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thoracic spine, TMJ, ventilation
thoracic spine, TMJ, ventilation kinesiology
185
Anatomy
Graduate
11/20/2011

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Term
what is the orientation of the thoracic spine
Definition
kyphotic
Term
what is the orientation of the facets of the thoracic spine
Definition
vertical
Term
in what plane do thoracic vertebrae facets facilitate movement?
Definition
frontal
Term
what is kyphosis?
Definition
looks like you're in flexion, but it's fixed
Term
describe spinous process of thoracic spine
Definition
downward angle
Term
how does downward angle of thoracic spinous process affect palpation
Definition
you're palpating at the level below
Term
where are the costal facets on thoracic vertebrae?
Definition
on body and on transverse processes
Term
which 2 thoracic vertebrae are atypical and why?
Definition
T11, T12: ribs only attach to body, no costal facet on transverse process
Term
what are the thoracic vertebrae ligaments?
Definition
anterior longitudinal ligament anterior to vertebral bodies, posterior longitudinal ligament posterior to vertebral bodies, ligamentum flavum on posterior side of spinal canal, intertransverse ligaments between transverse processes, interspinous ligaments between spinous processes, facet capusle
Term
at what 2 joints do ribs articulate with vertebrae?
Definition
costotransverse joint, costovertebral joint
Term
which ribs don’t have constotransverse joints?
Definition
11, 12
Term
what are the ligaments at costotransverse joints?
Definition
costotransverse ligaments
Term
what are the ligaments at the costovertebral joint?
Definition
capsular and radiate ligaments
Term
why is the intervertebral disc in the thoracic spine rarely injured?
Definition
structural stability from rib articulations and ligaments
Term
describe motion/strength in thoracic spine
Definition
We have less motion and more stability/strength in the thoracic spine. Ligaments are strong. Not as many disc injuries in thoracic spine
Term
what influences osteokinematics and provides stability to thoracic vertebrae?
Definition
ribs
Term
how much flexion in T spine?
Definition
30-40 deg
Term
how much extension in T spine?
Definition
20-25 deg
Term
why is there less extension than flexion?
Definition
spinous processes close
Term
what happens when you sidebend to the right?
Definition
right side of vertebra slides posterior, left side of vertebra slides superior
Term
how much lateral flexion is in the thoracolumbar spine?
Definition
25 deg
Term
how much axial rotation is in the thoracolumbar spine
Definition
30 deg, decreases distally
Term
how is lateral flexion coupled with axial rotation in upper T spine
Definition
ipsilateral
Term
how is lateral flexion coupled with axial rotation in lower T spine?
Definition
contralateral
Term
how to maximally close left in lower T spine
Definition
sidebend to left, rotate to right
Term
what motion always closes spine?
Definition
sidebend toward
Term
Why is T spine often involved in postural dysfunctino?
Definition
it's the longest segment
Term
how much is normal kyphosis?
Definition
40 deg
Term
how much is normal kyphosis in kids?
Definition
20 deg
Term
scheurmann disease
Definition
adolescent kyphosis
Term
dowager's hump
Definition
osteoporosis causes wedged vertebral bodies => kyphosis
Term
describe kyphosis and internal forces
Definition
when the spine is in flexion, the internal extensor muscles have to work hard to pull you up against gravity. However, they are also lengthened because of flexion, so they are not as strong.
Term
why does kyphotic orientation worsen?
Definition
creep: posterior ligaments have a constant force pulling on them, so they stretch longer
Term
describe compression fractures and kyphosis
Definition
caused by compression on vertebral body. The bone collapses/fractures and the vertebral body forms a wedge shape.
Term
where do compression fractures of the spine usually occur
Definition
T11-L1
Term
what part of spine does scoliosis mostly affect?
Definition
thoracic
Term
what is a right thoracic curve?
Definition
scoliosis that is convex to right
Term
what is a right thoracic-lumbar curve
Definition
scoliosis that is convex in lower right
Term
what causes scoliosis
Definition
usually idiopathic
Term
how is lateral flexion and axial rotation coupled in scoliosis?
Definition
contralaterally: as in lumbar spine
Term
what is functional scoliosis?
Definition
curve corrects with change in posture
Term
how is ventilation different from respiration?
Definition
ventilation = air in and out; respiration = exchange of gases
Term
what principle guides movement of air in and out of lungs?
Definition
Boyle's Law: pressure and volume are inversely related, so that as volume increases, pressure decreases AND air travels from areas of high pressure to areas of low pressure
Term
describe interpleural space
Definition
has negative pressure that makes it link lungs to chest wall.
Term
how does movement of the chest wall increase volume of lungs?
Definition
lungs are linked to chest wall by interpleural space
Term
what is inside interpleural space?
Definition
fluid
Term
what is pneumothorax
Definition
collapsed lung: puncture of interpleural space causes air to leak out of space and destroy the connection between lungs and chest wall
Term
how do we control air?
Definition
we can control volume, and by boyle's law we control pressure. Air always flows from areas of high pressure to areas of low pressure.
Term
what are our components of breathing
Definition
rib cage, muscles of ventilation, diaphragm
Term
describe inspiration
Definition
1. increase volume in the thoracic cavity and the lungs, 2. lower intrathoracic pressure, 3. air flows into the lungs because it goes from high pressure outside to low pressure inside
Term
around which 2 joints do ribs elevate superiorly for inspiration/
Definition
costovertebral, costotransverse
Term
where is the axis of rotation for rib elevation for inspiration?
Definition
through imaginary line between costotransverse and costovertebral joints
Term
what does rib elevation do to assist inspiration?
Definition
increases anterior/posterior diameter of thorax
Term
what type of fibers are in the muscles that elevate the rib cage?
Definition
slow oxidative, type I
Term
what do the mucles that elevate ribs work against?
Definition
resistive forces of lung elasticity, airway resistance
Term
what is quiet ventilation?
Definition
normal breathing, using primary muscles
Term
what is forced breathing?
Definition
taking deep breaths, using accessory muscles
Term
what are the primary muscles of inspiration?
Definition
diaphragm, scalenes, external intercostals
Term
what is the primary force of expiration?
Definition
passive, elastic recoil of lungs: volume decreases, pressure increases, forces air out
Term
what does diaphragm do to increase thoracic volume?
Definition
flatten
Term
how far does the diaphragm move in normal inspiration?
Definition
1cm
Term
how far does the diaphragm move in forced inspiration?
Definition
10cm
Term
what muscle accounts for 80% of inspiration?
Definition
diaphragm
Term
how do the scalenes contribute to ventilation?
Definition
raise the rib cage, counteract the effects of diaphragm to help stabilize rib cage
Term
when does the activity of the scalenes increase?
Definition
at the end of inspiration
Term
how do the external intercostals contribute to ventilation?
Definition
raise and spread the rib cage
Term
how do the external intercostals change the position of the ribs
Definition
ribs move from downward resting position to almost perpendicular to spinal column
Term
how much does the chest cavity expand from the intercostals?
Definition
20.00000%
Term
what pushes diaphragm back up in expiration?
Definition
abdominal pressure
Term
what reverses the action of the scalenes during expiration?
Definition
gravity
Term
how do the internal intercostals contribute to expiration?
Definition
depress and squeeze the ribcage
Term
what muscles assist in forced expiration?
Definition
rectus abdominis, external oblique, internal oblique, transversus abdominus
Term
when are accessory muscles used in breathing?
Definition
increased activity, disease
Term
where do accessory breathing muscles attach?
Definition
shoulder, head, or vertebral column
Term
what are the accessory muscles of inspiration?
Definition
sternocleidomastoid, trapezius, pectoralis major, pectoralis minor, subclavius
Term
how does the sternocleidomastoid contribute to inspiration?
Definition
(accessory) elevates ribs
Term
how does trapezius contribute to inspiration?
Definition
(accessory) fixes head for SCM action
Term
how does pectoralis major contribute to inspiration?
Definition
when arms are up, pec major helps inspiration by lifting rib cage
Term
what accessory muscles assist in expiration?
Definition
pectoralis major, abdominals, quadratus lumborum
Term
how does the pectoralis major contribute to expiration?
Definition
(accessory) when arms are down, pec major compresses the rib cage to help expiration
Term
how does quadratus lumborum assist with expiration?
Definition
(accessory) stabilizes ribs
Term
what does air resistance in the body's airways depend on?
Definition
viscosity/thickness of air, smoothness of container walls, diameter of the container
Term
what is a ventilation disorder
Definition
anything that impedes movement of thoracic cavity
Term
what types of things cause ventilation disorders?
Definition
injury or paralysis of muscles of inhalation, restrictions of airway openings (obstructions, bronchospasms, asthma), decreased rib cage compliance
Term
what are the mechanical effects and results of COPD?
Definition
decreased lung elasticity causes outward pull of rib cage to be greater than elastic recoil of lungs, leading to barrel shaped chest. Muscles are placed in shortened positions. Can't expire completley
Term
how does scoliosis affect ventilation?
Definition
curve crushes lung on convex side; length-tension relationships are altered; rib mobility reduced
Term
how does scoliosis affect length-tension relationships of ventilation muscles?
Definition
muscles on convex side stretched, muscles on concave side shortened
Term
what are the normal aging effects on ventilation?
Definition
decreased lung elasticity, decreased rib cage compliance, decreased mobility of thoracic spine and rib cage (from kyphosis), decreased muscle strength
Term
describe asthma
Definition
reactive airway disease; change area; can't get as much air in
Term
how are rheumatoid conditions ventilation disorders?
Definition
decreased joint mobility bc it hurts to move joints
Term
describe pneumonia
Definition
mucous in lungs, not as much room for air
Term
do we have good or band control of temporomandibular joint?
Definition
good: very fine
Term
what kind of joint is TMJ?
Definition
2 associated but distinct articulations (left and right); synovial joint with fibrocartilage instead of hyaline cartilage
Term
which 2 bones articulate at TMJ?
Definition
temporal, mandible
Term
what is the primary articular surface of the temporal bone at the TMJ?
Definition
articular eminence
Term
what part of temporal bone articulates with mandibular condyle (with biconcave disc in between)?
Definition
mandibular fossa
Term
what is the body of the mandible?
Definition
front part, where teeth are
Term
what are the rami of the mandible?
Definition
part that sticks up from body and articulates with tempral bone
Term
where is the angle of the jaw?
Definition
on mandible, where rami meet body
Term
what is the mandibular condyle?
Definition
primary articular surface of mandible on temporal. Has medial and lateral poles
Term
what is the notch on the mandible between the coronoid process and the mandibular condyle?
Definition
mandibular notch
Term
what is another term for mandibular fossa?
Definition
glenoid fossa
Term
what surrounds the glenoid/mandibular fossa?
Definition
posterior glenoid spine posteriorly, articular eminence anteriorly
Term
how is the articular disk of the TMJ biconcave?
Definition
both its superior (below articular eminence) and inferior (above mandibular condyle) surfaces are concave
Term
what are the medial/lateral attachments of the TMJ disc?
Definition
temporal bone, mandibular condyle
Term
what are the anterior attachments of the TMJ fibrocartilagnous disk?
Definition
articular capsule, lateral pterygoid
Term
what are the posterior attachements of the TMJ disk?
Definition
2 lamina
Term
what separates an upper and lower joint in each side of the TMJ?
Definition
biconcave disk
Term
what are the parts of the upper TMJ joint?
Definition
temporal bone's glenoid fossa + disk
Term
what are the parts of the lower TMJ joint?
Definition
disk + mandibular condyle
Term
what kind of joint is the lower TMJ joint and how many degrees of freedom does it have?
Definition
hinge, 1 DOF
Term
what kind ofjoint is the lower TMJ joint?
Definition
plane
Term
what type of movement does the lower TMJ do?
Definition
primarily anterior-posterior translation
Term
is the disc attached more firmly to temporal bone or to mandibular condyle?
Definition
mandibular condyle
Term
how does the disc slide on the temporal bone?
Definition
anteriorly and posteriorly
Term
how does the disc move medially and laterally on the temporal bone?
Definition
it doesn't move medially and laterally
Term
describe the jaw's anterior/posterior capsule
Definition
loose to allow forward glide
Term
how is the looseness of the anterior/posterior capsule sometimes a bad thing?
Definition
can allow dislocation
Term
what does the disc do as the mandible moves?
Definition
the disc moves with the mandible
Term
is the motion of the TMJ disc active or passive?
Definition
passive
Term
what does the disc glide against as it goes anteriorly/
Definition
articular eminence
Term
what are the 3 primary ligaments of the TMJ?
Definition
temporomandibular ligament, stylomandibular ligament, sphenomandibular ligament
Term
what are the 2 parts of the temporomandibular ligament?
Definition
oblique portion, horizontal portion
Term
what does the oblique portion of the TM ligament attach to?
Definition
neck of the condyle and articular eminence
Term
what is the function of the oblique portion of the temporomandibular ligament?
Definition
limits downward/posterior motion of the mandible, limits rotation of the condyle during opening
Term
what does the horizontal portion of the temporomandibular ligament attach to?
Definition
lateral condyle, posterior disk, articular eminence
Term
what is the function of the horizontal portion of the temporomandibular ligament?
Definition
inhibit posterior motion of condyle thereby protecting the retrodiscal lamina
Term
what are the attachments of the stylomandibular ligament?
Definition
styloid process of the temporal bone, posterior border of the ramus of mandible
Term
what is the function of the stylomandibular ligament
Definition
may limit protrusion
Term
what are the attachments of the sphenomandibular ligament?
Definition
sphenoid bone and middle of ramus of mandible
Term
what is the function of the sphenomandibular ligament?
Definition
may limit protrusion
Term
what is mandibular depression
Definition
mouth opening
Term
what is mandibular elevation
Definition
mouth closing
Term
what is mandibular protrusion
Definition
jutting chin forward
Term
what is mandibular retrusion
Definition
sliding teeth back
Term
what is left and right lateral deviation
Definition
sliding teeth side to side
Term
what TMJ joint moves first in mouth opening
Definition
lower joint
Term
what is the motion of the lower TMJ
Definition
rotation
Term
how much motion is provided by the lower TMJ
Definition
10-25mm
Term
describe the arthrokinematics of the lower TMJ
Definition
convex mandibular condyle rolls posteriorly, slides anteriorly on concave disk
Term
as the convex mandibular condyle rolls posteriorly on the concave disk, how does the disk move on the mandible?
Definition
convex disk slides and rolls anteriorly on mandibular condyle
Term
where does most of the mouth opening come from?
Definition
upper TMJ
Term
what type of movement does the upper TMJ do?
Definition
translation
Term
how much movement does the upper TMJ provide in mouth opening
Definition
40-50mm
Term
describe arthrokinematics of upper TMJ
Definition
anterior glide of concave disk on convex temporal bone
Term
what is a functional ROM for mouth opening?
Definition
2 PIP joints worth
Term
what is the normal ROM for mouth opening?
Definition
3 PIP joints worth
Term
what is the breakdown of movement of opening at the TMJ?
Definition
posterior rotation followed by anterior translation
Term
what is the breakdown of movement of closing at the TMJ?
Definition
closing starts with posterior glide, ends with anterior rotatoin
Term
what is the first part of mouth closing?
Definition
posterior translation of mandible from full open to half open?
Term
what provides active disk movement?
Definition
lateral pterygoids: forceful opening, eccentric control during mouth closing
Term
what provides passive control of disk movement?
Definition
ligaments, articular capsule
Term
what joint movement creates protrusion/retrusion?
Definition
movement between articular disk and temporal bone: gliding of upper joint
Term
what does protrusion stretch?
Definition
restrodiscal tissue
Term
how much movement can you get in protrusion?
Definition
6-9mm
Term
what does protrusion look like?
Definition
bottom teeth in front of top teeth
Term
what limits retrusion?
Definition
temporomandibular ligament
Term
how much movement can you get in retrusion?
Definition
<3mm
Term
what are the motions of lateral deviation?
Definition
ipsilateral condyle spins, contralateral condyle glides forward
Term
how much normal motion can you get in lateral deviatoin?
Definition
about 10 mm
Term
what is TMJ rest position?
Definition
teeth slightly apart, tongue on roof of mouth, least stress on joint
Term
how much do our teeth contact a day?
Definition
15-20 min
Term
what provides non-forceful mouth opening?
Definition
gravity
Term
what provides forceful mouth opening?
Definition
digastric, infrahyoids, lateral pterygoid
Term
what muscles provide mouth closing?
Definition
temporalis, masseter, medial pterygoid, eccentric control of disc from lateral pterygoids
Term
what muscles control protrusion?
Definition
lateral pterygoids, medial pterygoids, masseter
Term
what muscles control retrusion?
Definition
temporalis posterior fibers, digastric
Term
what muscles pull contralateral side forward in lateral deviation?
Definition
lateral pterygoid, medial pterygoid
Term
what muscle pulls ipsilateral condyle posteriorly in lateral deviation?
Definition
temporalis
Term
what muscles are working during R lateral deviation?
Definition
R temporalis, L lateral and medial pteryd
Term
what are some TMJ pathomechanics?
Definition
inflammation from rheumatoid arthritis, capsular fibrosis resulting in hypomobility, osseous mobility conditions resulting in hypermobility and dislocation, articular disk displacement, degeneration
Term
how can you tell that a TMJ is hypermobile?
Definition
laxity of capsule/ligaments/tendons, joint noise at the end of opening, unilateral hypermobility can produce lateral deviation
Term
in a hypermobile TMJ, what causes the clicking?
Definition
condyle sliding over eminence at end of opening
Term
what happens in TMJ dislocation?
Definition
condyle passes anteriorly to articular eminence
Term
what happens if you have a dislocated TMJ?
Definition
contralateral deviation, inability to close mouth after yawn, bite
Term
what muscle is contracted during TMJ dislocation?
Definition
lateral pterygoid
Term
what happens in articular disc displacement?
Definition
disc moves anteriorly over articular eminence
Term
what are the 2 types of articular disc displacement?
Definition
with and without reduction
Term
describe articular disc displacement with reduction
Definition
joint noise during opening and closing bc mandibular condyle touches retrodiscal tissue rather than disc at rest
Term
describe articular disc displacement without reduction
Definition
no noise, posterior ligaments are further stretched, condyle doesn't glide over disk but glides over retrodiskal tissue instead
Term
in forward head posture, which TMJ muscles are stretche?
Definition
infrahyoids (sternohyoid, omohyoid)
Term
what happens to the mandibular condyle in forward head posture?
Definition
forced posteriorly
Term
what happens to retrodiscal tissue on forward head posture?
Definition
compressed
Term
what happens to lateral pterygoid in forward head posture?
Definition
spasms for protection
Term
where is the jaw pulled in forward head posture?
Definition
posteriorly, inferiorly
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