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Movement of the Thoracic Cage During Movements of the Thoracic Spine

Movement of the Thoracic Cage During Movements of the Thoracic Spine


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Just for a bit of context: I am trying to create a 3D digital model of the human skeleton as the first step towards computer generated muscle simulation, and as such I want the skeleton to be as anatomically and biomechanically correct as possible. However, I am currently struggling with the movement of the ribcage. I am quite capable in the 3D side of things, but without any medical background I've essentially had to learn everything about the skeleton so far from the ground up.

Whilst there is plenty of information on the internet about the movement of the ribs and sternum during inspiration and expiration, I haven't been able to find any detailed descriptions/diagrams/animations of how the various movements of the thoracic spine (lateral flexion, sagittal flexion and extension, and axial rotation) influence the positioning of the ribs, including in scientific papers (however I can't see that this topic hasn't come up before?).

The only thing I've found for this are three diagrams from this website http://body-disease.com/movements-in-the-thoracic-region/ (bottom right hand corner in each case):

Whilst these diagrams are definitely helpful in showing the general movements and shape, they don't really have the detail that I am looking for: for example the movement of the sternum isn't specified or the exact movements of the ribs and costal cartilage. These diagrams are a good starting point but I can't really work with them - as really I need to understand the four movements of each rib (torsion, calliper, bucket handle and pump handle) where they connect to the thoracic spine in order to create an accurate 3D model.

I would most like an accurate diagram or (even better) an animation of the spine movements with a complete rib cage; however X-ray images, sketches or anything that might provide more information would be useful. Descriptions are also great but as I'm not very experienced with anatomy I may not be able to glean as much information from text as I would from images. Essentially I am not trying to understand the concept of how the rib cage changes, but the specifics of this complex movement.

I know this might be quite a specialist topic (especially given the lack of online information) however I thought I would ask anyway in case anyone knew. Thanks for any information you can give me!

(Also let me know if I've made an error - this is my first forum question)

Edit: after some more digging I've found this image (from http://www.orthotech.ethz.ch/research/musculoskeletal-biomechanics/sarcopenia--implications-of-age-related-muscle-loss-for-spinal-p.html) showing thoracic flexion and extension, which may help in understanding the sorts of thing I'm after. the issue with this image is the fact that the movement of the sternum and costal cartilage is still very unclear:


Biomechanics Test 3 - Spine

b. The physical properties of the annulus fibrosus enable it to stabilize theadjacent vertebral bodies but at the same time allow the annulus to deform so that the bodies can move in multiple direction. As the annulus deforms during movements of the vertebral bodies, the proteoglycans and collagen will limit the amount of annulus deformation and thus limit the movements of the vertebral bodies.

c. The spherical configuration of the nucleus pulposus, which is maintained by the annulus fibrosus, acts as a pivot point about which the adjacent vertebral bodies can tilt or rock in multiple directions. The direction of tilting is guided by the angulation of the facets and the extent of motion restricted by the physical properties of the annulus.

d. The cruciform ligament has 3 components. The transverse ligament of the atlas forms a sling around the dens to hold it in proper alignment at the median atlanto-axial joint so that the atlas and head can pivot smoothly about the dens. Upward or downward slippage of this sling is controlled by the superior and inferior longitudinal ligaments of the cruciform. Slack of these ligaments would lead to wobbling of the dens and uneven motion at the lateral atlanto-axial joints. This type of motion could affect the degree of rotation and accelerates joint wear. Further, slack of the cruciform may allow the dens to move posteriorly, decreasing the size of the spinal canal and potentially compress the spinal cord. Tightness of the cruciform may limit rotation by increasing compression forces at the median atlanto-axial joint.

e. The alar ligaments, like the cruciform are important in holding the dens in proper alignment and limiting any posterior movements of the dens toward the spinal canal. The alar ligaments also restrict rotation of the atlas and head about the dens. Slack of the alar ligaments may allow the dens to move posteriorly and increase the tension on the cruciform. This tension may in time stretch the cruciform and allow the dens to decrease the spinal canal and potentially compress the spinal cord. Tightness of the alar ligaments would tend to restrict rotation of the atlas and head.

f. The anterior longitudinal ligament lie on the anterior surface of the spine and will limit extension of the spine. Slack in this ligament can allow vertebral bodies to slide anteriorly on each other. This slippage is most often seen in the lower lumbar spine and can be associated with fractures of the pars articularis. Anterior slippage of one vertebrae on another will decrease the size of the intervertebral foramen and increase compression of the facets. The increase in facet joint compression can limit movement in all three planes.

g. The ligamentum flavum is an elastic ligament that stretches with flexion and recoils with extension. Streching of this ligament during flexion may control the rate of facet motion. An imbalance in the elastic properties between a paired set of ligaments may result in the facet on one side moving more rapidly then the other and segmental obstruction occurring during flexion. The recoil of this ligament assists in the re-positioning of the facets. Because it attaches to the joint capsule, the ligamentum flavum also prevents the facet capsule from being pinched between the facets as the capsule slackens during extension. Tightness of the falvum would restrict spinal flexion. Slackening of the ligamentum flavum could result in abnormal segmental movement, pinching of the facet capsule between the facets and a bulging of the slackened ligamentum flavum into the spinal canal. This bulging is known to occur in the cervical spine during extension and can result in compression of the spinal cord.

h. The supraspinous ligament becomes tight with flexion and slack with extension. Its tightness during flexion limits flexion but its slackness during extension allow extension.


Applied Anatomy

The costovertebral joints are synovial plane joints located between the ribs and the vertebral bodies (Figure 8-2). There are 24 of these joints, and they are divided into two parts. Ribs 1, 10, 11, and 12 articulate with a single vertebra. The other articulations have no intra-articular ligament that divides the joint into two parts, so each of ribs 2 through 9 articulates with two adjacent vertebrae and the intervening intervertebral disc. The main ligament of the costovertebral joint is the radiate ligament, which joins the anterior aspect of the head of the rib radiating to the sides of the vertebral bodies and disc in between. For ribs 10, 11, and 12, it attaches only to the adjacent vertebral body. The intra-articular ligament divides the joint and attaches to the disc.

The costotransverse joints are synovial joints found between the ribs and the transverse processes of the vertebra of the same level for ribs 1 through 10 (see Figure 8-2). Because ribs 11 and 12 do not articulate with the transverse processes, this joint does not exist for these two levels. The costotransverse joints are supported by three ligaments. The superior costotransverse ligament runs from the lower border of the transverse process above to the upper border of the rib and its neck. The costotransverse ligament runs between the neck of the rib and the transverse process at the same level. The lateral costotransverse ligament runs from the tip of the transverse process to the adjacent rib.

The costochondral joints lie between the ribs and the costal cartilage (Figure 8-3). The sternocostal joints are found between the costal cartilage and the sternum. Joints 2 through 6 are synovial, whereas the first costal cartilage is united with the sternum by a synchondrosis. Where a rib articulates with an adjacent rib or costal cartilage (ribs 5 through 9), a synovial interchondral joint exists.

As in the cervical and lumbar spines, the two apophyseal or facet joints make up the main tri-joint complex along with the disc between the vertebrae. The superior facet of the T1 vertebra is similar to a facet of the cervical spine. Because of this, T1 is classified as a transitional vertebra. The superior facet faces up and back the inferior facet faces down and forward. The T2 to T11 superior facets face up, back, and slightly laterally the inferior facets face down, forward, and slightly medially (Figure 8-4). This shape enables slight rotation in the thoracic spine. Thoracic vertebrae T11 and T12 are classified as transitional, and the facets of these vertebrae become positioned in a way similar to those of the lumbar facets. The superior facets of these two vertebrae face up, back, and more medially the inferior facets face forward and slightly laterally. The ligaments between the vertebral bodies include the ligamentum flavum, the anterior and posterior longitudinal ligaments, the interspinous and supraspinous ligaments, and the intertransverse ligament. These ligaments are found in the cervical, thoracic, and lumbar spine. The close packed position of the facet joints in the thoracic spine is extension.

Facet Joints of the Thoracic Spine

Resting position: Midway between flexion and extension
Close packed position: Full extension
Capsular pattern: Side flexion and rotation equally limited, extension

Within the thoracic spine, there are 12 vertebrae, which diminish in size from T1 to T3 and then increase progressively in size to T12. These vertebrae are distinctive in having facets on the body and transverse processes for articulation with the ribs. The spinous processes of these vertebrae face obliquely downward (Figure 8-5 ). T7 has the greatest spinous process angulation, whereas the upper three thoracic vertebrae have spinous processes that project directly posteriorly. In other words, the spinous process of these vertebrae is on the same plane as the transverse processes of the same vertebrae.

T4 to T6 vertebrae have spinous processes that project downward slightly. In this case, the tips of the spinous processes are on a plane halfway between their own transverse processes and the transverse processes of the vertebrae below. For T7, T8, and T9 vertebrae, the spinous processes project downward, the tip of the spinous processes being on a plane of the transverse processes of the vertebrae below. For the T10 spinous process, the arrangement is similar to that of the T9 spinous process (i.e., the spinous process is level with the transverse process of the vertebra below). For T11, the arrangement is similar to that of T6 (i.e., the spinous process is halfway between the two transverse processes of the vertebra), and T12 is similar to T3 (i.e., the spinous process is level with the transverse process of the same vertebra). The location of the spinous processes becomes important if the examiner wishes to perform posteroanterior central vertebral pressures (PACVPs). For example, if the examiner pushes on the spinous process of T8, the body of T9 also moves. In fact, the vertebral body of T8 probably arcs backwards slightly, whereas T9 will move in an anterior direction. T7 is sometimes classified as a transitional vertebra, because it is the point at which the lower limb axial rotation alternates with the upper limb axial rotation (Figure 8-6).

The ribs, which help to stiffen the thoracic spine, articulate with the demifacets on vertebrae T2 to T9. For T1 and T10, there is a whole facet for ribs 1 and 10, respectively. The first rib articulates with T1 only, the second rib articulates with T1 and T2, the third rib articulates with T2 and T3, and so on. Ribs 1 through 7 articulate with the sternum directly and are classified as true ribs (see Figure 8-3). Ribs 8 through 10 join directly with the costocartilage of the rib above and are classified as false ribs. Ribs 11 and 12 are classified as floating ribs, because they do not attach to either the sternum or the costal cartilage at their distal ends. Ribs 11 and 12 articulate only with the bodies of the T11 and T12 vertebrae, not with the transverse processes of the vertebrae, nor with the costocartilage of the rib above. The ribs are held by ligaments to the body of the vertebra and to the transverse processes of the same vertebrae. Some of these ligaments also bind the rib to the vertebra above.

At the top of the rib cage, the ribs are relatively horizontal. As the rib cage descends, they run more and more obliquely downward. By the 12th rib, the ribs are more vertical than horizontal. With inspiration, the ribs are pulled up and forward this increases the anteroposterior diameter of the ribs. The first six ribs increase the anteroposterior dimension of the chest, mainly by rotating around their long axes. Rotation downward of the rib neck is associated with depression, whereas rotation upward of the same portion is associated with elevation. These movements are known as a pump handle action and are accompanied by elevation of the manubrium sternum upward and forward (Figure 8-7, A). 1–3 Ribs 7 through 10 mainly increase in lateral, or transverse, dimension. To accomplish this, the ribs move upward, backward, and medially to increase the infrasternal angle, or they move downward, forward, and laterally to decrease the angle. These movements are known as a bucket handle action. This action is also performed by ribs 2 through 6 but to a much lesser degree (Figure 8-7, B). The lower ribs (ribs 8 through 12) move laterally, in what is known as a caliper action, to increase lateral diameter (Figure 8-7, C). 2 The ribs are quite elastic in children, but they become increasingly brittle with age. In the anterior half of the chest, the ribs are subcutaneous in the posterior half, they are covered by muscles.


1. INTRODUCTION

The influence of the rib cage, such as the thoracic spine and ribs, on glenohumeral mobility and the development of shoulder disorders are interesting clinical and biomechanical topics. However, neither thoracic spine and ribs movement during elevation of the upper limbs nor the mobility changes with the influence of ageing and gender have been adequately investigated in the clinical practice. The biomechanical properties of the human ribs and thoracic spine during arm elevation are also largely unknown, since many studies have mainly focused on movements of the glenohumeral and the scapulothoracic joints.

Humeral, scapular, and thoracic segments demonstrate synchronous interactions during arm elevation [ 1 ]. When healthy individuals elevate their arms, the humeral head is rotated externally, and the scapula is elevated, rotated upwardly and internally, and tilted posteriorly, adjusting the positional relationship between the humeral head and the glenoid cavity [ 2 , 3 ]. The upper thoracic spine shows extension, side flexion, and axial rotation during unilateral arm elevation, however during bilateral arm elevation in the sagittal plane produces thoracic extension but no axial rotation and side flexion [ 1 , 4 ].

Flexibility decay of the trunk and shoulder joint accelerates over middle age in both males and females [ 5 ]. A scapular restriction of depression, downward rotation, and posterior tilt was described in comparison between healthy individuals in their 20s and in their 50s, and which may be a critical cause of frozen shoulder [ 6 ]. A disturbance of scapular motion that generates stress under the acromion and malalignment in the glenohumeral joint leads to shoulder disorders [ 7 , 8 ]. Thus, regression of scapular and thoracic spine movement leads to decreased shoulder joint motion, and consequently results in shoulder disorders such as impingement syndrome, frozen shoulder, and degenerative rotator cuff tears.

Analysis of ribs movement has not been sufficiently conducted due to the anatomic characteristics of the rib cage and the complexity of the rib movement, which includes the sternum and the 24 ribs consisting of the rib bone and costal cartilage. If we are able to investigate the amount of movement in each rib or the level of thoracic spine movement during arm elevation, the kinematic properties for shoulder disorders could be interpreted further. The purposes of this study were to evaluate the elevation of each rib and the extension of the thoracic vertebrae during bilateral arm elevation in healthy individuals and to clarify the characteristics with the differences of age and gender.


Thoracic and Lumbar Spine Trauma

Kern Singh , . Alexander R. Vaccaro , in Core Knowledge in Orthopaedics: Spine , 2005

The thoracic spinal cord is protected from injury by the surrounding paraspinal musculature, the vertebral elements, and the thoracic rib cage.

The thoracolumbar junction is a transitional region between the less mobile thoracic spine and the more flexible lumbar spine.

Decreasing the spinal canal diameter to spinal cord ratio, particularly between T2 and T10, makes this region more susceptible to spinal cord injury.

Physiologic kyphosis of the thoracic spine may predispose it to flexion-axial load–type injuries.

Spinal injuries in this region are associated with a high incidence of neurological injury.

Thoracic vertebral bodies are not as large as the lumbar vertebral bodies thus, they are less able to resist deformity following specific load applications.


Discussion

This study is the first follow-up of thoracic mobility in previously treated patients with early onset idiopathic scoliosis. The main finding is that both brace-treated and surgically treated patients showed significantly reduced thorax expansion and respiratory movements at a mean of 26.5 years after completed treatment. Our aim was to explore these findings in relation to the pulmonary function, which were previously presented (https://doi.org/10.1016/j.jspd.2015.07.007).

Thoracic mobility

The range of motion of the thoracic spine was measured with a Debrunner Kyphometer and, as expected, the ST group had significantly reduced values compared with the BT group as a result of several fused vertebrae, as in previous studies of adolescent idiopathic scoliosis [5]. The ability for the chest cage to expand the thorax was significantly reduced by 14–19 mm in both groups, compared with the reference values. Two other studies have previously, with other methods, evaluated rib-cage movements in patients with idiopathic scoliosis and found them to be reduced [32, 33]. As information about onset of scoliosis or treatment is lacking in those studies, comparisons are troublesome. The clinical value of the reduction, being less than 20 mm, needs to be established before a proper evaluation on pulmonary function can be made.

Maximal breathing movements during deep breathing were measured with RMMI, and the patients had approximately 10 mm less movement compared with the reference values [27]. No previous studies on individuals with scoliosis exist for comparison. The reduction is likely to be considered small, in relation to the total anteroposterior diameter, and the clinical significance needs to be evaluated with further studies.

Respiratory muscle strength

The possibility for later evaluation of respiratory muscle strength led us to add this examination in a subgroup of 33 patients, as this component is considered to be of high importance for respiration. This subgroup was similar in terms of curve size and ever-smokers.

The surgically treated patients in this subgroup had significantly less muscle strength compared with the reference group, whereas the braced patients had not. In addition, the moderate correlations between respiratory muscle strength and pulmonary variables were found. Muscle strength and function are closely associated with one another and decreased thoracic mobility was found in the scoliotic patients. Whether these findings are results of the scoliotic rib-cage deformity itself or a stiffer spine after surgery or a prolonged brace treatment is unknown. This study evaluates late additive results of both deformity and the treatment of the deformity, and was not designed to evaluate these issues separately.

Respiratory muscle strength has previously been tested in patients with chronic obstructive pulmonary disease [34], cystic fibrosis [35], and ankylosing spondylitis [36] and found to have different levels of associations. In the latter study [36], they found correlations between thorax expansion and MIP and MEP, similar to our findings.

From our results, it is not possible to evaluate whether the diaphragmatic motion is affected, because we have not evaluated its function. Kotani et al. [33], who also found restricted rib-cage movements in patients with idiopathic scoliosis, reported that the diaphragmatic motion was normal. This is contradictory to Chu et al. [37], who found that diaphragmatic heights significantly reduced in patients with severe idiopathic scoliosis when measured by dynamic magnetic resonance imaging.

Correlations between results

The ability for thorax expansion and the respiratory muscle strength correlated (moderately) with the pulmonary function (TLC, FVC, and FEV1), whereas the breathing movements (RMMI) did not show any correlations of significance. Hagman et al. [38] found a strong correlation between measured breathing movements and breathing volumes. They did their measurements, with RMMI and a dynamic spirometer, simultaneously in three different body positions—supine, sitting on a chair, and standing with the back against a wall. In our study, the supine position was used for the breathing movements with RMMI because of the need of a stable position for the measurement of the anteroposterior movements and the fact that the reference values were collected in the supine position [27]. Both the spirometry and the respiratory muscle strength were measured in the sitting position, whereas the expansion of the thorax during breathing was measured in an upright standing position because of the testing position of this reference group [13]. These different body positions during the tests might be an explanation for the lack of correlation.

Further comments on pulmonary function tests and smoking habits

The ventilatory capacity of the patients in this study was evaluated by use of spirometry, with data on FVC and FEV1 as well as by use of body plethysmograph measuring TLC. The pulmonary function tests are presented as percentage predicted values. These are mean values for the normal population adjusted for height, age, and gender, and therefore, normal individual predicted values range from 80 to 120% [25]. The main deterioration of pulmonary function due to scoliosis and its treatment is restrictive ventilation. TLC is the key measurement to evaluate restrictive disorders of ventilation and was, therefore, chosen as the main outcome of the pulmonary function in this study.

The multivariate linear regression model, aimed to explain the TLC percentage predicted, included five variables, of which two belong to the time of the treatment (curve size and type of brace), two to demographics (gender and smoking), and one to the time of the current follow-up (lower thorax expansion). Their level of explanation was an R-squared value of 0.619. Gender, brace model, smoking habits, thorax expansion (xiphoideus), and curve size at start of treatment were strongly associated with TLC percentage predicted.

The impact of gender in lung volumes is well-known, as men in general have larger lung volumes than women. Despite our analyses using the percentage of predicted values, constructed to eliminate the gender difference, the male gender has an association with lower TLC in this study. That the type of brace was of importance can be explained by the use of the stiffer Milwaukee brace compared with the less rigid Boston brace, which is still in use. With more modern braces in use, for instance, the night braces worn for less time, these negative effects might be reduced in the future.

Smoking has a strong association to TLC percentage predicted values, where “ever-smokers” have higher values (96% of predicted) than never-smokers (86% of predicted). This finding presents a possible difficulty in evaluating the effect on the decrease of TLC related to treatment for scoliosis. The higher values in smokers is most probably due to the development of emphysema, which also has been reported to increase TLC in apparently healthy smokers [39]. As the proportion of smokers does not differ between the surgically or brace-treated groups, our interpretation is that smoking does not influence the effect of various treatments for scoliosis, where increasing curve size or decreasing thoracic expansion is related to a low TLC, as a matter of restrictive pulmonary function. Emphysema adds an obstructive component to any restrictive consequence of scoliosis therefore, avoiding or quitting smoking is a very important advice for patients treated for scoliosis.

Strength and limitations of the study

One advantage of this study is the long follow-up time of a group of 106 patients with early onset scoliosis. The original group of 179 patients is considered a consecutive series of which finally 59% participated. Another advantage is that we have analyzed the mobility of the thoracic cage and its relation to the total lung capacity, which has previously not been studied. A limitation of the study is that we did not compare the results to matched control subjects. To compensate, we used reference values consisting of corresponding groups of healthy individuals of similar age and gender. Another limitation is that the number of patients in the subgroup having measured MIP and MEP is small. However, both brace-treated and surgically treated were evaluated together.


Why does t-spine mobility matter?

Regional Interdependence

Every area of your body has a specific role to play during movement. If one region fails to do its job then it could affect other areas and have significant consequences. This complex interplay is called regional interdependence. Here are a few examples of how the thoracic spine affects other regions of the body.

Overhead pressing

In overhead pressing movements thoracic extension allows the shoulder blade to tip back, or posterior tilt. The shoulder blade (scapula) moves in very intricate ways and in all planes of motion. It is connected to the torso by several muscles and dysfunction in one of them is enough to send the system into disarray.

The position of the t-spine will affect how those muscles engage and support the shoulder blades.

When the t-spine is tight a common compensation during pressing is to lean back at the lumbar spine, this decreases core stability and leads to compression, pain, and injury.

If the shoulder blade can’t tip back it may also force the shoulder joint to compensate for the lost movement. This can lead to shoulder injuries like impingement and tendinitis.

Rotation

In the case of rotation movements and exercises, the thoracic spine and hips should rotate but if one or both is unable then the low back and shoulders will often have to pick up the slack.

This is especially apparent in sports with large rotational components like baseball and golf. You lose power in your swing if all the necessary parts aren’t playing nice together.

You may even notice problems in some everyday rotation tasks like reaching across your body to grab your seatbelt. If your t-spine isn’t mobile then your shoulder will attempt to make up for it, potentially leading to one of those embarrassing injuries that you hate to admit happened.

Breathing

Thoracic mobility can affect how efficient your breathing mechanics are. The diaphragm should be the primary muscle involved during inhalation but many of us end up using muscles in the chest, neck, and spine instead. This results in thoracic mobility limitations.

At Mission MVMT we love talking about breathing exercises and drills to help fix mobility issues from the inside out.


Thoracic Spine Pain Definition

Let's start with a reliable definition of thoracic spine pain which necessarily includes a reliable definition of the thoracic region.  

Thoracic spine pain is defined as pain in the back that is located between your first thoracic vertebra and your 12th thoracic vertebra.

Your first thoracic vertebra represents the place where your neck ends and your rib cage area begins.   It is located approximately at the level of your shoulders (or just a little above). Your 12th thoracic vertebra corresponds to the bottom of your rib cage.

There are 12 rib pairs in all, and in back, each attaches to one spinal bone. So T1, which is your first thoracic vertebra, provides a place of articulation for the first ribs T2 provides a place of articulation for the second ribs, and so on down the line.

The lowest or last ribs connect to T12, which is also the last bone in the thoracic spine. The bone below T12 is L1, or your first lumbar (low back) vertebra. Because the thoracic region is large, it is often divided into upper and lower areas for diagnosis and communication purposes.  


Selective Functional Movement Assessment

The selective functional movement assessment for functional movement screens is relatively straightforward . For each pattern, there’s a certain criterion that your clients must meet to accomplish a high score.

The scores are broken down into four basic criteria . These criteria include:

Three

During the screen, you’ll give your client a three if they can perform the movement. However, they must do so without any compensation according to the guidelines of the screen.

In some cases, your client might perform the movement. However, they may do so with poor mechanics and compensatory patterns to accomplish the task. In that case, you’ll give the client a two for that screen.

In some cases, you may find that a client cannot perform a movement pattern. Even with compensations, they cannot perform the task correctly. In this instance, you’ll give your client a score of one.

Finally, your client may have pain during a screen. If your client experiences pain during any part of a movement, you’ll grade them with a zero.zzzzzxczxc


Thoracic Spinal Cord Injury Prognosis and Recovery

Prognosis and recovery from a thoracic spinal cord injury may differ from patient to patient. The difference is due to the type of injury and the level of severity.

A patient&rsquos health is also a factor in determining the level of independence achieved after an injury. This includes body type, existing medical conditions and other injuries that may have occurred at the time of the spinal cord injury.

Patients with a thoracic spinal cord injury may be able to do the following:

  • Have normal arm, hand and upper-body movement
  • Use a manual wheelchair
  • Learn to drive a modified car
  • Stand in a standing frame or walk with braces



Comments:

  1. Ghislain

    Unsubscribe !!!!

  2. Raydon

    the logical question

  3. Wulfcot

    Your notes helped me a lot.



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