Common conditions of the trunk Flashcards
What is costochondritis?
Inflammatory process of 1 or more costochondral cartilages that causes localised tenderness and pain in the anterior chest wall
What is the most common gender and age for costochondritis?
F>M 2:1
Less than 50 years
What is the aetiology of costochondritis?
No cause can be identified in many cases
There may be a history of trauma or mechanical overloading (strenuous exercise, recent URTI)
Rheumatological conditions
What are the risk factors for costochondritis?
Cartilage is irritated or torn leading to inflammation and pain
Direct trauma, aggressive exercise (straining joint)
Upper respiratory tract infections with cough
What is the pathophysiology of costochondritis?
Poorly understood
Inflammatory process of costochondral or costosternal joints
Most common sites: 2nd to 5th costochondral junctions
What is tietze syndrome?
Often confused with costochondritis
Rare condition associated woith a visible, painful enlargement of the costochondral junction
-70% cases: occurs in CC junction of a single rib
What are the clinical features of costochondritis?
-90% patients have multiple painful joints
Pain is mild to moderate
Aggravated by breathing, physical activity or a specific position
Palpation of affected joints elicits tenderness
+/- radiation along chest, abdomen or to back
Not usually accompanied by swelling
What is the aetiology of rib fractures?
Trauma
-Direct blow to ribcage
Pathological
-Osteoporosis
Stress fractures
-Due to excessive muscle traction at rib attachments
Sports: rowing (excessive action of serratus anterior), golfers, fast bowlers, baseball pitchers
What are the clinical features of rib fractures?
History
-Trauma
-Health status
Pain – aggravated by deep inspiration or coughing
Localised tenderness
+/- bruising (direct blow)
Damage to underlying viscera
Splenic rupture (can be life threatening)
Traumatic pneumothorax (breach of pleura)
What are sternoclavicular joint sprains?
Traumatic and non-traumatic injuries to the SC joint
What structures are involved in sternoclavicular joint sprains?
Sc joint involves and articular disc, clavicle, sternum, costal cartilage, costoclavicular ligament
What is associated with traumatic SC joitn sprains?
Associated with high-energy impact
1. Sprain with no joint laxity
2. Subluxation
3. Complete disruption of SC and CC ligs with instability. Anterior dislocation more common than posterior dislocation
What is associated with non-traumatic SC joint sprains?
Most commonly degeneration: SCJ OA is seen in 50-90% adults over 60
Infection: septic arthritis – staphylococcus aureus is the most common organism
Rheumatological: rheumatoid arthritis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease
What are the clinical features of SC joint sprains?
History (trauma, health status)
Localised pain: aggravated by movement of the SC
Palpable tenderness +/- laxity
+/- soft tissue swelling, deformity/defect
Degeneration: stiffness, crepitus
Infection & rheumatological
What are CT/CV joint sprains?
Dysfunction of the costotrans-verse and costo-vertebral joints of the spine
What is the aetiology of CT/CV joint sprains?
Mechanical joint sprains
Degenerative change (OA)
Inflammatory spondylo-arthopathies
e.g. anklylosing spondylitis
What is the pathophysiology of CT/CV joint sparins?
Underlying pathological process will depend on cause
Acute mechanical joint injury: inflammatory cascade
What are the clinical features of CT/CV joint sprains?
Localised tenderness (3-4cm lateral to the midline)
Restricted ROM or “catching” sensation
Often evident on deep inspiration and Tx AROM
Hypertonicity of paraspinal muscles
What are the clinical findings of CT/CV joint sprains?
Movement of rib provokes pain at CV/CT joint and will simultaneous reproduce the referred pain
What is scheuermann’s disease?
Disorder of calcification of vertebral epiphysis characterised by notching and wedging of the vertebral end-plates and abnormal kyphotic spinal curvature
Diagnosis usually made by xray
What is the common gender and age for scheuermann’s?
M>F 2:1
12-17 years
What are the risk factors for scheuermann’s?
Poorly understood
Hereditary?
Left-handedness shows increased correlation
Possible prior back trauma
Abnormal end plate ossification
Disproportionate vertebral body growth
What is the pathophysiology of scheuermann’s?
Trauma to endplate (thinning) arrests growth
Malnutrition (vit A, fluoride)
Aseptic necrosis, osteoporosis
What are the clinical features of scheuermann’s?
Subacute tx pain, no inciting event
Agg by activity, rel with rest
Some cases asymptomatic
Increasing thoracic kyphosis
Cervical and/or lumbar hyperlordosis; +/- scoliosis
Tight hamstrings
Radiographic findings
Loss of disc space, schmorl nodes and irregular vertebral endplates
What is osteoporosis?
A reduction in the total amount of bone where the remaining bone has a normal mineral content
Not to be confused with rickets/osteomalacia – in which bone is deficient in mineral content
What gender and age are most common for osteoporosis?
*Adults 60-64
15% women;1.6% men
*Adults >80
71% women;19% men
What is the aetiology of osteoporosis?
Primary
Type 1: post-menopausal
Type 2 – senile
Secondary
Immobilisation
Long-term corticosteroid use
Cushing’s syndrome
Hyperthyroidism
What is the pathophysiology of osteoporosis?
Bone strength depends on:
Peak strength of bone achieved in early adult life
Age-related and hormone deficiency related bone loss
Throughout life there is a balance of deposition (osteoblasts) & resorption (osteoclasts)
What is post menopausal osteoporosis?
Reduction in the amount of circulating oestrogen has an impact on bone metabolism
Oestrogen functions as an anti-resorptive hormone, which enhances bone formation and suppresses osteoclast activity
What is senile osteoporosis?
Imbalance between resorption and deposition
Loss of both trabecular and cortical bone
What are the clinical features of osteoporosis?
Rarely produces symptoms
Until bone is weak enough to fracture
Loss of height
Increased kyphosis
What are vertebral fractures?
Fractures of the vertebral spine
Usually associated with major trauma, but pathological fractures can occur with minor or trivial trauma
What are the clinical features of vertebral fractures?
Acute onset spinal pain – positions of comfort will vary between patients
Radiation of pain anteriorly (chest), abdomen, or flanks
May be aggravated by straining
Exquisite tenderness on palpation
Limited ROM
+/- neurological features
What is non-specific LBP?
Pain that is not attributable to a specific pathology i.e. infection, tumour, fracture, inflammatory disorder
What is the aetiology of non-specific LBP?
> 80% patients who present with LBP are non-specific in nature
What are the clinical features of non-specific LBP?
Location: usually localised in the lumbar region
Nature: Pain often described as dull, aching
Onset: can be gradual or sudden, often triggered by PA
What is a lumbar radiculopathy?
A radiculopathy arising from the lumbar spine
What is the aetiology of lumbar radiculopathies?
Disc injuries
OA (IVF narrowing)
Tumour infection
Haematoma
What is the pathophysiology of lumbar radiculopathies?
Nerve root compression
Inflammation
Ischaemia
Nerve damage
What are the clinical features of lumbar radiculopathies?
Radicular pain: sharp, shooting pain radiating from lower back down to the leg
Unilateral pain
Dermatomal distribution
Sensory changes
Motor deficits
Reflex changes
What is osteoarthritis causing central stenosis?
Osteoarthritis (lumbar spondylosis) causing stenosis of the spinal canal
What is the pathophysiology of OA causing central stenosis?
Disc degeneration
Facet joint deterioration and displacement
Osteophytic change
Narrowing of the IVF
Stenosis of the spinal canal
What are the clinical features of OA causing central stenosis?
Initial:
Neurogenic claudication – with walking and prolonged standing
Discomfort eases when bending forward or sitting down
Leg weakness
Progressive features reflect the worsening compression of the cauda equina or spinal cord:
Cauda equina syndrome
Presence of UMN signs
What is a spondylolisthesis?
Displacement of part of all of one vertebra on another
What is an atnerolisthesis?
Forwards slippage (most common)
What is a retrolisthesis?
Posterior displacement can occasionally occur (esp. in Cx spine)
What is the aetiology of an isthmic spondylolisthesis?
most common type due to bilateral pars fracture
Occurs most often at L5-S1
What is the aetiology of degenerative spondylolisthesis?
Intersegmental instability produced by facet and IVD degeneration
Occurs mostly at L4-5
What are the other types of spondylolisthesis?
Congenital
Traumatic
Pathological
What condition can progress to a spondylolisthesis?
Spondylosis
What can spondylolisthesis develop in the absence of?
Spondylosis/pars fracture
What are the grades of spondylolisthesis?
G1: vertebra has slipped up to 25%
G2: Slippage > 25%
G3: Slippage >50%
G4: Slippage >75%
What are the clinical features of spondylolisthesis?
Commonly asymptomatic
Not predictive of LBP
Prevalence of LBP in adults with confirmed non-degrative spondylolisthesis not higher than general population
With certain populations (athletic, occupational) it may become symptomatic
Usually gradual onset LBP
What are the clinical findings of spondylolisthesis?
Aggravated by extension and prolonged standing, relieved by sitting
Observation of increased lordosis and compensatory kyphosis above
May be palpable “step-off” corresponding to the slip
What is a spondylolysis?
Bony lesion in the region of the pars interarticularis
Commonly involves pedicle and lamina as well as pars
What is the most common age for spondylolysis?
20 years
What are risk factors for spondylolysis?
Sports
Repetitive loading of the pars
Hyperextension especially when combined with rotation
When experiencing a force during landing
What are the clinical features of spondylolysis?
Possible to be asymptomatic even in active stress fracture state
Gradual onset LBP – begins as low grade pain or stiffness
Progresses in severity with continued loading
Can radiate to buttock and posterior thigh
Often a history of cyclical spinal loading
May arise following increased training volume / intensity
Localised tenderness and muscle spasm on palpation
