
- Convex rib on both vertebral bodies, and the annulus of the disc
What structure divides the inside of the joint capsule of the costovertebral joint into 2 sections?
- An interosseus ligament
What ligament reinforces the joint capsule of the costovertebral joint?
- Annular ligament
What are the joint surfaces of the costotransverse joints?
1 - 7/8: convex rib tubercle on concave transverse process
8 - 10: Transverse surfaces
What 3 ligaments stabilize ribs 8 - 10?
- Posterior costotransverse
- Superior costotransvserse
Through what joints does rib motion occur?
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 )
What type of motion occurs at the Lower ribs?
What type of motion occurs in the inferior ribs?
What type of motion occurs in the upper ribs?
- Pump handle
What type of motion occurs in the middle ribs?
- Combination of pump and bucket handle
What 3 muscles are found in the superficial layer of the posterior T-spine?
- Trapezius muscles
- Latissimus dorsi
What 2 muscles are found in the 2nd layer of the posterior T-spine?
- Serratus posterior
What 3 muscles are found in the 3rd layer of the posterior T-spine?
What 5 muscles are found in the 4th layer of the posterior T-spine?
- Levator costorum
What are the 5 muscles of the ribs?
- External intercostals
- Internal intercostals
- Levator costae
Which intercostal assists in inhalation? Which assists in exhalation?
What is the function of the levator costae?
- Elevates ribs
Where is the sternocostalis located? What is its function?
- Retrosternal location
- Exhalation muscle
What is the function of the diaphragm?
- Increases all 3 dimensions of the ribs
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)
What type of intervention shows promise in the literature for T-Spine ROM increases and pain relief?
How is T-spine hypomobility differentiated from rib hypomobility?
- Perform PA over spine
- Perform PA over rib
Which is treated first if T-spine and rib hypomobility occur concurrently?
- T-spine first
- Then address lingering rib hypomobility
What is another name for T-spine hypomobility with Upper Extremity referred pain?
- T4 syndrome
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)
What condition is T4 syndrome often misdiagnosed as?
- Carpal tunnel
What is the theory behind T4 syndrome?
- Irritated nerve root ganglion
What 3 areas may symptoms be referred to in T4 syndrome?
- Upper extremities
What level of evidence shows success for T4 syndrome with upper T-Spine manips?
Level 4/ case study
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
What are the 3 components of an FABQ?
- Physical Activities
- Work Activities
- Smoke Screen
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
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
What shoulder structures are commonly affected by T-spine hypomobilitY?
- Rotator cuff (impingement)
What soft tissue links the T-spine and L-spine?
- Thoraco-lumbar fascia
Where is T-spine stiffness typically compensated for?
How can manipulation of the T-spine relieve symptoms in the L-spine?
- The manipulation may inhibit hyperactive musculature
If a patient's T-Spine stiffness is affecting their lower back, what impairment category are classified into?
T-Spine Hypomobility with LBP
Are hyper or hypomobile T-spines more common?
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)
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
What are 4 tests for systemic hypermobility?
- Thumb to forearm
- Hyper extension at elbows
- Hyper extension at knees
- Ability to palm floor
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
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
What is a sign from the history that the patient may have a fracture?
- Major trauma
What are 2 signs that a patient may have an infection instead of T-spine impairments?
- Night seats
What is the most common reason for T-spine pain?
- Overuse/ postural deviations
What are 2 causes of sprains and strains of the T-spine?
- Overuse/ postural deviations
What are 2 causes of referred pain to the T-spine?
- C-spine pain
- Abdominal/ thoracic organs
What is a sign that the pain may be visceral and not musculoskeletal?
- Movement and pain are unrelated
What 2 pathologies does T-spine disc lesions mimic?
- Fractured ribs or chondral problems
- Visceral disease
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
A fracture through which column of the T-spine tends to result in serious problems?
In which column of the T-spine is instability due to fracture not uncommon?
Fracture through which column of the T-spine does not usually result in severe symptoms?
What is a Schmorl's node?
Protrusion of nucleus pulposis into vertebra
Are Schmoral's nodes typically symptomatic?
What is the surgical intervention for instability/ hypermobility of the T-spine?
- Pedical screws
What is the conservative intervention for instability/ hypermobility of the T-spine?
- Stabilization exercises
What tissues are COMMONLY affected by rib fractures?
- The ribs themselves, and the costal cartilage
What needs to monitored with a rib fracture?
Need to avoid/ monitor pneumothorax
How are rib fractures typically treated?
Conservatively without immobilization
What is costochondritis?
- Painful swelling of the costochondral junction due to trauma or infection
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
What is the conservative treatment for costochondritis?
- OCC injections