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MSK Thoracic > Clinical Conditions > Flashcards

Clinical Conditions Flashcards

1
Q

osteoporosis

A

vertebral bodies, lose bone trabeculae

loss of transverse trabeculae lead to collapse of loadbearing beams

end plates collapse leads to end plate concavity

Increase kyphosis and loss of stature with aging

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2
Q

fused mid thoracic vertebrae

A

Results results from diffuse idiopathic spondylitic hyperostis DISH
Or ankylosing spondylitis

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3
Q

hypomobility

A

localized posterior slightly off the midline towards one side
Suggesting costotransverse joint

One side radiates slightly a few inches
Chest wall pain common
Costochondral region
Low back pain as a referral from the TL junction

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4
Q

Traumatic thoracic injuries

A

In flexion or axial compression vertebrae or more injured more often than the discs

In the upper thoracic spine extension causes more injury with thoracic facet injuries, almost as common as cervical facet injuries

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5
Q

traumatic injuries in order of severity, least to most

A

endplate fracture
bone bruise
Wedge compression
Burst fracture

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6
Q

disc injuries versus vertebral body injuries prevalence

A

Disc injuries predominate in cervical spine
vertebral body injuries predominate in thoracic spine

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7
Q

what are the most regularly injured segments?

A

T12 and L1

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8
Q

Flexion compression trauma

A

affect the anterior elements
end plate fracture
Bone bruising
Wedge compression fracture
Burst fracture
Disk disruption

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9
Q

highest level was for compression fractures

A

T 11
T12
L 1

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10
Q

kyphoplasty cannot correct

A

An established deformity of the spine and certain patients with osteoporosis are not candidates for the treatment

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11
Q

Who are likely candidates for kyphoplasty?

A

patient experiencing painful symptoms or spinal deformities from recent osteoporotic compression fractures

Within an eight weeks of the fracture

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12
Q

Changes in height and spinal alignment can lead to

A

chronic or severe pain
Limited function and reduce mobility
Loss of independence in daily activities
Decreased lung capacity
Difficulty sleeping

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13
Q

Greatest percentage of patients presenting with thoracic pain will

A

Have been involved in any trivial accident, such as a fall, someone bumping into the rib cage or prolonged loading

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14
Q

thoracic disc lesions

A

Attachment of ribs to annulus fibers may be one reason for higher incidence

Blow to rib may affect or disrupt the disc

other reasons
Higher viscosity of IVD
Asymmetrical loading-

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15
Q

most affected area for thoracic disc lesions

A

Lower thoracic spine
Thoracolumbar junction

common on convex side of a scoliosis or kyphosis
Due to asymmetrical loading

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16
Q

thoracic radiculopathy

A

mechanical pressure on a healthy nerve root results in numbness, weakness and paresthesia, not pain

local ischemia may occur for local discomfort

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17
Q

nerve root pain is either mechanical compression or chemical irritation

A

Mechanical- local discomfort with numbness and paresthesia

Chemical - severe pain distal is greater than proximal

may occur due to
Disc lesions
Facet injury or swelling
Osteophytes
Scarring

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18
Q

True nerve root pain, distal pain will be

A

Distal pain( anterior next to sternum) will be greater than proximal pain(back)

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19
Q

Costochondritis may closely simulate

A

Thoracic nerve roots symptoms because the pain is also located anteriorly at the sternum

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20
Q

upper thoracic spine will refer symptoms into

A

The upper extremities

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21
Q

facet joint injuries are common in

A

both regions
Cervical and thoracic spine

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22
Q

facet joint dysfunction

A

Usually produce localized sharp pain unilaterally

For chronic stage, it may be dull and achy

Pain more likely to be aggravated by compressing or closing down facet joints extension

Pain may be Referred into nerve root distribution, but no neurological symptoms

referred pain will be more intense proximally versus distally

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23
Q

ligamentous injuries

A

Pain in the thoracic spine can be from highly ligamentous reinforced joints

Small ligaments-sprain

Any force applied to the rib cage can affect ligaments

Ligaments stabilize and play important role in proprioception

24
Q

Pain from ligamentous structures

A

described as vague, ill defined
Spread around the area
Not producing symptoms, distillate, nor producing neurological symptoms

Both ALL and PLL innervated by sinovertebral nerve
will cause pain that spread up and down the spinal canal

25
Q

rib cage injuries

A

Breathing may increase pain
area very tender palpation

acute
-Hematoma may be present
-tap test with reflex hammer or vibration

chronic
-Old slow, healing rib fractures may become a chronic source of discomfort

26
Q

Muscle injuries

A

True muscle injuries of the spine are very uncommon

musculoskeletal system does get affected through joint injuries and postural changes

Muscle spasms are very common in upper thoracic spine especially around the scapula

27
Q

T4 syndrome

A

etiology unknown
Maybe an autonomic syndrome or mechanical problem involving facet joints

Glove Syndrome because of dull aching symptoms covering whole hand, non-dermatome and with or without pins and needles

Symptoms usually unilateral

28
Q

cervical uncovertebral joint symptoms

A

very little pain, vague discomfort
stiffness is greater problem than pain
no Referred or neurological symptoms
Morning Stiffness

29
Q

posterior primary rami innervate

A

Skin on the back between angles of the ribs

Can mimic trigger points when traveling through the muscles

30
Q

common red flags

A

unaffected by spinal movement
Associated symptoms like heartburn
Past medical history
Insidious onset of symptoms

Age under 20 or over 50
Family history
Past personal history
Sudden, unexpected weight loss or gain

31
Q

Cardiac pain

A

pain for myocardium

from decreased blood flow buildup of metabolites and ischemic segment of the heart

Characterized as squeezing substernal sensation tightness, or pressure

Usually in the morning or end of the day

32
Q

acute myocardial infarction

A

Intolerable, gripping or crushing sensation under their sternum
Diaphoresis and shortness of breath

33
Q

angina pectoris

A

Increased pain with exertion

Regardless of location, pain is always worsen with exertion and relieved with rest

34
Q

aortic dissection

A

Marked distention of aortic adventitial coat which contain high concentration of nociceptive fibers

pain is sudden and rapidly becomes severe
paint is unrelenting and not changed by position
Patient appears in distress and may be pale or cyanotic
Blood pressure is often normal, but distal pulses are frequently decreased or absent

35
Q

Pericarditis

A

inflammation of the pericardium

Secondary to
Infection- bacteria, viral or fungal
systemic disease - rheumatoid arthritis, connective, tissue diseases or uremia
Metastatic tumors
Drugs - procainamide, hydralazine, phenytoin, anticoagulants
Idiopathic

36
Q

Pericarditis symptoms

A

mild to severe chest pain that is aggravated by respiration cough or thoracic motion

Pain may be relieved with sitting and forward bending

Fever, chills and weakness are common

Tachycardia and cough are variable

37
Q

pericarditis pain pattern

A

Within epigastrium and left parasternal region

If the diaphragm is irritated, pain is referred to the left trapezius

Patient with acute symptoms should be transferred immediately to an ER

38
Q

mitral valve prolapse

A

Results from thickened leaflets that are large and redundant

Effect 4 to 7% of population

More common in women than men

Chest pain reported 40 to 50% of affected patients

Pain is characteristically, sharp or sticking in nature
Some may report dull pain

39
Q

Agina like symptoms for mitral valve prolapse

A

10 to 20% of affected patients

stethoscope
Mid systolic non-ejection click and late holosystolic murmur

Pain generally non-exertional and momentarily but occasionally lingers minutes to hours

40
Q

mitral valve prolapse frequency and location

A

More frequent during periods of emotional stress

Typically
Retro sternal
Left sided chest
Not referred to distal sites

41
Q

esophageal disorders

A

Irritation from foreign bodies or tumors, erosion from acid reflux and motility problems

Gastro esophageal reflux leads to a mild severe burning sensation in the epigastric to retro sternal area

Pain often worse at night because of a supine position allows reflux of stomach acid into the esophagus

Patient may complain of brackish taste, and frequent belching

42
Q

tracheobronchial pain

A

Pain from inflammation of the tracheobronchial tree characteristically is referred to the upper portion of the sternum and lateral to the sternum at points corresponding to the major bronchi

43
Q

Pleurisy

A

parietal pleural contains pain fibers that are conveyed through the chest wall through the intercostal nerves

Irritation of the pleura, thereby results in chest wall pain

widening Of the intercostal space during inspiration stretches, the inflame parietal pleural and accentuates the pain

44
Q

Pleural inflammation, may be caused by

A

Underlying lung insult from pneumonia or pulmonary infarction

Direct entry of infection to the pleural space empyema

Hematological or lymphatic spread - TB, uremia, cancer, collagen, vascular disease

Pleural trauma like rib fracture

45
Q

pleurisy pain pattern

A

over side of pleurisy or the chest wall

Central diaphragm is irritated Pain may be referred to the neck and shoulder.

46
Q

pulmonary embolism

A

Caused by a sudden lodging of a blood clot in the pulmonary vascular tree with resultant obstruction of blood flow

Complete obstruction - pulmonary infarction, which may lead to a consolidation necrosis of lung tissue

Medical emergency

Thrombus formation usually occurs at a distance site like the venous system of the leg or subclavian vein in the arm

47
Q

Predisposing factors of pulmonary embolism

A

recent surgery less than one month
Trauma
Immobilization
Cancer
Pregnancy
Oral contraceptive use
Obesity
Advanced age

48
Q

pulmonary embolism pain

A

usually Secondary to pleurisy from a peripheral infarction

same pain pattern

Dyspnea
hemoptysis
tachypnea

49
Q

Thoracic pain referred from abdominal

A

Generally transmitted through T6 to T 12

Some structures in the chest are innervated as low as T9

50
Q

cholecystitis

A

inflamed gallbladder

Typically occur one to two hours after a heavy meal

Sudden or gradual onset of severe pain which peaks after 2 to 3 hours and resolves in approximately 10 hours

Passing gallstones gives the sudden intense proximal pain of biliary colic pain is characteristically located in the right upper quadrant of the abdomen the right subscapular area or both

51
Q

acute cholecystitis

A

Fever
Chills
Moderate to severe distress
Tenderness could be elicited in the right upper quadrant that verses on deep inspiration aka Murphy sign

52
Q

peptic ulcer disease

A

Increase production of gastric acid or decreased cytoprotection of the stomach lining from chronic NSAID use leads to erosion of the gastric mucosa

Pain originating from the stomach transmitted through the seventh through ninth thoracic nerve roots

53
Q

peptic ulcer disease pain

A

Burning
felt in epigastrium below the xiphoid process or left upper quadrant of the abdomen

significant erosion may cause patient to complain of boring sensation through the back

Burning pain typically begins when two hours after a meal and could be temporarily relieved with antacids

Perforation of the stomach wall lead to free air accumulation under the diaphragm and causes referred pain to the shoulder

54
Q

renal disease

A

Pain originating from the genitourinary system involves the thorax only at the costovertebral angle

Pain could be result of either renal inflammation (pyelonephritis) or distention (sudden obstruction)

Patient with acute pyelonephritis generally will have signs of urinary tract infection, which will proceed the development of flank pain

55
Q

renal disease symptoms

A

Fever, chills, sweats, and tenderness can be elicited by percussing the costovertebral angle

no change of position relieves the pain

MSK Thoracic (4 decks)

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