CHIR12006

Week 7 Study Guide Answers

Q1. Which is the most appropriate primary contact for a T3-T4 Prone Crossed
Bilateral Hypothenar/Transverse Push – Rotation?

A1. Pisiform

Q2. Which is the most appropriate contact for a T7- 8 Opposite Side Thenar
Transverse Drop?

A2. Cupped hand, clenched fist, index or thenar of contact hand

Q3. Which is the correct LOD for T4- T5 Opposite-Side Thenar-Transverse

Drop?

A3. A- P and I-S through the doctor’s torso. A-P for extension or rotational
dysfunction

Q4. Which is the correct LOD for Prone Bilateral Hypothenar/Transverse Push
(Carver Bridge)?

A4. P- A and I-S depending on the level in the thoracic spine.

Q5. Which is the most appropriate method of management in scoliosis cases

with curves less than 10 degrees?

A5. Observe and continue with conservative care

Q6. Which is the most appropriate method of management in scoliosis cases

with lumbar curves between 30-40 degrees?
A6. Conservative management with surgical consult referral

Q7. Which is the most appropriate method of management in scoliosis cases

with thoracic curves greater than 50 degrees?

A7. High probability of surgery

Q8. What is considered the average number of degrees for the thoracic spine
to form a kyphotic curve?

A8. The thoracic spine forms a kyphotic curve of less than 55 degrees with an
accepted range of 20- 50 degrees and an average of 45 degrees.

Q9. Explain the significance of the disc height to body ratio of 1:5 in the
thoracic spine.

A9. The IVDs are comparatively shallow in the thoracic spine. The disc height
ratio is 1:5 making it the smallest ratio in the spine (Fig 5-109). This low ratio
contributes to the decreased flexibility in the thoracic spine. The nucleus is also
more centrally located within the annulus of the thoracic disc than it is in
either of the other spinal regions.

Q10. What is the significant structural characteristic of the thoracolumbar

spine?

A10. The T11 segment has complete costal facets, but no facets on the
transverse process for the rib tubercle. This vertebra also begins to take on
characteristics of a lumbar vertebra. The spinous process is short and almost
completely horizontal. T12 has complete facets on the vertebra for articulation
with the ribs, but otherwise resembles a lumbar vertebra. The inferior
articulating surface of T12 are convex and are directed laterally and anteriorly
in the sagittal plane, like those in the lumbar spine. Superior, inferior, lateral
tubercles replace the transverse processes.
Q11. Name all of the structures of the thoracic spine in the diagram ABOVE

A11.

1 Spinous process
2 Transverse process
3 Superior articular process
4 Vertebral foramen
5 Body of the thoracic vertebra
6 Pedicle
7 Laminae
8 Superior vertebral arch

Q12. Complete the table below Global ROM of thoracic spine

A12.

Flexion 25- 45 degrees

Extension 25- 45 degrees
Lateral Flexion 20- 40 degrees
Rotation 30- 45 degrees
Q13. The presence of a idiopathic structural scoliosis is suggested by what
findings in the thoracic spine?

A13. Scoliosis is a lateral curvature of the spine (i.e., coronal plane deformity)
that has several general causes. The most common form is idiopathic
scoliosis, which arises in otherwise normal children for reasons that are not
fully understood, but there is an underlying genetic cause. Idiopathic scoliosis
is subdivided according to age at which the disease is diagnosed: adolescent
(≥10 years), juvenile (3 to 10 years), and infantile (0 to 3 years).

The clinical presentation of idiopathic scoliosis.

Curves do not straighten when the trunk is flexed forward (Adam’s test).
Structural curves exhibit rotatory components during forward flexion, and the
patient’s symptoms usually include rib hump or asymmetry in the trunk,
referred to as the angle of trunk rotation (ATR). The ATR is easily measured
with the scoliometer.

National Scoliosis Foundation: http://www.scoliosis.org. How is screening for

spinal deformity performed?
The child should be undressed or dressed only in underwear with a gown open
at the back. The child is asked to bend forward while standing, and the contour
of the back is examined from behind and the side. This examination is then
repeated with the child sitting.
The following signs can suggest scoliosis:
 Shoulder or scapular asymmetry
 Asymmetry of paraspinal muscles or rib cage (the so-called rib hump) in
the thoracic spine noted on forward bending (>0.5 cm in lumbar region
and >1.0
 Sagittal plane deformity such as increased kyphosis when viewed from
the side
 Waist-crease asymmetry that does not disappear when sitting (many
waist-crease asymmetries are the result of leg-length discrepancies).
This finding is very helpful in obese patients whose paraspinal
prominence may be obscured by their subcutaneous adipose tissue.
Q14. Label the radiograph below.

A14.

A. Right Sternoclavicular Joint (SC joint)

B. Spinous Process T3
C. T7 Vertebral Body
D. Right T9 Pedicle
E. Right T10 Transverse Process
F. T11 Intervertebral Disc
G. Left Clavicle
H. Left 5T Rib
I. Inferior Articular Process
J. Heart
K. Left T10 Costotranverse Joint
L. L1 Vertebral Body
Q15. Label the radiograph below.

A15.

A. Right Pedicle
B. Left Superior Articular Facet Joint
C. Left Costovertebral Joint
D. Spinous Process
E. Inferior Thoracic Endplate
Q16. Using (Cobb Lippman’s method) what is the Cobb’s Angle in the image
below.

A16.