The Thorax Functions of the thorax? 1. Facilitates respiration 2.

Supports the functions of the upper extremity and neck (allows redirection & absorption of torque & momentum within the thorax). 3. Supports locomotion - rotation & side bending. Provides attachment for fascia from lumbar spine, pelvis & shoulder. The facet plane is nearly vertical allowing up to 30 degrees of rotation in the thorax aiding the integration of the shoulder and pelvic girdles during gait. The thoracic vertebral transverse processes are directed posteriorly allowing efficient rotation by rotatores. 4. Protects and supports the thoracic organs 5. Supports the outflow of the SNS from T1 to L1/2. 6. Compensates when there is dysfunction in other areas The relative elasticity of the rib cage, the rotatory capacity and volume of muscle attachments enable the thorax to offer a good degree of adaptability, especially in early life. Costotransverse Ligaments (superior, posterior interosseous). Radiate Ligaments runs to the disc as well as the body above and joint below

What are the main ligaments of the costotransverse joint?

What structural factor may contribute to the increase in respiratory disorders increase with age? How do the ribs move?

Costovertebral joints become less pliable

Why are the upper ribs particularly susceptible to dysfunction? Common causes of upper rib dysfunction?

Bucket handle motion (front of rib moves up & out in inspiration): Rib 1, then 6th to 9th Pump handle motion ( side of rib moves up & out in inspiration): Ribs 2nd to 6th (rotate around the neck) Caliper/Pincer motion: Ribs 11, 12 Duncan the true ribs move like pumphandles apart from 1st Integration with CSpine & Shoulder girdle Proximity with Neurovascualr tissues Coughing Whiplash maintained emotional stress hyperventilation syndrome A syndesmosis is slightly movable joint where the contiguous bony surfaces are united by an interosseous ligament, as in the inferior tibiofibular articulation. It comes from the Greek syn (meaning "with")

What is a syndesmosis?

How does rib joint dysfunction often present? Name three things that can effect costovertebral function How are the clavicle and thoracic viscera related?

How does the clavicle support neck viscera?

and desmos (meaning "a band") Pain at the posterior joints (costo-transverse & costovertebral) & at the anterior syndesmoses (costo-chonral & costo sterna). A syndesmosis may also be sensitive if required to make compensatory movements for a dysfunction elsewhere. 1. Respiratory motion. 2. Upper and lower extremity motion. 3. Trunk motion. The clavicle and first rib give an anterior attachment to the investing fascia of the thoracic viscera, (forms during development when they are drawn down by the migrating septum transversum). The pleura attaches mainly to the medial internal surface of the 1st rib and extends through the strong fascia of subclavius muscle to also attach to the clavicle The clavicle gives inferior attachment to the muscles and cartilages formed by the pharyngeal arches, and the clavicle's normal movements support their healthy function, such as phonation, etc Clavicle can influence thyroid and thymus function, head & neck lymphatic drainage, vocal function, coughs, cervical & shoulder girdle health.

Name the ligaments of the heart:

The following two groups are always present: 1. Superior sterno-pericardial ligament from the manubrium and the inferior sterno-pericardial ligament from the lower sternum. 2. Anterior and posterior diaphragm-pericardial ligaments. The following are reported are difficult to determine in adults: 3. Vertebro-pericardial ligaments from (T3) T4 and from C4 (C5). 4. The descending group: the Viscero-pericardial from the body of the occiput & sphenoid (median pharyngeal raph), and the Thyropericardial ligaments from the thyroid, hyoid and mandible. 2

How many thoracic nerves are there and from where do they arise Each Thoracic nerve has a branch which goes back into the spinal foramen. What is called? What does it supply?

12. T1/2 to T12/L1 Recurrent Meningeal Nerve

Each thoracic nerve has two main divisions

PLL adjacent periosteum posterior disc fibres spinal dura ligamentum flavum It probably provides some sympathetic fibres to these tissues and their blood vessels. Posterior Primary Ramus Lateral branch to the skin Medial (mainly motor to posterior axial spinal muscles) Anterior Primary Ramus: Intercostal nerve communicates w sympathetic ganglia, thus can affect organs Lateral Cutaneous Branch (leaves ribs midway,supplies pleura Anterior Cutaneous Branch supplies skin of chest wall (occurs only at ribs T3-12)

How are nerves T1&2 different?

How can the intercostalbrachial nerve be injured? Symptoms

What aggravates this 3

T1 joins the brachial plexus and has no lateral cutneous branch T2 has anterior cutaneous branch supplying the infr-clavicular area and the lateral upper border of breast. It also has a lateral branch called the intercostobrachial nerve which joins the medial cutaneous nerve of the arm. Supplies skin of medial & posterior aspect of arm. It is often the source of referred cardiac pain. forced flexion of the upper thoracic spine, esp if followed by strong extension: pulling a cork out of a bottle, whiplash, etc Pain in the upper thorax, spreading across the scapula, under the axilla, and radiating down the post/medial aspect of the arm, often to the elbow thoracic extension ie. lying prone or on strong expiration.

type of injury? Describe the thoracic sympathetic trunk P13-15 Description of Sympathetics The thoracic portion of each sympathetic trunk usually consists of 11 segmentally arranged ganglia lying ventral to the necks of the corresponding ribs, closely related to the radiate ligament of the head of the rib. This portion of the sympathetic trunk receives most of the sympathetic pre-ganglionic fibres emerging from the spine. Its postganglionic fibres supply the heart, lungs, bronchi & other thoracic viscera. T3, 4, 5 and 6 via middle & inferior cervical ganglia (situated close to the nerve roots of C5-8) T7-12 via the lumbar ganglia for the femoral n, sacral ganglia for sciatic n T5-12: 1. Greater splanchnic T5 - T9. 2. Lesser splanchnic T10 and T11. 3. Lowest splanchnic T12 Splanchnic (means organ) nerves contribute to the innervation of the viscera, carrying fibers of the autonomic nervous system (visceral efferent fibers) as well as sensory fibers from the organs (visceral afferent fibers). All carry sympathetic fibers except for the pelvic splanchnic nerves, which carry parasympatheticfibers. L1-L2

What is the sympathetic supply of the upper limb? What is the sympathetic supply of the lower limb? What is the sympathetic supply to the viscera?

What are Splanchnic nerves?

What is the sympathetic supply to the bladder?

How does the thorax have conflicting roles? So how can dysfunction manifest?

Stability: protecting organs Mobile: integrating cervical & lumbar movements As areas of Hypomobility with associated

hypermobility

Symptoms and differential diagnosis

Where does mechanical thoracic pain usually occur? Why are the IV nerves unlikely to be compressed? How would compression of a thoracic nerve present ? If u had ant & lateral chest pain what is it likely to be? What are some differentials for thoracic pain? Usually in the spinal or paraspinal area.

Because the formanen are large

Radicular pain into the chest wall

Visceral or ?

angina pectoris (lack of blood to heart, thus lack of O2 & lack of waste removal due to spasm or obstruction of coronary vessels can lead to myocardial infarction, pain in left shoulder). herpes zoster (HA fever, itching pain, malaise) cholecystitis (pain in right scapula region or upper quadrant, inflammation of gallbladder) and pleuritic pain AS Neoplasm Does facilitation always involve paraspinal mms?

REFERRED PAIN
Experimental results for irritation of facet joint tissue.

Innervation of the Viscera (from Wikipedia) The viscera are mainly innervated parasympathetically by the vagus nerve and sympathetically by the splanchnic nerves. The sensory part of the latter reaches the spinal column at certain spinal segments. Pain in any viscera is perceived as referred pain, more specifically pain from the dermatome corresponding to the spinal segment.[5]

Viscus

Nerves

[6]

Origin in spinal column[6]

stomach

anterior and posterior vagal trunks greater splanchnic nerves vagus nerves greater splanchnic nerves vagus nerves thoracic splanchnic nerves posterior vagal trunks greater splanchnic nerves vagus nerves and pelvic splanchnic nerves (parasympathetic)

T6, T7, T8, T9 and, sometimes, T10

duodenum

T5, T6, T7, T8, T9 and, sometimes, T10

pancreatic head

T8, T9

jejunum and ileum

T5, T6, T7, T8, T9

colon

T10, T11, T12 (proximal colon) L1, L2, L3, (distal colon)

spleen

greater splanchnic nerves (sympathetic) greater splanchnic nerves (especially) T6, T7, T8

vermiform appendix

nerves to superior mesenteric plexus sympathetic nerves to celiac plexus

T10

gallbladder and liver

T6, T7, T8, T9 vagus nerve right phrenic nerve vagus nerve thoracic and lumbar splanchnic nerves T11, T12

kidneys and ureters

Autonomic nervous system, showing splanchnic nervesin middle, and the vagus nerve as "X" in blue. The heart and organs below in list to right are regarded as viscera.