MMII: THORACIC
Treatment of the thoracic spine has been shown in research to decrease pain/ improve status of what other areas/conditions
- reduction in spondylolisthesis -increase in trap strength -improvements in LBP and shoulder pain
What are options for cervical intervention of osteoporosis
1. Kyphoplasty 2. Vertebroplasty
What are the three general categories of pain sources for the thoracic spine
1. Local source 2. Remote MSK source 3. Remote non-MSK source
What are risk factors for fracture in the thoracic spine
1. caucasian race 2. Hx of smoking 3. Early menopause 4. Thin build 5. Sedentary 6. Steroid Hx 7. Excessive consumption of caffiene or alcohol 8. Acute thoracic pain in someone who is >60 y/o
At what rib levels is costochondritis most common
3-5
Scoliosis is a deviation in ___ planes of motion, mostly which planes?
3; frontal and horizontal
Early onset of scoliosis occurs from age ___-___ while late onset is >____ y/o
6-9; 9
What are risk factors/signs of potential neoplastic conditions/tumors
> 50 y/o unexplained weight loss constant pain w out relief Night pain
What Cobb angle indicates scoliosis
>10d
What muscles produce rotation in the thoracic spine
Anterior serratus EO IO Rhomboids Post serratus Rotators Intertransversarri
Pump handle motion during breathing increases what diameter of the rib cage
Anteroposterior
Bucket handle motion during breathing increases what diameter of the rib cage
Anteroposterior and posterolateral
Thoracic pain can often be referred from what other level of the spine? What are the two pathoanatomical sources of this pain?
Cervical - disc or facet
Describe the difference between cervical disc referral and cervical facet referral?
Disc referral is more focal ("Cloward sign") where facet referral is more general to thoracic/periscapular areas
What are the primary muscles of inspiration?
External intercostals Diaphragm
Patient presents with unilateral posterolateral thoracic pain of sudden/insidious onset that is aggravated by coughing/sneezing. They have some radiation of pain and posterior chest pain. What is their suspected diagnosis?
Facet joint pain
Is there more relative movement into flexion or extension in the thoracic spine?
Flexion
What muscles contribute to active exhalation?
Internal intercostals Abdominal muscles (RA, EO, IO, TA)
What are risk factors for ankylosing spondylitis/ other inflammatory disorders
Limited chest expansion Sacroilitis Morning pain/stiffness Peripheral joint involvement HLA B27
What structural components of the thoracic vertebra adds to its stability?
Longer spinous process
Where is the highest rate of compression fracture in the thoracic spine?
Lower levels
Describe Tx for T4 syndrome
Medical (NSAIDs, injections) PT (Mobs, soft tissue, flexibility, posture/stability)
What degrees of scoliotic curvature equal mild, moderate, or severe scoliosis
Mild: 10-15 Mod: 25-50 Severe: >50
Treatment for costochondritis
Minimize irritation, cough suppressant CT junction mob STM Stretching Postural
What makes the T-spine even more complicated to treat than the L-spine
Multiple articulations and shared innervations/convergence of shared afferents (ANS, sympathetic ganglion)
Where are the costal articulating surfaces located on thoracic vertebra?
On the transverse process an the body
What muscles produce flexion of the thoracic spine
Open chain: Abdominal mm Closed chain: hip flexor mm, iliopsoas, psoas major
What muscles produce extension of the thoracic spine
Open chain: Erector spinae group (longissimus, iliocostsalis spinalis) Closed chain: lower traps, lat dorsi
What muscles produces lateral flexion in the thoracic spine
Quadratus Longissimus Iliocostalis EO Intertransversarri Intercostals
sign of skeletal maturity used in scoliosis exam
Risser sign
What are the accessory muscles of inspiration
Sternocleidomastoid Salenes
Treatment for hyperkyphosis
Stretching to post muscles Strength to neck flexors/back extensors Manual therapy (STM, CPAS, MET)
Disc herniation is relatively rare in the thoracic spine but the most common segment of herniation in the thoracic spine is:
T11-T12
What is the origin of the femoral nerve plexus
T12-L2
What are the watershed areas of the thoracic spine
T4 (most vulnerable) and T8-T10
Patient presents with diffuse symptoms in their neck, head, and UE with dull pain in their hand in a glove like pattern. They recently started a job that requires them to bend and lift up boxes throughout the day. What is their likely diagnosis?
T4 syndrome
What are signs of infection
Temp > 100 BP > 160/95 Pulse >100 RR > 25 Fatigue
Why do single curves usually have greater deviation
They are unbalanced
Name the segments: True ribs: False ribs: Floating ribs:
True ribs: 1-7 False ribs: 8-10 Floating ribs: 11-12
Is it safe to provide manual therapy/mobilizations in people with osteoporosis
Yes
painful inflammation of the costochondral junction
costochondritis
What segmental trends does axial rotation follow in the thoracic spine?
decreases as you go down segments (but also pretty limited to begin with)
Since there is limited evidence/guidelines as to how to guide examination of the thoracic spine it is important to identify ______
differential diagnosis
Lower trap is important to maintain what motion in the thoracic spine?
extension
The ilioinguinal and genitofemoral nn arise from what plexus
femoral
When is neural tension the highest during flexion or extension of the thoracic spine
flexion
What segmental trends does flexion and extension follow in the thoracic spine?
flexion and extension increase as you go down segments
Osteoporosis leads to successive compression fractures and what postural deviation?
kyphosis
Are nerve root lesions more common in the thoracic spine or the lumbar spine
lumbar
Suspected combined intercostal abdominal mm and soft tissue injury can usually be differentiated with what exam technique
palpation
If a patient has costochondritis they will likely be hypo mobile at what areas of the ribs
posterior and lateral
What is the primary role of the thoracic spine
protection
In addition to being the primary muscle of respiration, the diaphragm also has what affect on the lower t-spine and lumbopelvic region
provides a local level of stability
The primary scoliotic curve is more ____ while the minor curve is more ____
rigid; flexible
What is the single point of direct articulation of the UE to the trunk
sternoclavicular joint
If a patient presents with trauma, acute thoracic pain and they are >60 y/o, or unable to take a deep breath what Ddx should be considered?
thoracic or rib fracture
Condition where the brachial plexus, subclavian aa & vein get compressed between the first rib and the clavicle
thoracic outlet syndrome
areas of ischemic vulnerability in the thoracic spine are called ____ areas
watershed areas