Thoracic Spine

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Author:
amills1
ID:
237608
Filename:
Thoracic Spine
Updated:
2013-10-01 19:59:06
Tags:
Thoracic Spine PTA202 PTA 202
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Description:
PP and class notes for thoracic spine
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  1. Vertebrae differ by
    Longer spinous processs
  2. How many degrees of flexion and extension
    • 30
    • Slight kyphosis
  3. What happens to mobility in the lower thoracic
    More mobility due to lack of rib articulation
  4. Sternum Expansion
    • Pump handle
    • Anterior lung expansion
  5. Diaphragm Expansion
    • Piston
    • Pulls down lungs
  6. Intercostal Expansion
    • Bucket handle
    • -Lateral expansion
    • Caliper
    • - transverse, rotates ribs outward
  7. Internal intercostals
    Exhalation
  8. Spine segments most to least mobile
    Cervical>Lumbar>Thoracic
  9. What prevents rotation
    Rib cage
  10. What prevents flexion
    • Sternum
    • Facet orientation in frontal plane
  11. What prevents extension
    • Facets
    • Spinous process
  12. Amount of lateral side bend
    <20 degrees
  13. Amount of rotation
    <20 degrees
  14. Per segment thoracic has more or less mobility than lumbar?
    More
  15. As a whole lumber and thoracic have more, less, or equal mobility
    Equal
  16. Which test is more effective for thoracic? MMT or functional?
    Functional
  17. Most common hypomobility?
    Uniside bend or limited extension
  18. What motion in thoracic tends to occur with side bend?
    Rotation to other side
  19. T/F can have hypo and hyper mobility combination.
    • True
    • Ie functional scoliosis: L side could be hypomobile while right hyper
  20. If both hyper and hypo mobile what would you do to fix?
    • Stabilize hypermobile motion
    • Mobilize the hypomobile motion
  21. If a joint is hypo or hyper mobile what you might see else where?
    If joint is hypo you'd find a hyper mobile joint that accommodates it and vice versa
  22. Easiest to hardest planes for trunk exercises
    Sag->Frontal->Transverse
  23. An elongated muscle is best trained in what position?
    Shortened
  24. Exaggerated kyphosis can lead to the rib cage to rest on what?
    Anterior iliac crest.
  25. Severe kyphosis can shorten or lengthen the appendicular skeleton?
    Lengthen
  26. What is the only type of stretching an osteoporosis patient should receive?
    Active
  27. Idiopathic vs acquired scoliosis
    Structural vs functional
  28. Swayback is due to..
    Muscle imbalances
  29. Common population for osteoporosis
    • Post menopausal women
    • Elderly men
    • Smokers
    • Decreased calcium or vitamin D
  30. What progresses osteoporosis?
    • Decreased mobility
    • Sedentary lifestyle
  31. Osteopor clinical findings
    • Pain in bones, back, and muscle spasm
    • Height reduction
    • Kyphosis and scoliosos
  32. Osteopor Tx
    • Usually unable to restore to normal, just prevention of progression
    • Hi Ca++ diet, vitamin D, protein
    • Fluoride supplements
    • Foasmax to inhibit osteoclast activity
    • Weight bearing exercises
  33. Scheuermann's Disease
    • Greater than 45-50 degrees
    • Hereditary
    • Excessive thoracic associated with anterior wedging of thoracic vert
    • Juvenile- Occuring in kids
  34. Kyphosis Tx
    • Younger children with mild deform
    • -Spinal extensor strengthening
    • -Stretching hams, pec major, superior abs
    • Bracing in adolescents until maturity
    • Spinal fusion surgery in curves greater than 70
  35. Ankylosing Spondylitis
    • Freezing of the joints of the spine with inflammation
    • Chronic progressive
    • Affects SI, intervert and costovert spaces
    • 20-30 y/os
    • M>F
    • Remissions and exacerbations
    • Possible autoimmune disorder, genetic basis
  36. Ankylosing Spondylitis Pathology
    • Starts as inflam of the vertebral joints
    • Fibrosis then calcification (loss of ROM)
    • Initially LB and SI
    • Kyphosis develops from lack of ROM
    • Osteoporosis with possible patho fractures
    • Limited lung expansion due to calficiation of costovertebral joints
  37. Ankylosing Spondylitis SnS
    • Early: LBP and morning stiffness
    • Discomfort relieved by walking and mild EX
    • Spine rigid
    • May develop radicular pain
    • 1/3rd develop system signs
    • -fatigue, fever, iritis, weight loss
  38. Ankylosing Spondylitis Tx
    • Maintain joint mob
    • Breathing EX
    • Decrease synovitis: NSAIDs
    • Possible joint replacement
  39. Which side has a visible posterior rib hump in a structural scoliosis?
    Convex side
  40. Which side can you see anterior rib flare
    Concave
  41. Dowager's Hump
    Excessively large thoracic kyphosis
  42. How does LLD relate to scoliosis (does it always occur?)
    • Could be a compensation for scoliosis
    • Not always a result of scolosis
  43. T/F Positive Adam's test shows functional scoliosis
    • False
    • Positive Adam's test shows structural. If scoliosis disappears during Adam's test it means its a functional Scoliosis.
  44. Functional scoliosis is usually secondary to..
    • Spasm/pain in LW or midback musculature.
    • ie always standing on one leg
  45. Severe scoliosis curves may effect
    cardio pulmonary due to limited lung expansions
  46. Scoliosis classification
     
    • Mild: <20 degrees
    • Mod: 20-50 degrees
    • Severe: >50 degrees
  47. Etiology of structural scoliosis
    • Idiopathic 75-85%
    • Usually adolescent
    • F>M 10-15 y/o
    • Muscle imbalance, postural control, or bone malformation
  48. Neuromuscular Structural Scoliosis
    • CP
    • Myelomeningocele
    • Paraplegic
    • MD
  49. Osteopathic structural scoliosis
    • Bone malformation
    • Rickets
    • Fractures
  50. Non-structural scoliosis types
    • LLD (functional)
    • SI disorders
    • Dislocated hip (possible LLD)
    • LB spasms and/or disc protrusions
    • -Gives a posture to avoid pain; results in functional scoliosis
    • Habitual posture changes
    • -Standing on one hip
  51. Clinical findings Scoliosis
    • Scap winging (on convexity of curve)
    • Pelvic obliquity (crest not level)
    • Waist angle changes
    • Curve increases or stays with forward bending
  52. Interventions Scoliosis
    • Exercise with cast/brace
    • -Stretch and strengthen
    • Casts
    • Tractions
    • -Usually pre-op
    • Spinal bracing (boston, milwaukee)
    • Estim¬†
    • -On convex side to strengthen and realign spine upright
    • Surgery
    • -Spinal fusion with Harrington rod >40degrees
  53. What side do you strengthen, which do you stretch
    • Strengthen convex
    • Stretch concave

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