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MSK III > 4 Thoracic Conditions > Flashcards

4 Thoracic Conditions Flashcards

1
Q

How does Osteoporosis affect the T spine?

A
  • VB loses bone trabeculae
    • leads to collapse of load bearing beams
    • Vertebral end plates collapse = end place concavity
    • Increased Kyphosis and loss of statue with aging
  • Affects post menopausal women and men a decade later
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2
Q

What causes mid thoracic fusion?

A
  • Result from diffuse idiopathic spondylitic hyperostosis (DISH)
  • Ankyosing spondylitis

Ant

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3
Q

Describe normal thoracic aging and hypomobility

A
  • Very common
  • sudden onset of symptoms
  • Severe at times
  • Aggrivated by movements
    • Breathing
    • coughing
    • sneezing
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4
Q

What is the pain description of the costotransverse joint?

A
  • Localized posterior slightly off midline towards one side
  • one side radiates a few inches
  • Chest wall pain is common
  • costrochondral region
  • LBP as a referral from T/L junction
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5
Q

What happens during traumatic thoracic injuries?

A
  • more commonly injuried from flexion or axial compression than other discs
  • Most severe (burst fx, wedge compression, bone bruising, endplate fx)
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6
Q

What happens in traumatic thoracic extensiom injuries?

A

Causes more injury with thoracic facet almost as common as cervical facet injuries

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7
Q

Describe Cervical and upper T spine injuries following MVC

A
  • Disc injuries predominate in C spine, Vertebral bodies in the thoracic spine
  • Facet injuries are common in both regions
  • T12 and L 1 = most frequently injuried segments
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8
Q

MVC T1-2 fracture dislocation description?

A

upper thoracic resemble loewr cervical injuries

Avulsion of annulus fibrosis anteriorly

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9
Q

What are flexion-compression truma anterior elements?

A
  • end plate fracture
  • bone bruising (trabecular fx)
  • wedge compression fc
  • burst fc
  • disc distruption
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10
Q

Describe the age related changes in the T spine and its affect with injury

A
  • Osteoporosis and compression fx
    • spine not capable of handling loads in OP and fx
    • decreased BMD and loss of height
  • Osteoporsis
    • more common in females (40%) vs males 13%
    • Vertebral body fracture twice as common as hip fracture
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11
Q

Which segments of the T spine have the highest risk levels for compression fx’s?

A
  • T11
  • T12 (47% of bw)
  • L1
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12
Q

What is kyphoplasty procedure?

A

puff bone first and injects cement to fuse fx and no change to shape

cannot correct deformity in spine (OP candidates)

  • pts with deformities from osteoporosis within 8weeks of fx

Disc height changes can lead to health problems

  • Chronic/severe pain
  • limited function and reduced mobility
  • loss of independance in daily activities
  • decreased lung capacity
  • Difficulty sleeping
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13
Q

Describe some potential reasons for thoracic disc lesions

A
  • Attachment of ribs to annulus fibers may be one reason for higher incidence
    • blow to rib affects or disrupts disc
  • Higher viscocity of IVD in T Spine
  • Asymmetrical loading assoiated with segmental motion
    • Flexion = more anterior loading
    • Extension = posterior loading
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14
Q

which areas are most affected by thoracic disc lesions?

A
  • Lower T spine
  • Thoracolumbar junction
  • Common on Convex side of scoliosis or kyphosis
    • asymmetrical loading
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15
Q

Describe thoracic disc lesions

A
  • “blobs and patches”
  • somewhat segmental
  • unilateral
  • deep ache
  • cough, sneeze, deep breath
  • Dural influence -> sinuvertebral nerve = posterior pain
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16
Q

What is thoracic radiculopathy?

A

Nerve root compression/pressure (numbness, weakness, NOT pain)

Mechanical: local discomfort with numbness and paresthesia

Chemical: sever pain Distal > Proximal (anterior /sternum > Back)

17
Q

What is the cause of thoracic radiculopathy?

A
  • Disc lesions
  • Facet injury or swelling
  • Osteophytes (aging)
  • Scarring
18
Q

What can also stimulate thoracic nerve root symptoms? What are common referal symptoms for the Upper thoracic spine and Spinal dura?

A

Chostochondritis (pain located anteriorly near the sternum)

Upper thoracic spine will refer symptoms into UE

Dura can produce vague symptoms up and down the spine

19
Q

Where is T1-3 and T4-7 Refferal patters for radiculopathy?

A
  • 1-3 Arm pit, lateral side of forearm
  • 4-7 Ribcage
20
Q

What is facet joint dysfunction?

A
  • Sharp localized pain unilaterally
  • Chronic stage: pain is dull and aching
  • Aggs: compression/closing in extension
  • Reffered to nerve root distribution but no neurological symptoms
  • Pain Proximally (back) > Distally (front)
  • Acute: coughing and sneezing
21
Q

How is pain described in Ligamentous areas of the thoracic spine?

A
  • Vague/ill defined
  • spread around the area
  • not producing symptoms distally nor producing neurological symptoms

ALL/PLL innervated by sinuvertebral nerves - cause pain down canal

22
Q

Describe the findings of a ribcage fx

A
  • very painful
  • tender to palpation
  • Acute injuries:
    • Hematoma may be present
    • Tap test with reflex hammer or vibration
    • Old chornic slow healing rib fx may become chronic source of discomfort
23
Q

What is Trapezius Microcirculation?

A

Occur with MVA/WAD

  • attributed to continuous flow of afferent impulses from the sensory nerve endings resulting in an interference with vasodilation chemicals
24
Q

What are responses to trigger point injuries?

A
  • taught band
  • twitch response
  • reffered pain
25
Q

Describe T4 Syndrome

A
  • Etiology unknown
  • May be autonomic syndrome or mechicanical problem involving facet joints
  • “glove syndome” - dull aching symptoms covering whole hand (w or w/o pins and needles)
  • Unilateral symptoms
26
Q

What are cervical uncovertebral joint symptoms?

A

Very little pain - Vague discomfort

Stiffness > pain

No referred or neurological symtoms

AM stiffness

Unilateral

27
Q

How does the posterior primary rami play a factor in pain?

A
  • could be source of spine referral
  • makes way through muscles of the back and innervates skin between the angles of the ribs
  • Can be pulled through muscles and become hot spots (mimic trigger points)

Use slumps and sliders to ease pain

28
Q

What are common non-mechanical aggravating signs for thoracic spine and ribs?

A
  • Non- movement (meal or medication related, night pain)
  • Chest pain with no upper body movement/exertion (walking up stairs)
29
Q

What are common mechanical aggravating factors for the T spine and ribs?

A
  • Rotate trunk
  • Deep inhale/exhale
  • cough/sneeze
  • lifting/straining/
  • Neck or UE movements
  • Prolonged posture

MSK III (13 decks)

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