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