thoracic spine & ribs

facet joints are in what plane

frontal

most spinous process in thoracic spine align with

the body of the segment below

T1, T11, and T12 have [full costal facets/demifacets]

full costal facets (ribs articulate with 1 vertebral body)

what are the 6 main ligaments in the spine

- anterior longitudinal ligament

- posterior longitudinal ligament

- ligamentum flavum

- interspinous ligament

- intertransverse ligament

- supraspinous ligament

what are the joints for posterior articulation of the ribs?

- costotransverse

- costovertebral

T-spine: if rotation is the primary motion, sidebending is in the [same/opposite] direction

same - ipsilateral coupling

T-spine: if sidebending is the primary motion, rotation is in the [same/opposite] direction

opposite - contralateral coupling

thoracic/rib movement during flexion

facet: upglide/opening - superior and anterior

rib: anterior rotation

CT: superior glide

thoracic/rib movement during R sidebending

- coupling: L rotation

- facet: R anteroinferior/L posterosuperior

- rib: R anteroinferior/L posterosuperior

- CT: R superior glide/L inferior glide

thoracic/rib movement during R rotation

- coupling: R sidebending

- facet: R posteroinferior/L anterosuperior

- rib: R posteroinferior/L anterosuperior

- CT: R inferior glide/L superior glide

each typical thoracic vertebra has __ costal articular surfaces

6

- 2 demifacets on each side

- 1 on TP on each side

typical costovertebral joints are on ribs __-__

2-9

on what VB demifacets does rib 6 articulate?

T5 and T6

T1-T6: ___ costal tubercles on ___ costal facets

convex on cocave (opposite)

motion of ribs 1-6

pump handle - anterior/posterior rotation

motion of ribs 7-10

bucket handle - elevation and depression

motion of ribs 11-12

caliper - transverse plane motion

pain from thoracic spine inflammation can mimic serious conditions such as

- cardiac/pulmonary issues

- renal disease

- fx or tumors

- AAA

most common cause of thoracic pain

postural syndromes

screening questions for systemic involvement in t-spine

- bowel/bladder dysfunction

- numbness, tingling, or weakness in extremities

- visual or balance disturbances

- nausea/vomiting

- pain unchanged with movement or positions

indicators of ankylosing spondylitis

- difficulty lying prone

- morning sitffness >30 mins

- night pain

- pain improves with exercise, not rest

digestive-relate sxs may refer to T- to T-

T4-T6 (pain immediately after eating)

Thoracic spine observation

- flat areas --> loss of flexion

- increased curvature --> loss of extension

- scoliosis --> lateral curve

- shoulder ht --> dominant may be lower

- degree of kyphosis --> affected my lumbar lordosis or FHP

if someone has lateral curve to the R with scoliosis then theres SB to the ____ and therefore rotation to the ____

- left

- right

shingles may present with

characteristic dermatomal lesions

barrel chest

Ant/post diameter > med/lat diameter

pigeon chest vs funnel chest

- pigeon: sternum and ribs protrude anterior

- funnel: project posterior

are you more likely to do an UQS or LQS for t-spine?

LQS

t-spine capsular pattern

SB = rotation > extension > flexion

muscle length tests to consider in thoracic spine

- pec major and minor

- lats

- upper trap

- levator scap

- SCM

- scalenes

breathing assessment

- anterior/posterior upper ribs

- posterior upper ribd

- inferior border of scapula

- posterior lower ribs

what MMTs may you assess if a pt has postural sxs

scapular

what MMTs may you assess if a pt does a lot of standing or repetitive lower limb activities

hip/trunk muscle control

T-spine PAIVM

- pt prone with pillow support

- anterior glide

Rotation PAIVM

- fingertip contact staggered on adjacent levels

- ex: T6 TP on L, T7 TP on R (right rotation)

- apply anterior glide

rib spring test

- pt prone with pillow support

- apply anterior force to rib while blocking at SP on same side

- emphasize inhalation with inferior glide

- emphasize exhalation with superior glide

PAIVM in flexion

- pt sitting with arms folded across chest

- PT rests hand on contralateral shoulder

- push SP anterosuperior

PAIVM in extension

- pt hands interlocked behind the neck

- PT brings pt in extension

- push SP anteroinferior

PAIVM in rotation

push on side of SP laterally

- rotate R, push SP L

thoracic scoop mob

- improves general thoracic extension mobility for upper thoracic

- PT in stride stance and arms threaded through pts crossed arms

- apply anterior force through finger contacts while using patient's arms as counterpressure into extension