Reduction and Fixation of Sacroiliac joint Dislocation by the Combined Use of S1 Pedicle Screws and an Iliac Rod
Kai-Uwe Lewandrowski, Donald L. Wise, Debra J. Trantolo, Michael J. Yaszemski, Augustus A. White in Advances in Spinal Fusion, 2003
Extrapedicular screw placement was first described by Dvorak et al. [13] in 1993. With this technique, screws are placed laterally to the pedicle. The entry point is found on the outer third of the transverse element tip (Fig. 2). The costotransverse and costovertebral joints are intersected by the screws. This technique guarantees a greater distance from the screw to the spinal canal and also anchors the screw in more cortices (ribs and vertebral body) and in the cancellous bone of the vertebra. In comparison to conventionally placed intrapedicular screws, longer screws can be used with this technique, and therefore the length of the screw/bone interface is increased. Therefore, the technique would appear to be safer. Dvorak et al, in a study of extrapedicular screw placement, was able to insert significantly longer screws and demonstrated a biomechanical advantage by measuring a significantly greater pull-out force. In their conclusions, however, Dvorak et al. wrote that while extrapedicular screw placement was a safe in vitro technique, due to the anatomical variability of the thoracic spine a standardization of the technique was not possible [13].
Cancer Rehabilitation
K. Rao Poduri in Geriatric Rehabilitation, 2017
Post-thorocotomy pain syndrome occurs in about 50% of patients following thorocotomy.117 It presents with persistent pain at the incision site as well as along the distribution of the intercostal nerve, for longer than 2 months in duration.94 It is believed to result from intercostal neuralgia caused by multiple mechanisms, including poorly repositioned rib fractures, costochondral dislocation, costochondritis, intercostal neuroma, nerve entrapments, or local infections.118 It is often described as sharp, lancinating pain accompanied by dysesthesias.119 Altered biomechanics from the dissection of latissimus dorsi during the thoracotomy procedure also contributes to abnormal shoulder function.95 Musculoskeletal examination should closely inspect the incision site, palpate the chest wall to exclude costochondritis, and range the shoulder so as to evaluate associated musculature with careful attention to myofascial pain and muscle atrophy.116 Patients may benefit from postoperative pulmonary rehabilitation consisting of energy conservation and breathing techniques, aerobic conditioning following the surgery, scar mobilization, and soft tissue massage. Pain should also be treated aggressively with neuropathic pain medications, topical lidocaine, compounded creams, and intercostal nerve blockade.98 Preemptive thoracic epidural analgesia initiated before surgical incision has previously been shown to significantly reduce the severity of acute postoperative pain but seems to have had no effect on the incidence of chronic pain 6 months after surgery.120 Alternative pain management strategies have also involved direct manual costovertebral joint manipulation, with good effects.121
The back
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The axis of movements in the thoracolumbar spine is the nucleus pulposus; the disposition of the facet joints determines which movements occur. In the lumbar spine these joints are in the anteroposterior plane, so flexion, extension and sideways tilting are free but there is virtually no rotation. In the thoracic spine the facet joints face backwards and laterally, so rotation is relatively free; flexion, extension and tilting are possible but are grossly restricted by the ribs. The costovertebral joints are involved in respiration and their limitation is an early feature of ankylosing spondylitis.
Intra and inter observer agreement in the mobility assessment of the upper thoracic costovertebral joints
Published in Physiotherapy Theory and Practice, 2023
Michael Cibulka, Justin Buck, Bria Busta, Erika Neil, Drake Smith, Reece Triller
Each costo-vertebral articulation in the thoracic spine consists of two left and right synovial joints (i.e. costovertebral and costotransverse) that connect the head of each rib to the thoracic transverse process and the vertebral body. Although the costovertebral and costotransverse joints are two separate joints they move together, movement of one joint cannot occur without movement at the other joint (Fruth, 2006). The costovertebral joints are innervated with nociceptors capable of sending pain through the lateral branch of the thoracic dorsal rami (Bogduk, 2002; Erwin, Jackson, and Homonko, 2000). Pain originating from these joints is well-localized, unilateral, and level specific creating pain just slightly lateral to the spinous process (Saker et al., 2016; Young, Gill, Wainner, and Flynn, 2008). Assessing the mobility of the costovertebral joints is important when differentiating the source of a person’s upper thoracic pain, lower cervical pain, thoracic outlet syndrome, and planning a physical therapy intervention (Fruth, 2006; Hooper et al., 2010; Kuwayama, Lund, Brantigan, and Glebova, 2017).
Influence of morphology and material properties on the range of motion of the costovertebral joint – a probabilistic finite element analysis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2018
Benedikt Schlager, Frank Niemeyer, Christian Liebsch, Fabio Galbusera, Julius Boettinger, Daniel Vogele, Hans-Joachim Wilke
The rib cage plays an important role in human trunk biomechanics, such as respiration (Agostoni et al. 1967; Wilson et al. 1987; Cappello and De Troyer 2004), protection and support of the viscera, as well as in the stabilization of the spine (Andriacchi et al. 1974; Oda et al. 1996; Brasiliense et al. 2011; Liebsch et al. 2016, 2017). The main mechanical links between the rib cage and the thoracic spine are the costovertebral joints (CVJ), which provide an articular connection between a rib and its adjacent vertebrae. In consideration of the functions of the ribcage, the costovertebral joint provides a stable link between a rib and the adjacent vertebra with the ability to transmit high loads to the spine, while at the same time offering enough flexibility for respiration.
Related Knowledge Centers
- Thoracic Vertebrae
- Vertebra
- Vertebral Column
- Articulation of Head of Rib
- Rib
- Costotransverse Joint