Applied Anatomy

Anatomy and Kinesiology 12 vertebrae of the Thoracic Spine 12 pairs of ribs Costovertebral joints Cosotransverse joints Costosternal joints Review of the basics before we get Interchondral/interc down to assessment and diagnosis ostal joints Facet joints Intervetebral discs

Thoracic Vertebrae Thoracic Vertebrae Similar in basic make-up to the lower cervical and lumbar vertebrae Possess longer spinous processes which over lap considerably Design of the vertebrae lead to a natural mild kyphosis Contains less motion than either the lumbar or cervical regions

1 Facet Joints of the Thoracic Spine The Ribs

Resting position: Midway between flexion and extension

Close packed position: Extension

Capsular pattern: Side flexion and rotation equally limited, then extension

The Ribs Intercostal Muscles

12 pairs of ribs Muscles run between ribs in pairs Lowest pairs (11th and 12th) do not have an Internal intercostals extend from the front of anterior attachment – Floating Ribs the ribs, and go posteriorly past the rib Middle pairs (8th -10th) attach to sternum via angle. a combined cartilaginous attachment – False External intercostals (on the outside of the Ribs ribcase) wrap around from the back of the Uppermost pairs (1st-7th) have bony rib almost to the end of the rib anteriorly. attachments both anteriorly and posteriorly Diagonal direction improves elevation of the ribs during respiration.

Costovertebral Joints Costotransverse Joint Synovial joints Synovial joints The tubercle of the rib articulates with the Head of the rib articulates with the vertebral transverse process of the thoracic vertebra body below, the intervertebral disc and the The 11th and 12th ribs do not articulate in vertebral body above. this way 7th rib articulates with the 7th and 8th They are free floating ribs vertebral bodies as well as the intervening Pain on respiration may mean either disc. costotransverse and/or costovertebral joints could be affected

2 Costosternal Joints Intervertebral Discs

The 1st rib articulates with the manibrium as a Thin cartilaginous joint All the other articulations are synovial joints There are usually very few disc problems in Ribs 2-7 articulate with the sternum thoracic spine Ribs 8-10 are united to the 7th rib by cartilage as an interchondral joint Those that do present tend to clear quickly and have an easily identifiable cause

Facet Joints Movements of The Thoracic Spine

The shape and orientation of the facets Limited By determines the movement The rib cage Superior facets face posteriorly, superiorly The costotransverse and costovertebral joints and slightly laterally The facet joints Inferior facets face anteriorly, inferiorly and The thin IV discs slightly medially The shape and proximity of spinous processes Rotation is greatest movement

Thoracic Movement Thoracic Movement

Very few studies have been done on Amount of flex and ext, and lateral thoracic spine movements flexion increases from T1-2 to T11-12 Main movement of the thoracic spine The amount of rotation decreases is rotation T1 is the least mobile vertebrae Rotation and side flexion are coupled T12-L1 is a very mobile transitional in the thoracic region. point

3 Movements Movements

FLEXION- anterior sagittal rotation and ROTATION - Superior vertebrae will rotate translation, ribs stretch at CT and CV joints to the right and pull the rib with it.

EXTENSION - occurs with backward SIDE FLEXION - elevation of ribs on the bending or elevation of the arms. Posterior opposite side to the movement sagittal rotation and translation with compression of CT and CV joints

Movements of the Ribs Movements of the Rib Cage T1-6

The ribs are relatively horizontal at the top of During inspiration the first 6 ribs rotate the rib cage about their long axis As they descend they run more obliquely Downward rotation of the rib neck is The 12th rib is more vertical than horizontal associated with depression Inspiration draws the ribs upwards and Upward rotation of the same portion is outwards, thus increasing the antero-posterior associated with elevation diameter of the rib cage This gives rise to the Pump Handle Action

Movements of the Rib Cage T7-10 Movements of the Rib Cage T11-12

Ribs 7-10 mainly increase in lateral direction The lower ribs move mainly laterally in The ribs move upwards, backwards and what is referred to as the Caliper Action medially This increases lateral diameter This is known as the Bucket Handle Action The ribs are quite elastic in children but they eventually become hard and brittle

4 Possible Sources Of Pain Patterns of Referred Pain Vertebrae Need to diagnose difference between Dura visceral and spinal referred pain IV discs Chest pain - cardiac, pulmonary, pleural Posterior longitudinal ligament disease, oesophagus Posterior thoracic muscles Angina- may affect face, jaw, and neck CT and CV joints Hiatus hernia Facet joints Abdominal Nerve root compression Gynaecological

Pain Referral Kyphosis Thoracic pain “shooting through” - disc Most common condition in the thoracic region Pain referred horizontally around chest - Slight posterior curvature of the Synovial joint thoracic spine is normal PT must ensure an excessive curvature Pain referred down and around chest wall - or kyphosis is present root involvement (Grieve 1981)

Kyphosis Very often reducible and easily managed Ocsaionally may require surgical Any Questions? intervention Will be discussed next week

5