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THORACIC
(DORSAL)
SPINE
Agenda
Introduction
Applied anatomy
Patient history
Observation
Examination
Active ROM
Passive ROM
Isometric resisted ROM
Special tests
Thoracic Spine - Introduction
COSTOVERTEBRAL JOINTS
-b/w the ribs and vertebral bodies
-24 joints
-ribs 1, 10, 11 & 12 articulate with a single
vertebra
-ribs 2-9 articulate with two adjacent
vertebrae and the intervening IVD
Thoracic Spine – Applied Anatomy
COSTOTRANSVERSE JOINTS
-b/w the ribs and the TVPs of the vertebra of
the same level for ribs 1-10
-ribs 11 & 12 do not articulate with the -TVPs
so there is no costotransverse joint
associated for ribs 11 & 12
Thoracic Spine – Applied Anatomy
Thoracic Spine – Applied Anatomy
COSTOCHONDRAL JOINTS
-b/w the ribs and costal cartilages
STERNOCOSTAL JOINTS
-b/w the costal cartilage and the
sternum
Thoracic Spine – Applied Anatomy
Transitional vertebrae
-T1(facets are similar to that of the
cervical spine)
-T11-12 (facets are similar to that
of the lumbar spine)
Thoracic Spine – Applied Anatomy
The Ribs
-Articulate with the demifacets on
vertebrae T2-9
-T1 & T10 possess a whole facet for ribs 1 &
10, respectively
-Rib 1 articulates with T1 only
-Rib 2 articulates with T1-2, Rib 3 articulates
with T2-3, etc
Thoracic Spine – Applied Anatomy
-Kyphosis
-Scoliosis
Thoracic Spine – Observation
KYPHOSIS
-Most prevalent in the thoracic spine
-May be visually fooled by the
musculature or position of the
scapulae into thinking there is
excessive kyphotic curvature
Thoracic Spine – Observation
KYPHOSIS
ROUND BACK:
BACK
-Thoracolumbar or thoracic kyphosis
and decreased pelvic inclination (20°)
-Secondary to prolonged postural
stresses or growth disturbances (ie.
Scheuermann's disease) that have
altered the centre of gravity
Thoracic Spine – Observation
Thoracic Spine – Observation
KYPHOSIS
HUMP BACK:
BACK
-Localized, sharp, posterior angulation
= GIBBUS
-Usually structural
-Anterior wedging to one or two
vertebral bodies
-Pelvic inclination usually normal (30°)
Thoracic Spine – Observation
Thoracic Spine – Observation
KYPHOSIS
FLAT BACK:
BACK
-Pelvic inclination decreased (20°)
-Similar to round back except the T/S
remains mobile
-Although a kyphosis is or should be
present, it does not have the
appearance of an excessive kyphotic
curve
Thoracic Spine – Observation
KYPHOSIS
DOWAGER'S HUMP:
HUMP
-Secondary to postmenopausal
osteoporosis
-Osteoporosis causes anterior wedge
fractures to several vertebrae, usually in
the upper to middle thoracic spine
Thoracic Spine – Observation
Thoracic Spine – Observation
Thoracic Spine – Observation
SCOLIOSIS
-One or more lateral curvatures to the
thoracic and/or lumbar spine(s)
-Structural vs. Non-Structural
Thoracic Spine – Observation
Structural Scoliosis
-Structural change to the bone(s) of
the spine with associated loss of
normal flexibility
-Vertebral bodies rotate towards the
convexity of the curve
Genetics, idiopathic, congenital problem
(wedge vertebra, hemivertebra, failure of
vertebral segmentation)
Thoracic Spine – Observation
Non-Structural Scoliosis
-No structural changes and is more
amenable to correction
-Poor posture, nerve root irritation,
inflammation in the spine, LLI, hip
contractual
Thoracic Spine – Observation
Scoliotic Curves
-Designated according to the level of
the apex of the curve and in relation to
the convex side
-Cervical scoliosis (aka. Torticollis), the
apex is b/w C1-C6
-Cervicothoracic scoliosis, the apex is
at C7 or T1
Thoracic Spine – Observation
Scoliotic Curves
-Thoracic scoliosis, the apex is b/w T2-
T11
-Thoracolumbar scoliosis, the apex is
at T12 or L1
-Lumbar scoliosis, the apex is b/w L2-
L4
-Lumbosacral scoliosis, the apex is at
L5 or S1
Thoracic Spine – Observation
Scoliotic Curves
Example:
A right thoracic curve has a convexity
toward the right (concavity is towards
the left), and is in the thoracic spine.
Thoracic Spine – Observation
Scoliotic Curves
-because the vertebral bodies rotate
towards the convexity, in the thoracic
spine, this rotation will cause the ribs on
the convex side to push posteriorly
-Rib “humping”
-Thoracic cage narrows on the convex
side
Thoracic Spine – Observation
Scoliotic Curves
-Rotation of the vertebral bodies to the
convexity causes the SPs to deviate
towards the concavity
-Ribs on the concave side move
anteriorly causing Rib “hollowing” and
the thoracic cage widens
Thoracic Spine – Observation
Thoracic Spine – Observation
Chest Deformities
Pectus Carinatum (pigeon chest)
-Sternum projects forward and
downward
-Increases the AP dimension of the
chest
-Impairs breathing by restricting
ventilation volume
Thoracic Spine – Observation
Thoracic Spine – Observation
Chest Deformities
Pectus Excavatum (funnel chest)
-Sternum is pushed posteriorly by an
overgrowth of the ribs
-AP dimension of the chest is
decreased and the heart may be
displaced
-May result in kyphosis
Thoracic Spine – Observation
Thoracic Spine – Observation
Chest Deformities
Barrel Chest
-Sternum projects forward and upward
so that the AP diameter is increased
-Seen in pathological conditions such
as emphysema
Thoracic Spine – Observation
Thoracic Spine – Examination
Active ROM
Forward flexion 20° – 45°
Extension 25° – 45°
Lateral flexion 20° – 40°
Rotation 35° – 50°
Costovertebral expansion 3 – 7.5 cm
Rib motion (pump handle, bucket handle, caliper)
Combined, repetitive, & sustained movements
and postures (if necessary)
Thoracic Spine – Examination
Rib Motion
-Client supine with therapist's hands placed in a
relaxed fashion over the upper chest, middle
chest and lower chest
-If a rib stops moving relative to the other ribs on
inhalation = DEPRESSED RIB
-If a rib stops moving relative to the other ribs on
exhalation = ELEVATED RIB
Thoracic Spine – Examination
Passive ROM
Forward flexion tissue stretch
Extension tissue stretch
Lateral flexion tissue stretch
Rotation tissue stretch
Passive ROM
-Client seated
-Therapist places one hand on the head of client
and the other palpates over and b/w the SPs of
the lower cervical and upper thoracic spine (C5-
T3)
-Feel for movement while guiding the head into
flexion/extension/lateral flexion/rotation
Thoracic Spine – Examination
SPECIAL TESTS
Slump Test
First Rib Mobility Test
Thoracic Spine – Examination
Special Tests – Neurological Dysfunction
SLUMP TEST
(aka. Sitting Dural Stretch)
-Series of steps performed sequentially
-Only progress to the next step if no positive was elicited
-Perform test:
Start with non-affected side, then repeat on affected
side, then repeat with both sides simultaneously.
POSITIVE FINDING:
Reproduction of the symptoms
INDICATION OF:
Dural, cord and/or nerve root impingement
Thoracic Spine – Examination