Case Study: Group 1 Jerald Bates Kamaal Daniels Komuri Lejukole Part one: Regarding the osteologic features of the lumbothoracic region, it is primarily comprised of the thoracic and lumbar spine. The thoracic region consists of 12 vertebrae, and the lumbar consists of 5. The ribs and the sternum are also critical components of this region. Twelve ribs are divided into three categories. Ribs 1 - 7 are considered “true ribs” as they articulate with the thoracic spine posteriorly at the costotransverse joint and anteriorly at the sternocostal joint. Ribs 8 - 10 are “false ribs” as they attach to the sternum via cartilage. The last set of ribs are “floating ribs,” as they do not articulate with the sternum. The sternum is located at the central part of the anterior thoracic wall. The superior portion is the manubrium, and the inferior most structure is the xiphoid process, with the body in between. The cervical spine and the hips are important to acknowledge in this section due to their proximity to the lumbothoracic region. An injury to this region could cause deficits in its surrounding areas or vice versa. The cervical spine consists of 7 vertebrae to initiate the spinal column. Below the lumbar region rests the sacrum, one big bone composed of 5 vertebrae. It rests between the iliac bones in the hip. The lumbothoracic region consists of several important ligaments for optimal spinal and thoracic movement. The ligamentum flavum connects the laminae and fuses with the facet joint capsules. It prevents hyperflexion and promotes upright posture. The interspinous ligaments connect the spinous processes across their adjacent borders, and the supraspinous connects at the tip of their adjacent borders. Both are working in conjunction to limit hyperflexion of the spine. The anterior longitudinal ligament is a thick band that covers the ventral part of the vertebral bodies and prevents hyperextension. The posterior longitudinal ligament is a wide band that covers the dorsal aspect of the vertebral bodies and prevents hyperflexion. The costotransverse ligament is a fibrous band between the transverse process and the neck of the rib. It protects the rib and prevents dislocation. Regarding neural anatomy, the thoracic spine consists of 12 spinal nerves that extend from the spinal cord to the chest, upper back, and abdomen. The lumbar spine consists of 5 spinal nerves that extend from the spinal cord to the legs and feet. To conclude, the vertebral arteries consist of the anterior spinal artery, posterior spinal arteries, radicular arteries, and the arterial vasocorona. The internal vertebral venous plexus and external vertebral venous plexuses are responsible for draining the deoxygenated blood from the vertebrae. The other vital arteries and veins of the thoracic wall are the posterior intercostal artery, subcostal artery, internal thoracic artery, anterior intercostal artery, posterior intercostal vein, anterior intercostal vein, and internal thoracic vein. Part Two: • Muscles that influence the Lumbothoracic region include the following: o Erector Spinae -Extends the spine, lateral flexion of the spine, and rotation of the spine o Multifidus - Stabilizes the spine o Iliopsoas - Flexes the hips and stabilizes the trunk during sitting posture o Rectus Femoris - Thigh flexion o Quadratus Lumborum - Extensor and stabilizer of the lumbar spine, lateral flexion o Internal and External Obliques - Rotation and lateral flexion of the trunk o Rectus Abdominis - Anterior flexion of the trunk o Transverse Abdominis - Stabilizes spine and pelvis o Hamstrings - Extends Thigh o Gluteal Muscles - Extends thigh Muscle lengthening and shortening can significantly affect the positioning of bones and joints and lead to some painful pathology. Adaptive shortening and lengthening may limit the range of motion (ROM), flexibility, and strength of any muscles affected. An example of muscle shortening in the Lumbothoracic region would be shortened quads and hip flexors. When extremely tight or shortened, these muscles pull on the anterior side of the pelvis. This causes the pelvic bone to tilt forward, occurring in poor posture, an elongated back, and lower back pain (LBP). Today, adaptive shortening of the hip flexors and quads are expected due to how common it is to spend long hours sitting, keeping the muscles in the front of the pelvis and thighs in a concise position. Another excellent example of muscle shortening in the Lumbothoracic region is the latissimus dorsi. The latissimus dorsi is a massive muscle that spans virtually the entire width and length of the back. Shortening the latissimus dorsi is directly correlated to poor posture, limited ROM in the shoulders, and widespread back pain. While this doesn’t affect the joints of the Lumbothoracic region, it can cause widespread back pain, and the real cause of this back pain may go unnoticed by some clinicians. Lower Cross Syndrome (LCS) is categorized by weakness and tightness of muscles about each other. There are two types, one where there is an extreme anterior pelvic tilt and one where there is a slight posterior pelvic tilt. In the first type, the abdominals and gluteal muscles usually exhibit some muscle weakness, resulting in deficits in hip extension and an extreme lordotic curve. In anterior LCS, there is also some over-reactivity of hip flexors as compensation for the weak abdominals and glutes. This causes the hip flexors and thoracolumbar extensors to become tight, pushing the pelvis into an abnormal anterior tilt and often causing LBP. Tight hamstrings are also common in this form of LCS, and slight knee flexion is expected since the hamstrings also cross this joint. A pathology that arises from anterior LCS is pain and stiffness in the facet joints. The increased lumbar lordosis strains the facet joints of the lumbothoracic region, producing what is commonly known as Lumbar facet syndrome. Lumbar facet syndrome may cause severe back pain and is often overlooked by physicians because of how common LBP is. In the second type of LCS, there is nearly no lordotic curve as a result of not only weak but also shortened abdominal muscles. An almost perfect opposite image of the first type is seen; extreme kyphosis, head protraction, and knee recurvatum are all observed in this type of LCS. It produces a slouched, rounded posture in patients. Part Three: The joints and joint segments of the lumbar and the thoracic region that need to be measured are the 12 pairs of apophyseal joints in the thoracic region, the whole thoracic region that includes flexion, extension, and lateral extension. When concerning the lumbar region, the joints that need to be measured are the vertebrae of the lumbar region, along with the sacroiliac joint. The thoracic region's 12 pairs of apophyseal joints are sloped forward 15 to 25 degrees. In anatomical or standing positions, the spine exhibits 40 to 45 degrees of natural kyphosis; during flexion of the regions, normative values are 30-40 degrees; in extension, the normative values are 15 to 20 degrees. The posterior longitudinal ligament and anterior longitudinal ligament limit flexion and extension, respectively, as stated before. The thoracic spine exhibits 25-35 degrees of axial rotation in the horizontal plane. Unlike the other parts of the body that have abduction and adduction, the spine in the frontal plane has a movement called lateral flexion; the normative values for lateral flexion include 25-30 degrees. The kinematics of lateral flexion involves the inferior facets of one vertebra. The bad aspect of the vertebrae slides superiorly on the contralateral side of lateral flexion, and the part on the ipsilateral side of lateral flexion slides inferiorly. In the lumbar region, there are about 45 to 55 degrees of flexion and 15 to 25 degrees of extension, so there is a total of 60-80 degrees of sagittal plane motion in the lumbar spine. In the horizontal plane, there are only 5 to 7 degrees of motion in either direction. Like the cervical region, the frontal plane involves the movement of lateral flexion, and in the lumbar region, there are only 20 degrees of motion. The sacroiliac joint has 1 to 4 degrees of rotation and 1 to 3 millimeters of translation.
