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Common Conditions, Management and Imaging > Common conditions of the trunk > Flashcards

Common conditions of the trunk Flashcards

1
Q

What is costochondritis?

A

Inflammatory process of 1 or more costochondral cartilages that causes localised tenderness and pain in the anterior chest wall

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2
Q

What is the most common gender and age for costochondritis?

A

F>M 2:1
Less than 50 years

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3
Q

What is the aetiology of costochondritis?

A

No cause can be identified in many cases
There may be a history of trauma or mechanical overloading (strenuous exercise, recent URTI)
Rheumatological conditions

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4
Q

What are the risk factors for costochondritis?

A

Cartilage is irritated or torn leading to inflammation and pain
Direct trauma, aggressive exercise (straining joint)
Upper respiratory tract infections with cough

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5
Q

What is the pathophysiology of costochondritis?

A

Poorly understood
Inflammatory process of costochondral or costosternal joints
Most common sites: 2nd to 5th costochondral junctions

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6
Q

What is tietze syndrome?

A

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

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7
Q

What are the clinical features of costochondritis?

A

-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

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8
Q

What is the aetiology of rib fractures?

A

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

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9
Q

What are the clinical features of rib fractures?

A

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)

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10
Q

What are sternoclavicular joint sprains?

A

Traumatic and non-traumatic injuries to the SC joint

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11
Q

What structures are involved in sternoclavicular joint sprains?

A

Sc joint involves and articular disc, clavicle, sternum, costal cartilage, costoclavicular ligament

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12
Q

What is associated with traumatic SC joitn sprains?

A

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

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13
Q

What is associated with non-traumatic SC joint sprains?

A

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

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14
Q

What are the clinical features of SC joint sprains?

A

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

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15
Q

What are CT/CV joint sprains?

A

Dysfunction of the costotrans-verse and costo-vertebral joints of the spine

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16
Q

What is the aetiology of CT/CV joint sprains?

A

Mechanical joint sprains
Degenerative change (OA)
Inflammatory spondylo-arthopathies
e.g. anklylosing spondylitis

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17
Q

What is the pathophysiology of CT/CV joint sparins?

A

Underlying pathological process will depend on cause
Acute mechanical joint injury: inflammatory cascade

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18
Q

What are the clinical features of CT/CV joint sprains?

A

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

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19
Q

What are the clinical findings of CT/CV joint sprains?

A

Movement of rib provokes pain at CV/CT joint and will simultaneous reproduce the referred pain

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20
Q

What is scheuermann’s disease?

A

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

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21
Q

What is the common gender and age for scheuermann’s?

A

M>F 2:1
12-17 years

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22
Q

What are the risk factors for scheuermann’s?

A

Poorly understood
Hereditary?
Left-handedness shows increased correlation
Possible prior back trauma
Abnormal end plate ossification
Disproportionate vertebral body growth

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23
Q

What is the pathophysiology of scheuermann’s?

A

Trauma to endplate (thinning) arrests growth
Malnutrition (vit A, fluoride)
Aseptic necrosis, osteoporosis

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24
Q

What are the clinical features of scheuermann’s?

A

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

25
Q

What is osteoporosis?

A

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

26
Q

What gender and age are most common for osteoporosis?

A

*Adults 60-64
15% women;1.6% men
*Adults >80
71% women;19% men

27
Q

What is the aetiology of osteoporosis?

A

Primary
Type 1: post-menopausal
Type 2 – senile

Secondary
Immobilisation
Long-term corticosteroid use
Cushing’s syndrome
Hyperthyroidism

28
Q

What is the pathophysiology of osteoporosis?

A

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)

29
Q

What is post menopausal osteoporosis?

A

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

30
Q

What is senile osteoporosis?

A

Imbalance between resorption and deposition
Loss of both trabecular and cortical bone

31
Q

What are the clinical features of osteoporosis?

A

Rarely produces symptoms
Until bone is weak enough to fracture

Loss of height
Increased kyphosis

32
Q

What are vertebral fractures?

A

Fractures of the vertebral spine

Usually associated with major trauma, but pathological fractures can occur with minor or trivial trauma

33
Q

What are the clinical features of vertebral fractures?

A

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

34
Q

What is non-specific LBP?

A

Pain that is not attributable to a specific pathology i.e. infection, tumour, fracture, inflammatory disorder

35
Q

What is the aetiology of non-specific LBP?

A

> 80% patients who present with LBP are non-specific in nature

36
Q

What are the clinical features of non-specific LBP?

A

Location: usually localised in the lumbar region
Nature: Pain often described as dull, aching
Onset: can be gradual or sudden, often triggered by PA

37
Q

What is a lumbar radiculopathy?

A

A radiculopathy arising from the lumbar spine

38
Q

What is the aetiology of lumbar radiculopathies?

A

Disc injuries
OA (IVF narrowing)

Tumour infection
Haematoma

39
Q

What is the pathophysiology of lumbar radiculopathies?

A

Nerve root compression
Inflammation
Ischaemia
Nerve damage

40
Q

What are the clinical features of lumbar radiculopathies?

A

Radicular pain: sharp, shooting pain radiating from lower back down to the leg
Unilateral pain
Dermatomal distribution
Sensory changes
Motor deficits
Reflex changes

41
Q

What is osteoarthritis causing central stenosis?

A

Osteoarthritis (lumbar spondylosis) causing stenosis of the spinal canal

42
Q

What is the pathophysiology of OA causing central stenosis?

A

Disc degeneration
Facet joint deterioration and displacement
Osteophytic change
Narrowing of the IVF
Stenosis of the spinal canal

43
Q

What are the clinical features of OA causing central stenosis?

A

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

44
Q

What is a spondylolisthesis?

A

Displacement of part of all of one vertebra on another

45
Q

What is an atnerolisthesis?

A

Forwards slippage (most common)

46
Q

What is a retrolisthesis?

A

Posterior displacement can occasionally occur (esp. in Cx spine)

47
Q

What is the aetiology of an isthmic spondylolisthesis?

A

most common type due to bilateral pars fracture
Occurs most often at L5-S1

48
Q

What is the aetiology of degenerative spondylolisthesis?

A

Intersegmental instability produced by facet and IVD degeneration
Occurs mostly at L4-5

49
Q

What are the other types of spondylolisthesis?

A

Congenital
Traumatic
Pathological

50
Q

What condition can progress to a spondylolisthesis?

A

Spondylosis

51
Q

What can spondylolisthesis develop in the absence of?

A

Spondylosis/pars fracture

52
Q

What are the grades of spondylolisthesis?

A

G1: vertebra has slipped up to 25%
G2: Slippage > 25%
G3: Slippage >50%
G4: Slippage >75%

53
Q

What are the clinical features of spondylolisthesis?

A

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

54
Q

What are the clinical findings of spondylolisthesis?

A

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

55
Q

What is a spondylolysis?

A

Bony lesion in the region of the pars interarticularis
Commonly involves pedicle and lamina as well as pars

56
Q

What is the most common age for spondylolysis?

A

20 years

57
Q

What are risk factors for spondylolysis?

A

Sports
Repetitive loading of the pars
Hyperextension especially when combined with rotation
When experiencing a force during landing

58
Q

What are the clinical features of spondylolysis?

A

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

Common Conditions, Management and Imaging (7 decks)

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