Podcast
Questions and Answers
What is the normal kyphotic curvature of the thoracic spine?
What is the normal kyphotic curvature of the thoracic spine?
Which thoracic spine landmark is located at the level of the inferior angle of the scapula?
Which thoracic spine landmark is located at the level of the inferior angle of the scapula?
Which rib articulates only with a single vertebra?
Which rib articulates only with a single vertebra?
What is the resting position of the thoracic spine?
What is the resting position of the thoracic spine?
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How do the superior and inferior facets of T2 to T11 face?
How do the superior and inferior facets of T2 to T11 face?
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How many pairs of true ribs are there?
How many pairs of true ribs are there?
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What is the primary function of the rib cage in relation to the thoracic spine?
What is the primary function of the rib cage in relation to the thoracic spine?
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Which ligaments aid in the articulation between the ribs and thoracic vertebrae?
Which ligaments aid in the articulation between the ribs and thoracic vertebrae?
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Which factor contributes to the rigidity of the thoracic spine?
Which factor contributes to the rigidity of the thoracic spine?
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What can commonly cause rib injuries?
What can commonly cause rib injuries?
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What is the normal range of forward flexion movement?
What is the normal range of forward flexion movement?
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Which ribs are primarily involved in the bucket handle rib motion?
Which ribs are primarily involved in the bucket handle rib motion?
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What symptom is associated with the T7 – T8 thoracic nerve root?
What symptom is associated with the T7 – T8 thoracic nerve root?
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Which of the following dysfunctions is NOT commonly associated with thoracic spine issues?
Which of the following dysfunctions is NOT commonly associated with thoracic spine issues?
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During Posteroanterior Unilateral Vertebral Pressure (PAUVP), where do the thumbs rest?
During Posteroanterior Unilateral Vertebral Pressure (PAUVP), where do the thumbs rest?
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What is the purpose of the Costovertebral expansion test?
What is the purpose of the Costovertebral expansion test?
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Which treatment technique applies pressure laterally from the spinous process?
Which treatment technique applies pressure laterally from the spinous process?
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The rib springing technique requires the patient to be positioned in which manner?
The rib springing technique requires the patient to be positioned in which manner?
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What is a common referral site of pain from the heart?
What is a common referral site of pain from the heart?
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Which of the following statements about dermatomes is true?
Which of the following statements about dermatomes is true?
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What is a common characteristic of Scheuermann's disease?
What is a common characteristic of Scheuermann's disease?
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Which type of chest deformity is characterized by the sternum projecting forward and downward?
Which type of chest deformity is characterized by the sternum projecting forward and downward?
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What condition is most likely to cause a rib hump on the convex side?
What condition is most likely to cause a rib hump on the convex side?
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Which muscle is primarily responsible for inspiration?
Which muscle is primarily responsible for inspiration?
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How is non-structural scoliosis primarily caused?
How is non-structural scoliosis primarily caused?
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What typically follows a line joining the inferior angles of the scapula?
What typically follows a line joining the inferior angles of the scapula?
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What is a common feature of the barrel chest deformity?
What is a common feature of the barrel chest deformity?
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Which deformity is characterized by sharp localized posterior angulation due to anterior wedging of the thoracic vertebral body?
Which deformity is characterized by sharp localized posterior angulation due to anterior wedging of the thoracic vertebral body?
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Which condition results from postmenopausal osteoporosis causing anterior wedge fractures?
Which condition results from postmenopausal osteoporosis causing anterior wedge fractures?
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What muscle group assists in expiration?
What muscle group assists in expiration?
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Study Notes
Thoracic Spine Anatomy
- The thoracic spine is the most rigid section of the spine, due to its association with the rib cage.
- The rib cage protects the heart and lungs.
- It typically has a kyphotic curvature of approximately 40 degrees.
Thoracic Spine Landmarks
- C2: First palpable spinous process (SP) below the occipital bone.
- C7 or T1: Most prominent SP at the base of the neck. C7 may slide forward with neck extension.
- T4: Level with the root of the scapular spine or apex of the axillary fold.
- T7-T8: Level with the inferior angle of the scapula. This is less reliable as the scapula is mobile.
- T12: Level with the head of the 12th rib.
Unique Identifiers
- Facets on the vertebral body and transverse processes (TVPs) are present for rib articulation.
- Spinous processes are more pointed and angle sharply downward.
- Vertebral bodies are smaller compared to lumbar vertebrae.
Thoracic Spine Joints
- Manubriosternal, Sternocostal, and Costochondral joints are present.
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Facet joints:
- T1: Transitional, similar to cervical spine.
- T2-T11: Superior facets face upwards, backwards, and slightly laterally; Inferior facets face downwards, forwards, and slightly medially. This facet orientation allows for slight rotation.
- T11 & T12: Transitional, similar to lumbar spine.
- Costotransverse ligaments: Connect ribs to transverse processes.
- Radiate ligament: Wraps around the rib head.
Rib Anatomy and Joints
- Costovertebral joints: Rib articulates with vertebral body; stiffens the thoracic spine.
- Ribs 1, 10, 11, and 12 articulate with a single vertebrae (whole facet) - "rule of 1".
- Ribs 2-9 articulate with two adjacent vertebrae (demi-facet) - "rule of 2".
- First rib articulates with T1 only; Second with T1 and T2; third with T2 and T3, and so on.
- Costotransverse joints: Ribs articulate with transverse processes.
- Ribs 1-10 articulate with their equivalent TVP. Ribs 11 and 12 do not have a TVP articulation.
Rib Classification
- True ribs (ribs 1-7): Directly connect to the sternum.
- False ribs (ribs 8-10): Connect to the costal cartilage of the rib above.
- Floating ribs (ribs 11 & 12): Do not connect to the sternum or cartilage.
Thoracic Spine Clinical Considerations (History, Observation, Movement, Neurological)
- Mechanism of Injury (MOI): Trauma is a common cause of rib/thoracic spine problems. Facet syndromes presents with stiffness and localized pain.
- Pain Referral: Pain can originate from abdominal structures (stomach, liver, pancreas), referred pain from respiration; pain above a line joining the inferior angles of the scapulae suggests cervical origin. Costal pain related to breathing or arm motion.
- Observation: Hyperkyphosis (greater than 40 degrees between T4 and T12), Kyphotic Deformities (structural and postural), Scheuermann's disease, Humpback (gibbus), Flatback, Dowager's hump, Scoliosis. Rib hump appears on convex side.
- Movement: Active movement allows for forward flexion (20-45 degrees), extension (20-45 degrees), side flexion (20-40 degrees), rotation (35-50 degrees). Costovertebral expansion is 3.5-7cm. Different rib types have specific motions (pump handle, bucket handle, caliper).
- Neurology: Dermatomal overlap; thoracic nerve root symptoms (e.g., T5, T7-T8, T10-T11, T12) and referred pain.
- Breathing: Diaphragm and various intercostals muscles are crucial (see table 8-4)
Common Thoracic Spine Dysfunctions and Treatment
- Facet irritation, Hypo/Hyperkyphosis, Vertebral body rotations/translations, Rib faults, Thoracic Outlet Syndrome.
- Specific treatment techniques such as : Joint Play Movements, Posteroanterior central vertebral pressure (PACVP), Posteroanterior unilateral vertebral pressure (PAUVP), Transverse vertebral pressure (TVP), and rib springing.
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Description
Explore the anatomy of the thoracic spine, the most rigid section of the spinal column closely associated with the rib cage. This quiz delves into key vertebral landmarks and unique identifiers relevant to thoracic spine structure and function. Test your knowledge on the thoracic joints and their significance in the human body.
