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After completion of this chapter, the physical therapist should be able to do the following:
Discuss the functional anatomy and biomechanics of the cervical and thoracic spine.
Compare and contrast the regional differences between the cervical and thoracic spine.
Discuss the rehabilitation approach to conditions of the cervical spine.
Discuss the rehabilitation approach to conditions of the thoracic spine.
Explain the rationale for why therapeutic exercise programs for the cervical and thoracic spine would include neuromuscular control of the scapulothoracic joint or the lumbopelvic region.
Describe why a comprehensive history and examination are necessary to develop a rehabilitation program for cervical and thoracic spine pathology.
Compare and contrast common clinical presentations for cervical or thoracic spine pathologies.
Explain the components of a comprehensive rehabilitation approach for the management of cervical or thoracic spine pathology.
Incorporate the rehabilitation approach to specific conditions affecting the cervical or thoracic spine.
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Functional Anatomy and Biomechanics
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The cervical and thoracic spine are comprised of 19 vertebrae (7 cervical and 12 thoracic). Typically, components of the vertebrae include the body, pedicle, lamina, transverse processes and spinous process (Figures 27-1 and 27-2). The posterior aspect of the vertebral body, lamina, transverse processes and spinous process form the vertebral foramen. The spinal cord passes through the vertebral foramen with nerve roots that pass through the intervertebral foramen. The size of the vertebral foramen progressively decreases in a caudal direction as the spinal cord tapers in size. The intervertebral foramen are larger at the cervical and lumbar levels to accommodate the larger nerve roots at each level which are responsible for innervation of the limbs. The cervical nerve roots (C1-7) exit through the intervertebral foramen above the associated vertebral segment, while the other nerve roots exit below their associated vertebral segment (eg, C8 nerve root exits below C7, T1 nerve root exits below T1).
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There are 2 major joints for each vertebral segment: the intervertebral and zygapophyseal (facet) joints. The intervertebral joint is a symphysis joint consisting of 2 vertebral bodies connected by an intervertebral disc. The zygapophyseal joint (right and left side) is a diarthrodial synovial joint with articulations between the inferior facet of a vertebral segment and the superior facet of the caudal segment.
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The intervertebral disc transmits loads between segments and provides spacing between segments allowing motion to occur. There is a progressive increase in disc size from the cervical to the lumbar region. The anterior portion of the disc is wider and relatively stronger than the thinner posterior aspect of the disc. Each vertebral segment is separated by an intervertebral disc, with the exception of the atlantooccipital and atlantoaxial joints. ...