Thoracic flattening

Localized thoracic flattening may also be caused by chronic somatic dysfunction in two contiguous vertebrae. The examiner should look for a segmentally related visceral-somatic reflex pattern as the imderlying cause. Chronic visceral pathology can cause this condition. 

Localized thoracic flattening is most often caused by areas of posterior muscular lension and/or somatic dysfunction. It can also be habitual in nature as in a militaiy posture, with the shoulders held back and the spine straightened. Flattening can also be compensatory because of flattening In other regions of the spine, cervical or lumbar. 

Description Scuds (amphipoda) are laterally flattened, often colorful forms that usually measure 5 to 20 mm when mature. Head and first thoracic segment form a cephalothorax. The remainder of the thorax possesses seven pairs of legs, the first two pairs being modified for grasping. 

Velocity varies across the vessel due to viscous and inertial effects as mentioned earher. The velocities in Figure 56.3 were measured at one point in the artery. Velocity profiles are complex because the flow is pulsatile and vessels are elastic, curved, and tapered. Profiles measured in the thoracic aorta of a dog at normal arterial pressure and cardiac output are shown in Figure 56.4. Backflow occurs during diastole, and profiles are flattened even during peak systohc flow. The shape of the profiles varies considerably with mean aortic pressure and cardiac output [Ling et al., 1973]. 

The understanding of the relationship static spine - position of the pelvic/ sacrum and position of the femoral heads - can best be derived from a Bech-terew kyphosis - pre- and postoperatively. In addition to the flattened lumbar lordosis and thoracic kyphosis, the preoperative picture shows clear retrover-... 

Fig. 3. Behavior of the positional and spinal parameters in a 9-year old child with dysplastic spondylolisthesis tremendous changes of the positional parameters, but also of the entire spinal parameters with flattening of the lumbar lordosis and the thoracic kyphosis, including displacement of the gravityline anterior to the center of the femoral head...

Through formation of lumbar hyperlordosis and flattening of thoracic kyphosis, the slipping process can be compensated up to a certain point, i.e., the position of the gravity line will, as described above, move around the center of the femoral heads. However, if a critical value is exceeded during the slipping process, there are two basic possibilities as to how the spine behaves towards the center of the femoral head ... 

Now that the mechanism of action of vitamin D has been discussed, it will be easier to understand the morbid anatomy and the clinical aspect of rickets [18, 19]. Vitamin D deficiency leads to low calcium absorption through the intestinal tract, and thereby to deficient mineralization of bone matrix. When rickets develops in the young child, all bones soften with typical malformation. The long bones are curved, especially the tibia, which often acquires a saber-blade shape. The thorax is distorted as a result of scoliosis and kyphosis and enlargement of the lower part of the thoracic cage. The pelvic bones are often underdeveloped and lead to narrowing of the pelvic lumen, which may be responsible for dystocia of the female patient. The bones of the skull are soft and flattened and present an appearance described as crania tabes. 

Fig. A Cross section of the middle thoracic region of a control embryo showing the closed neural tube (top) with the paired dorsal aortae. The foregut overlies the pericardial coelom and heart. Cross section of the middle thoracic region of a hamster embryo recovered 10 hr after a teratogenic dose of sodium arsenate. The region shows retardation in approximation and fusion of the neural folds and shows flattening and exposure of the neuroectoderm. (x 350).

Thoracic spine slightly kyphotic in upper portion, then flattens in lower segments... 

The examiner may find a localized area of thoracic spine, encompassing no more than three contiguous vertebrae, that exhibits severe flattening of the usual kvphotic pattern. This relationship can occur at an area of change of direction of a scoliotic curve, such as a right convexity becoming a left convexity. If rotation in both... 

Is the thoracic posterior convexity a smooth curve Is its kyphosis exaggerated Do segments seem flattened ... 

Observation of the thoracic spine shouid be performed from the back and from each side. One should observe for any abnormal curvature of the spinal column. Kyphosis, an increase in the normal anteroposterior curvature of the spine, or scoliosis, an abnormal lateral curve should be looked for. Kyphosis is sometimes manifested in the upper thoracic spine as the dowager s hump so frequently seen in osteoporosis, especially in older women. Flattening of the thoracic spine may be seen in the presence of muscle spasm or somatic dysfunction. See Chapters 48, 58, and 78 for a further discussion of these postural changes and their significance. 

Facilitated Positional Release in the thoracic region may be performed with the patient in either a seated position or in a prone position. If the patient is treated in a prone position, use of a pillow will be necessary. The pillow is placed under the patient s abdomen or head and neck to assist in flattening the thoracic kyphosis. 

Flattening of the lumbar lordosis is often caused by muscle spasm and may be a part of a herniated disc syndrome. The flattening associated with a herniated disc generally is seen with a listing of the patient away from the side toward which the disc has herniated. The flattening may also be compensatory to flattening of the kyphosis in the thoracic spine. 

The thoracic diaphragm is the major muscie of respiration. Disease processes in the thoracic cavity or in the abdominal cavity can affect its ability to function normaiiy. When diaphragmatic tone increases, it tends to flatten. As it flattens, the motion of the iower ribs may be reversed and a decrease in the transverse diameter of the chest cavity may occur. This may be the result of acute or chronic obstructive iung disease. A flattened diaphragm wiii resuit in iess efficient respiration and a decrease in the pressure gradients necessary for the movement of lymph. 

The structural examination revealed marked restriction of all ribs. The first ribs were elevated bilaterally. The thoracic spine was kyphotic with restricted motion of the vertebrae. The scalene and sternocleidomastoid muscles were hypertrophied and tense. The trapezius and other scapular muscles were hypertonic. Shoulder motion was restricted bilaterally in flexion and abduction. The sternum was rigid with no flexibility at the angle of Louis. Cervical motion was restricted in all directions. The lumbar spine was flattened with hypertonic paraspinal muscles. 

Hurst s The Heart, ninth edition and Braun-wald s Heart Disease sixth edition describe flattening of the thoracic spine with evolving MI and progressive narrowing of the anterior posterior (AP) diameter in advancing mitral valve prolapse. 

The occipital atlantal junction was restricted in flexion and extension but symmetric and sidebending in rotation. There was tenderness along the superior nuchal line bilaterally. There was a mild thoracic and lumbar flattening with a decreased excursion of the diaphragm and rib structures on inhalation. The left first rib was restricted with the rib in the elevated position. The thoracolumbar junction was tender to palpation in the midline and bilaterally across the... 

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