Unit 2 Week 5 Thoracic

Question 1

what are the functions of the thoracic spine?

Answer 1

protects vital organs (heart and lungs)
transitional zone: transfers load to/from the lower and upper halves of the body
posture
bony stability
allow for limited mobility
respiration: mechanical bellows

Question 2

what are the three functions of the rigidity of the thorax?

Answer 2

stable base
protection
mechanical bellows (respiratory function)

Question 3

which layers of the posterior trunk muscles are “extrinsic”?

Answer 3

superficial and intermediate

Question 4

which layers of the posterior trunk muscles are “intrinsic”?

Answer 4

deep

Question 5

what is the primary muscle for inspiration?

Answer 5

diaphragm

Question 6

which muscles oppose the diaphragm during inspiration?

Answer 6

scalenes

Question 7

what do the intercostal muscles do for respiration?

Answer 7

collapse the rib cage, give rigidity to the rib cage to oppose the diaphragm

Question 8

what are the norms for thoracic and lumbar flexion? arthrokinematics?

Answer 8

thoracic: 35
lumbar: 50
sliding up/anterior

Question 9

what are the norms for thoracic and lumbar extension? arthrokinematics?

Answer 9

thoracic: 20
lumbar: 35
sliding down/posterior

Question 10

what are the norms for thoracic and lumbar lateral flexion? arthrokinematics?

Answer 10

thoracic: 25
lumbar: 20
slide contralateral

Question 11

what are the norms for thoracic and lumbar axial rotation? arthrokinematics?

Answer 11

thoracic: 35
lumbar: 5
slide contralateral

Question 12

what are the arthrokinematics of the ribs?

Answer 12

upper segments (pump): in sagittal plane
middle to lower: (bucket) flare outwards
11-12: (calipers) spread laterally

Question 13

what would be considered a yellow flag vs a red flag for thoracic pain?

Answer 13

yellow: fear avoiding behavior
red: history of cancer

Question 14

what should you screen when performing a thoracic examination?

Answer 14

always shoulder
symptoms location above inferior angle: include c-spine
below inferior angle: include l-spine

Question 15

what extra questions should be asked in a history of the thoracic spine?

Answer 15

pain radiating or occurring anywhere else?
symptom relationship to: breathing, cough, sneeze, eating or certain foods, CV exertion
recent stressful life events or changes?

Question 16

what are the 4 components of a metastatic cancer screening?

Answer 16

1. history of non-skin cancer
2. failure of conservative management in past month
3. > 50 years age
4. unexplained weight loss more than 4.5kg in past 6 months

Question 17

what are the 5 risk factors included in a thoracic fracture screening?

Answer 17

1. age > 50 years
2. female
3. major trauma
4. pain and tenderness
5. distracting painful injury

Question 18

what is the difference between structural and non-structural scoliosis?

Answer 18

structural: may be genetic, idiopathic, or caused by some congenital problem such as wedge vertebrae, hemivertebra, or failure of vertebral segment

non-structural: relatively easily correctable. poor posture, psychosocial, nerve root irritation, inflammation in spine, leg length discrepancy, or hip contracture

Question 19

how is scoliosis named?

Answer 19

named for the part of the spine and where the apex of the curve occurs

Question 20

where does a rib hump appear with scoliosis? depression?

Answer 20

rib hump: on the side of thoracic convexity
depression: on the side of concavity

Question 21

what are the three chest variations? describe each.

Answer 21

1. pectus carinatum (pigeon): sternum forward and downward. restricts ventilation
2. pectus excavatum (funnel): sternum posteriorly by overgrowth of the ribs. hyperkyphotic compensation
3. barrel chest: acquired. sternum forward and upward. emphysema

Question 22

what is the difference between quiet and active breathing?

Answer 22

quiet: relies on diaphragm to pull air in and elastic recoil to get air out
active: pulls in more muscles causing accessory use during activity

Question 23

how would you measure thoracic motion vs thoracolumbar motion?

Answer 23

thoracolumbar: standing
thoracic: seated (takes hips out)

Question 24

what is the difference between upper thoracic and lower thoracic PIVMs?

Answer 24

lower cervical and upper thoracic: C5-T3 just move head
middle to lower thoracic: T3-T11 heads behind head move body

Question 25

what specific MMTs are pertinent in a thoracic examination?

Answer 25

middle trap rhomboids lower trap lats lumbar, cervical, and shoulder as needed

Question 26

what is the rule of 3s?

Answer 26

T1-T4, T9: up 1 T5-T8: up 2 T9-T11: at base of spinous process

Question 27

what are the common thoracic trigger points?

Answer 27

serratus anterior pectoralis major sternalis external oblique

Question 28

what are the thee t-spine mobility relationships to the head, neck, and shoulder?

Answer 28

1. neck and shoulder pain more common with hypomobility at C7-T1 2. C7-T1 and T1-T2 hypomobility is a predictor of neck-shoulder pain and hand weakness 3. C7-T1 and T3-T4 hypomobility predict headaches

Question 29

what should be assessed in an AP thoracic spine radiograph?

Answer 29

vertebral body alignment, pedicles equidistant, spinous processes at equal intervals, rib joints

Question 30

what is the most common spinal injury detectable on a radiograph in all age groups? what is the MOI?

Answer 30

anterior compression fractures MOI: flexion, MVA or falls from heights, older adults with osteoporosis

Question 31

what are the 3 radiographs used in an assessment for scoliosis?

Answer 31

erect AP, erect lateral, erect AP sidebending R and L

Question 32

what is the pedicle method when looking at a radiograph of scoliosis?

Answer 32

gives value for axial rotation that has occurred in combination with the lateral curve 0 = normal/no rotation 1+ = pedicle moved 1/3 of the way toward midline 2+ = 2/3 3+ = when the pedicle is midline on the image of the vertebral body 4+ = pedicle has rotated beyond midline

Question 33

what are the three radiologic indicators of bone age?

Answer 33

1. PA view of left hand 2. fusion of vertebral rig apophyses 3. Risser's sign: formation of the apophysis over the iliac crests

Question 34

what are some potential causes of t-spine pain?

Answer 34

pain from local thoracic structures referral from c-spine, l-spine, shoulder or ribcage visceral referral

Question 35

what are the 4 syndromes that fall under the thoracic outlet syndrome umbrella?

Answer 35

scalene syndrome cervical rib syndrome costoclavicular syndrome hyperabduction syndrome

Question 36

what is the etiology of scalene syndrome? what is being compressed?

Answer 36

etiology: scalene tightness, fibrous bands (congenital or scar), accessory scalene muscle, enlarged C7 TP, cervical rib syndrome subclavian artery and nerve roots C5-T1

Question 37

what is cervical rib syndrome?

Answer 37

rudimentary cervical rib elongated C7 TP

Question 38

what causes costoclavicular syndrome?

Answer 38

elevated first rib clavicle fracture or callus subclavius muscle disorder or morphological abnormality

Question 39

what causes hyperabduction syndrom?

Answer 39

tight pectoralis minor expansion of fascia prolonged arm elevation

Question 40

what should you look out for in a history that could hint towards thoracic outlet syndrome?

Answer 40

general ache neck to shoulder non-specific paresthesia heaviness of extremity fatigue worse sustained overhead or arm movements

Question 41

what interventions should be used for thoracic outlet syndrome?

Answer 41

posture/work education treat impairments 1st rib mobilization flexibility of pectoralis minor and scalene neural mobility surgical (if not responding)

Question 42

what are some clues that TOS is indeed a relevant diagnosis?

Answer 42

neural and/or vascular extremity symptoms produced with sustained arm positions cervical radiculopathy usually is reduced with arm overhead vascular

Question 43

what are some red flags/risks when thinking of using thrust techniques?

Answer 43

myelopathy cancer upper cervical ligamentous instability vertebral artery insufficiency inflammation or systemic disease

Question 44

what are some yellow flags/precautions when thinking of using thrust techniques?

Answer 44

factors that increase risk of developing or perpetuating long term disability and work loss associated with low back pain