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53 Cards in this Set

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Thoracic region mobility

Stiffer and less mobile



Due to attachment to ribcage --- produces stability

Thoracic kyphosis

Results from less anterior height of vertebral body and wedge-shaped disc



Avg 20 - 40 degrees



Apex of curve @ T7 - T8

Vertebral body

Heart shaped



Concave



Normal = T2-T9


Atypical = T1 and T12

Concave joint surface

Between T1 - T10 for articulation with the ribs


Aka - costal facet



T1-T6 = concave joint faces anteriorly


T7-T10 = concavity faces superiorly

Spinal cord tension points

Occur at T4, T6, and T9 due to narrowing of spinal canal



Common site of tension due to whiplash

Thoracic rule of 3s

Refers to the spinous processes and their corresponding vertebral levels

Thoracic rule of 3s



T1-T3

SP is level with its own body

Thoracic rule of 3s



T1-T3

Thoracic rule of 3s



T4-T6

SP level with inferior disc of own body, superior disc of segment below

Thoracic rule of 3s



T4-T6

Thoracic rule of 3s



T7-T9

SP level with TP of segment below

Thoracic rule of 3s



T7-T9

Thoracic rule of 3s



T10-T12

SP inclination decreases until SP and TP are on same horizontal plane

Thoracic rule of 3s



T10-T12

Facet joint angles

20-30 degrees from frontal plane in upper tspine



Angle of inclination increases as you move lower along tspine



Changes into sagittal plane in lower tspine

Frontal plane orientation

Allows for more rotation and sidebending (upper tspine)

Sagittal plane orientation

Allows fro more flexion and extension (lower tspine)

Superior articular process (of inferior vertebrae)

Faces lateral, posterior, and superior (LPS)

Inferior articular process (of superior vertebrae)

Faces medial, inferior, anterior (MIA)

Capsular ligaments of facet joint

Thin and loose



Strengthened by ligamentum flavum

Facet joint function

Provide stability in thoracic spine



Protect against anterior translation (flexion/extension) in upper tspine



Protect against rotation in lower tspine when it changes to a sagittal orientation

T1

Superior aspect is concave (formed by uncinate process)



Uncinate processes articulate with the inferior body of C7 to form uncovertebral joints



Concave facet articulates with convex facet of 1st rib = costotransverse joint

T12

Superior articular facet oriented in frontal plane



Inferior articular facet oriented in sagittal plane (restricts rotation and mimics lumbar spine)

Rib articulation

Articulates with 2 adjacent vertebrae and disc at the costovertebral joint (at tspine level and inferior aspect of tspine body above)



Occurs at the costal demi-facets

T1 and rib attachmet

T1 articulates with both the 1st and 2nd rib



Costal facet articulates with 1st rib


Demi-facet articulates with 2nd rib

T2-T9 rib attachments

Demi-facets articulate with rib heads

Ribs and Tspine

The ribs articulate with the superior demi-facet and costal facet (TP) of its vertebrae level as well as the inferior demi-facet of the vertebrae above it



Rib 7 = Costal facet (TP) of T7 and inferior Demi-facet of T6



T4 = Rib 4 on superior demi-facet and costal facet (TP) and rib 5 on inferior demi-facet

Ribs and T-spine

10th rib articulation

Articulates with T9 and T10

Costovertebral joint

Compound synovial joint - where rib articulates with the demi-facet



Strengthened by the radiate lig (3 parts):



1. Superior -head of rib to vertebral body above


2. Middle - head of rib to the disc


3. Inferior - head of rib to vertebral body below

Rib attachments

Costotransverse joint

Synovial joint - where rib articulate with costal facet (Transverse Process)



Strengthen by medial and lateral costotransverse ligaments from the rib tubercle to the TP



Supported by superior costotransverse ligament along rib neck to TP above

Rib attachments cont

Ribs 1-7 and the sternum

Attach through costal cartilage

Ribs 8-10 and the sternum

Attach through fused costal cartilage

Ribs 11 and 12

Floating ribs (anteriorly)



Attach to diaphragm and trunk muscles

1st rib sternocostal joint

Synchondrosis joint --- increases stability of upper thoracic spine

2nd rib sternocostal joint

2nd rib articulates with demi-facets of both manubrium and sternum



Synovial joint

Sternum facets and ribs

Concave facets on sternum


Articulate with costocartilage of 3rd-6th ribs

7th rib articulation

Articulates with both xyphoid and sternum

Costocartilage of 1st and 2nd rib

Articulates with manubrium and clavicle

Vertebral ligaments



Ligamentum flavum

Attaches to laminae and pedicle to strengthen the anterior facet joint



Prevents flexion and spinal impingement during extension

Vertebral ligaments

Vertebral ligaments



Interspinous ligament and Supraspinous ligament

Limits extension and A-P translation

Vertebral ligaments



ALL

Plays no major role in stability



Limits flexion

Vertebral ligaments

Vertebral ligaments



PLL

Prevents flexion and posterior translation

Intervertebral discs

Thinner and narrower


Rare to have a prolapse in Tspine


2% of back issues are in Tspine


Issues occur at T7 or T8 (then T6 or T9)


Most common sx = anterior chest pain

Sympathetic innervation mobilization

Sympathetic nerve trunk (SNT) lies anterior to costotransverse (CT) joint



Mobilization of the CT joint can mobilize the SNT



Useful in tx of complex regional pain syndrome

Sympathetic innervation in tspine

T1-2 = Head



T3-T7 = UE



T7-T12 = LE



T1-T12 = Trunk

Cervicothoracic Region

Levels C6-T3 --- area of transition from hyper to hypo mobile



Hardest working -- contains shoulder girdle



Facet orientation changes from oblique to frontal (decrease in sagittal movements)

Pattern of pain and limitation at CT joint

Clinical presentation: localized pn in CT junction w/ radiating pn in shoulder



Limited flex/ext and rot/SB to same side (ipsilateral)

Restricted cervical flexion



Causes

CT junction restriction (HYPOMOBILE)


Cervical disc


Soft tissue restriction in cspine