4 Thoracic Conditions Flashcards
How does Osteoporosis affect the T spine?
- 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
What causes mid thoracic fusion?
- Result from diffuse idiopathic spondylitic hyperostosis (DISH)
- Ankyosing spondylitis
Ant
Describe normal thoracic aging and hypomobility
- Very common
- sudden onset of symptoms
- Severe at times
- Aggrivated by movements
- Breathing
- coughing
- sneezing
What is the pain description of the costotransverse joint?
- 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
What happens during traumatic thoracic injuries?
- more commonly injuried from flexion or axial compression than other discs
- Most severe (burst fx, wedge compression, bone bruising, endplate fx)
What happens in traumatic thoracic extensiom injuries?
Causes more injury with thoracic facet almost as common as cervical facet injuries
Describe Cervical and upper T spine injuries following MVC
- 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
MVC T1-2 fracture dislocation description?
upper thoracic resemble loewr cervical injuries
Avulsion of annulus fibrosis anteriorly
What are flexion-compression truma anterior elements?
- end plate fracture
- bone bruising (trabecular fx)
- wedge compression fc
- burst fc
- disc distruption
Describe the age related changes in the T spine and its affect with injury
- 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
Which segments of the T spine have the highest risk levels for compression fx’s?
- T11
- T12 (47% of bw)
- L1
What is kyphoplasty procedure?
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
Describe some potential reasons for thoracic disc lesions
- 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
which areas are most affected by thoracic disc lesions?
- Lower T spine
- Thoracolumbar junction
- Common on Convex side of scoliosis or kyphosis
- asymmetrical loading
Describe thoracic disc lesions
- “blobs and patches”
- somewhat segmental
- unilateral
- deep ache
- cough, sneeze, deep breath
- Dural influence -> sinuvertebral nerve = posterior pain
What is thoracic radiculopathy?
Nerve root compression/pressure (numbness, weakness, NOT pain)
Mechanical: local discomfort with numbness and paresthesia
Chemical: sever pain Distal > Proximal (anterior /sternum > Back)
What is the cause of thoracic radiculopathy?
- Disc lesions
- Facet injury or swelling
- Osteophytes (aging)
- Scarring
What can also stimulate thoracic nerve root symptoms? What are common referal symptoms for the Upper thoracic spine and Spinal dura?
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
Where is T1-3 and T4-7 Refferal patters for radiculopathy?
- 1-3 Arm pit, lateral side of forearm
- 4-7 Ribcage
What is facet joint dysfunction?
- 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
How is pain described in Ligamentous areas of the thoracic spine?
- 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
Describe the findings of a ribcage fx
- 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
What is Trapezius Microcirculation?
Occur with MVA/WAD
- attributed to continuous flow of afferent impulses from the sensory nerve endings resulting in an interference with vasodilation chemicals
What are responses to trigger point injuries?
- taught band
- twitch response
- reffered pain
Describe T4 Syndrome
- 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
What are cervical uncovertebral joint symptoms?
Very little pain - Vague discomfort
Stiffness > pain
No referred or neurological symtoms
AM stiffness
Unilateral
How does the posterior primary rami play a factor in pain?
- 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
What are common non-mechanical aggravating signs for thoracic spine and ribs?
- Non- movement (meal or medication related, night pain)
- Chest pain with no upper body movement/exertion (walking up stairs)
What are common mechanical aggravating factors for the T spine and ribs?
- Rotate trunk
- Deep inhale/exhale
- cough/sneeze
- lifting/straining/
- Neck or UE movements
- Prolonged posture
