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