Thoracic Region

thoracic region has more emphasis on

stability than mobility due to lots of muscle attachments (think of scapula articulation too), for protection of organs and for bellows of respiration

facet orientation in thoracic region

frontal plane allowing flexion/extension, lateral flexion, and a little rotation primarily via glide motions

costal demifacets on thoracic vertebral body articulate with

ribs via costocoporeal joint

costal facets on transverse processes of thoracic vertebrae articulate with

ribs via costotransverse ligament

IVD is reinforced anteriorly via

anterior longitudinal ligament

IVD is reinforced posteriorly via

posterior longitudinal ligament

IVD is reinforced posterior-laterally via

costocorporeal joint

between two thoracic vertebrae, the articulating rib is numbered

as the number of the inferior vertebrae articulating - rib 6 is between T5 and T6

full thoracic flexion available

30-40

full thoracic extension available

20-25

sometimes thoracic motion is referred to as thoracolumbar because

its difficult to measure thoracic spine in isolation

flexion at thoracic spine

upward slide, posterior structures taut, ALL slackened, compressed annulus fibrosis

lower thoracic vertebrae can

flex and extend more than other columns - T11/12 have floating ribs attached and dont attach on the sternum, and theyre starting to change facet orientation to match lumbar in sagittal

thoracic extension

facets sliding downward, resisted by ALL, spinous process articulation and facet articulation (soft tissue work anteriorly can address excessive kyphosis)

thoracic axial rotation available

30-35

thoracic rotation

facets slide contralateral to the rotation of the turn (direction is based on VB, not spinous process)

thoracic lateral flexion available

25-30

thoracic lateral flexion

ipsilateral inferior slide, contralateral superior slide

there is no coupling at the thoracic spine because

facet movements are slightly different

scoliosis

abnormal curvature in the frontal plane, apex is measured on most convex portion, 80% idiopathic, described by location, direction and number of fixed curves

with scoliosis, flexion with the spine will cause

rib hump on convex side - rib rotating backwards with flexion movement

with scoliosis, there is abnormal coupling of

flexion and rotation in the thoracic spine

functional scoliosis

a pinched nerve is causing postural deviation for pain relief, and an attempt to straighten the body - address nerve root

structural scoliosis

web-shaped changes in VB or disc

cobbs angle

angle between thoracic orientation and lumbar orientation in scoliosis

mild

30-45 degree cobb angle

moderate

>/= 45 degree cobb angle

surgery is likely needed - can compress lungs and organs (need fusion to break and straighten orientation of VB)

nonsurgical interventions to correct cobbs angle

bracing, foam roller stretching, etc.

pathologic, fixed coupling pattern with scoliosis

spine lateral flexed one way, VB rotate the opposite

cervico-thoraco-lumbo-sacral orthosis

applies forces to offset curvature

thoracic hyperkyphosis

small forward head posture causes increased force of gravity/BW to put thoracic spine into kyphosis, the more kyphosis it forms into, the worse kyphosis will become - need a lot of muscle force to correct (abdominal fatigue is common)

address hyperkyphotic thoracic with

posture, foam rolling to loosen, stretching (dentists often in this)