B1. Thoracic Disease Flashcards
Is visceral pain referral made worse by coughing or deep respiration?
No
About 1 in ___ will have an episode of shingles in their lifetime.
4
What is the shingles prodrome?
Itching or tingling pain in the area 1-5 days prior to blisters developing
How long does it take for the shingles rash to completely heal?
2-4 weeks
When is shingles no longer contagious?
After the last blister is scabbed over
What is postherpetic neuralgia?
A complication of shingles in which nerves are damaged and can cause pain even after the rash has resolved.
What are two preventions that can decrease the risk of developing post herpetic neuralgia?
Acyclovir within 72 hours of onset
Vaccination
Patients who are what age and above are at an increased risk of developing post herpetic neuralgia and therefore should get a vaccine?
50+
1 in how many women will develop breast cancer?
1 in9
What percentage of breast cancer survivors will develop metastasis?
50%
Of the breast cancers that metastasize, what percentage will go to the bone?
40-60%
What is the survival rate for breast cancer?
> 60%
What percentage of breast cancer deaths are due to recurrence?
25%
What are some major risk factors for developing a hematoma (epidural or subdural) that affects the thoracic spine as an SOL?
- over 50
- taking anticoagulants
- bleeding disorders
- recent epidural injections or instrumentation
What is the ancillary study of choice for diagnosing a hematoma in the thoracic spine?
MRI
Disease that causes progressive structural thoracic or thoracolumbar
hyperkyphosis (>45 degree) characterized by calcification of vertebral epiphyses, notching of vertebral end plates and wedging of vertebral bodies
Scheuermann’s disease
What is the typical onset of Scheuermann’s disease?
Puberty (13-17 years)
Who more commonly gets scheuermann’s disease?
Males>females around puberty
What are the percentages of scheuermann’s in thoracic and thoracolumbar regions?
75% thoracic, 25% thoracolumbar
How common is Scheuermann’s disease?
4-8.3% of population is affected
What percentage of Scheuermann’s patients also have an associated scoliosis?
30-40%
What is the Heuter-Volkmann principle?
One of the etiologic theories for Scheuermann’s disease in which an increased axial load compression affects epiphyseal plate and inhibits growth, while decreased pressure accelerates growth
Under what conditions should non-surgical treatment of Scheuerman’s be considered?
If the curvature is >40 but <65 degrees and there is > 1 year of spinal growth remaining
what are some non surgical treatment options for scheuermann’s disease?
- bracing/casting
- CMT to promote extension
- postural training
- home care to enhance extension and core strength
- limit weight bearing and contact sports
- assess nutritional status
- stretch tight hamstrings
- reduce myospams
Where is the most common location for a compression fracture and where does it refer pain too?
TLJ and iliac crest, groin, and greater trochanter
What are the 3 common scenarios for patient presenting with compression fracture?
- trauma, sudden pain and audible snapping
- non-traumatic LBP in patient over 70 could be spontaneous compression fracture
- low or moderate load trauma in patient over 50, especially post menopausal
What effect does corticosteroids have on bone?
Rapid bone loss in the first 6 months (10-20% ), especially in hip, spine and forearm
Corticosteroids are often prescribed for what conditions?
- asthma
- IBS
- MS
- RA
- other CT diseases
How are compression fractures of the spine affected by activity?
- aggravated by standing or walking
- relieved by rest or lying down
What is paralytic ileum and when does it occur?
A temporary stoppage of intestinal peristalsis for 2-3 days (acute phase) following a compression fracture.
What are some findings on physical exam for a compression fracture?
- painful and limited AROM, especially in flexion
- muscles guarding and splinting
- sharp lingering pain with percussion
- Neuro abnormalities possible if there is NR or cord involvement
- need to rule out underlying cause of pathological fracture (MM or metastatic cancer, hyperparathyroid)
When should joint plays and orthopedic tests be performed if a compression fracture is suspected?
Although most compression fractures are stable and will heal on their own, joint plays and orthopedic tests should not be performed until after radiographs have been obtained
If an acute compression fracture is seen on radiograph, what is your next step?
Refer to orthopedist for medicolegal reasons, although management is primarily conservative
according to McNab, what is the % collapse cut off point for a surgical compression fracture?
50% collapse is considered surgical and under responds to conservative care
What is the surgical intervention for compression fractures?
MIFR - minimally invasive fracture reduction
What is the management plan for a compression fracture during the acute phase?
- restrict food intake for 2-3 days
- reduce inflammation
- control pain
- reduce myospasms (unless helping to stabilize)
- rest
When a patient is instructed to rest during the acute phase management of a compression fracture, what are their typical instructions?
- no weight bearing for 2 weeks
- another month of conservative treatment
- no lifting for 3 months
How long does it take a compression fracture to consolidate?
90 days
At what point should a compression fracture be re-Xrayed?
3 months
What is the most common metabolic disorder?
Osteoporosis
What is osteoporosis?
A reduction in bone mass per unit volume to a level below what is required for normal mechanical support and function. Both cortical thickness and #/size of trabeculae is lost
If you suspect your patient is at risk of osteoporosis, what test should you order?
- densitometry (DXA or DEXA) or quantitative computerized tomography (QCT)
NOTE: radiographic assessment is not recommended as a screen
What are radiographs not recommended for screening for osteoporosis?
X-rays will not detect bone loss until it has reached 30-50%
What is a T-score?
Score that is based on how many standard deviations the patient is away from average, healthy bone density
Normal > -1
Osteopenia < -1 and > -2.5
Osteoporosis < -2.5 (w/o fracture)
Established osteoporosis < -2.5 (w/ fracture)
What are the management goals and interventions for patients with established osteoporosis?
- manage predisposing medical conditions (meds, hormone therapy, etc.)
- reduce fall risk (vision, home safety, supportive shoes, etc.)
- optimize strength, balance and flexibility
- improve nutrition
What is the affect of Vitamin D and calcium supplementation in osteoporosis?
there was no significant
association of calcium or vitamin D with risk of hip fracture compared with placebo or no
treatment.
What exercises should be given to a scheuermann’s patient?
Ones that promote extension this can either be through distraction or traction exercises
What is the biggest clue a patient is having visceral pain referral?
NMS exam is relatively normal
- usually associated with chest or abdominal pain
- usually will have other symptoms of involved organ
What is the referral pattern for the esophagus?
Between the shoulder blades, narrowly
What is the referral pattern for the heart?
Between the shoulder blades, wide,
Left shoulder, below the xiphoid process
What is the referral pattern for the gallbladder?
Under the right scapula, can expand to the armpit or the top of the shoulder
What is the referral pattern for the pancreas?
TL junction across the entire flank area
What is the referral pattern for the stomach?
Wide across the mid back, more on the left, around T7-T9
