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Thoracic Spine Anatomy and Miomechanics

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Thoracic Spine Anatomy and Miomechanics Thoracic Spine Anatomy and Biomechanics Level III Thorax ! Vertebromanubrial ! Vertebrosternal Level III Upper ! Vertebrochondral Lenerdene Levesque BScPT, ! MClSc, FCAMPT Thoracolumbar junction Primal pictures Rohen JW. Yokochi C Color Atlas of Anatomy 1988 Thorax - osteology Thorax - osteology ! Paired costal demi- ! Height of body is slightly facets superior and higher posteriorly than inferior (except T1, anteriorly – kyphosis T10-T12) ! Spinous processes ! Vertebral bodies decrease project posterior and in size from T1-T3 inferior to varying degrees – very irregular Taylor Grays Anatomy Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Typical Thoracic Vertebra Typical Thoracic Vertebra ! Vertebral bodies are ! Demifacets for the head heart-shaped, of the ribs thicker behind ! Transverse processes project posteriorly as well ! Spinal canal – as laterally small, circular – ! Facets for the articular narrowest at T4-T9 portion of the tubercles of the ribs McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 Internal structure of thoracic vertebral body: Within a thin shell of compact bone, vertical trabeculae predominate; these loadbearing beams are stiffened by transverse trabeculae (cross-ties) which resist buckling of the vertical trabeculae under axial load. Cervico-thoracic junction X-ray of mid thoracic region from cadaver spine ! width of the transverse Section of thoracic vertebral body processes ! presence of the uncinate processes ! shape of the spinal canal ! orientation of the facets – coronal plane McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 Taylor Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Thoracolumbar Junction Thorax – osteology ! Transitional vertebra - usually T11 or T12 Ribs ! Superior articular facets are orientated in the coronal plane and the inferior in the sagittal plane ! Transverse process is replaced by three tubercles ! Single complete facet on the side of the vertebral body A Typical Rib Thorax - osteology ! Typical Ribs (3-9) ! Head " Two articular facets on ! Neck the head of each rib ! Tubercle " Distal to the head is the ! Shaft neck " Distal to the neck lies two tubercles for the CT joint and the CT ligament McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Vertebrosternal Region Vertebrosternal Region ! Ventral aspect of the transverse process contains a deep, concave facet for articulation with the rib ! Orientation of the facet - anterolateral McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 Lee, D. The Thorax An Integrated Approach 2003 Sternum STERNOCOSTAL & INTERCHONDRAL JOINTS 1 Cart Jt 2 Interchondral Jt Sternocostal Jt Synovial Synovial Eight concave facets which Radiate Lig articulate with the costocartilages of ribs 3 to 6 6 7 8 9&10, Fibrous Interchondral Ligs McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 Grays Anatomy Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Vertebrochondral Region Vertebrochondral Region ! Facet on the superior aspect of the transverse process is flat and faces anterolateral and superior McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 Lee, D. The Thorax An Integrated Approach 2003 Vertebrochondral Region Thorax-osteology Atypical Ribs (1,2) ! 1st rib " Small , flat, and most Anteriorly, the 8th, 9th curved of all ribs " Broad th and 10 ribs articulate " Small round head with one indirectly with the single oval articular facet sternum via a series of cartilaginous bars which ! 2nd rib blend with the 7th costal " Longer, not as flat cartilage. " Classified as atypical only because of its attachment to the manubrium McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 Rohen JW. Yokochi C Color Atlas of Anatomy 1988 Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Thorax-osteology Thorax - Arthrology ! Interbody Joint ! Atypical Ribs " Thoracic discs are thinner th " 10 rib – single costal compared to the lumbar facet to T10 " Annulus fibrosis may be th " 11/12 ribs – single thicker in this region costal facet and no " Laterally supported by the attachment anteriorly costovertebral articulation Contrast lower cervical (L) & upper thoracic discs (R) Thoracic discs have flat end-plates with no uncus &no uncovertebral Thoracic Discs clefts C3 T2 ! Relatively small nucleus with less capacity to swell ! Annular fibres criss-cross forming an angle of 27-30 uncus degrees to the horizontal, posterior fibres are thin and C4 T3 vertical ! May be the presence of horizontal clefts cervical thoracic Rohen JW. Yokochi C Color Atlas of Anatomy 1988 C5 T4 Unco- vertebral cleft Taylor Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Thorax – arthrology Thorax - arthrology Facet Joints ! Zygapophyseal joint ! Plane of the facet joints – o flat, nearly vertical " Superior articular facets are slightly convex, 60 from the horizontal and 20o from the frontal ! The superior articular processes face backward, " Inferior articular facets are slightly concave, face slightly superior and anteriorly slightly inferiorly and medially lateral as their slope undergoes a gradual change from the cervical spine Rohen JW. Yokochi C Color Atlas of Anatomy 1988 Arthrology – zygapophyseal joint Typical Thoracic Vertebra ! Z joint is gently convex in both the transverse and sagittal planes ! This orientation permits multidirectional movement McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Costovertebral Joints Rib - Joints Costovertebral joints Costotransverse joints Rohen JW. Yokochi C Color Atlas of Anatomy 1988 Grays Anatomy Ribs 2-9 articulate with the vertebral body of their Arthrology – Costovertebral Joint level, IVD and the vertebral body of the level above Head of Head of rib rib disc AC Joint cavity FC disc Joint capsule Vertebral body Taylor Taylor Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Thorax – arthrology Thorax - arthrology Costovertebral Joint ! Radiate ligament " Superior, ! Stabilized by the intermediate and capsular , radiate and inferior bands attach intra-articular to the vertebral body ligaments above and below and to the IVD Thorax - arthrology Costotransverse Joint ! Intra-articular ligament ! " Only from those Synovial joint between ribs articulating with an oval facet on the two vertebral transverse process bodies and facet on the " Attaches from the tubercle of the rib crest between the demi-facets and the ribs Grays Anatomy McMinn RMH. Hutchings RT. Color Atlas of Human Anatomy 1985 Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Costotransverse Joints Costotransverse Joints - Ligaments ! Upper 6 ribs – articular surfaces are curved ! Interosseous Ligament ! Lateral Costotransverse ! Lower 6 ribs – flattened or planar Ligament Grays Anatomy Costotransverse Joints Blood Supply ! Superiorly supplied via the anterior spinal and paired posterior spinal ! Augmented throughout course via medullary feeders ! Larger Artery of Adamkiewicz (T9) Rohen JW. Yokochi C Color Atlas of Anatomy 1988 Superior Costotransverse Ligament Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Blood Supply Intra canal tumour Note the supply to the nerve root and feeder supply to the cord Rohen JW. Yokochi C Color Atlas of Anatomy 1988 Neurology of the Thoracic Spine Sympathetic Nervous System ! Sinuvertebral nerve – supplies the dura mater, epidural blood vessels, PLL, and the posterior portion of the ribs ! Dorsal rami – supplies the posterior thoracic muscles, Z joints and the costotransverse jts. ! Intercostal nerves – anterior aspect of the ribs ! Innervation of the disc is not well understood Butler D. Mobilisation of the Nervous System 1991 Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Local System Anatomy – Force Closure ! Maintain low force continuous activity in all spinal positions and during all directions of motion ! Control of angular and translatoric motion especially in the neutral zone ! Anticipatory action prior to loading Local System Global System Hodges Global System Multifidus ! Action is direction specific – especially active during rotation Levator Costarum breves ! Generate torque and control motion concentrically, isometrically and eccentrically Rotatores thoracis Levator Costarum longus Primal Pictures Lenerdene Levesque BSc.P.T., MCLsc, FCAMPT Thoracic Spine Anatomy and Biomechanics Level III Iliocostalis thoracis Thoracic component of longissimus thoracis Primal Pictures Osteoporosis: Loss of Osteoporosis bone Predominantly affects post-menopausal density! women and generally affects men about a decade later. ! Increased Central collapse The x-ray shows collapse of the concavity! of the end plates vertebral endplates with marked ! Marked central increase in endplate concavity or loss porosity of the of vertebral height. Loss of vertebral bodies The decreased bone density of the height! ! Biconcavity of the internal cancellous bone contrasts with vertebra – fish the preservation of the peripheral mouth vertebra compact shell. Adequate
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