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MSK 3 > Common Thoracic Conditions > Flashcards

Common Thoracic Conditions Flashcards

1
Q

What is thoracic osteoporosis?

A

An age related change to the vertebrae where the vertebral bodies lose bone trabeculae which leads to collapse of vertebral end plates, increased kyphosis and loss of stature

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2
Q

What x-ray findings are indicative of osteoporosis?

A

collapse of endplates with marked increase in endplate concavity

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3
Q

What age range is common for osteoporosis to show up in adults?

A

Post menopause for women and about a decade later for men

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4
Q

What may cause the uncommon phenomena of anteriorly fused mid-thoracic vertebra?

A

diffuse idiopathic spondylitic hyperostosis (DISH) or from ankylosing spondylitis

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5
Q

How does pain from thoracic aging usually present?

A

localized posteriorly and slightly off to one side which radiates a few inches

chest wall pain is common and low back pain as a referral from T/L junction also common

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6
Q

Thoracic trauma when spine is flexed leads to what structure damage? How does this change when spine is in an extended position?

A

in flexion or axial compression vertebrae are injured more often than discs

in extension, thoracic facet injuries are just as common as cervical facet injuries

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7
Q

What are the four common injuries from a loading trauma to a flexed T spine from least to most severe?

A
  • endplate fracture (least severe)
  • bone bruise
  • wedge compression
  • burst fracture (most severe)
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8
Q

True or False: After a MVC it is more common in the T spine for a disc to be injured rather than the vertebral body

A

False, after a MVC the T spine will most likely have a vertebral body injury rather than a disc injury, this is not true, however, in the C spine where disc injuries are more common

Facet injuries are common in both spine segments after a MVC

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9
Q

What are the most commonly injured segments of the T spine after a MVC?

A

T12-L1

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10
Q

Which gender is more at risk for osteoporosis?

A

Females (40%) more than males (13%)

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11
Q

True or False: vertebral body fractures are twice as common as hip fractures

A

True

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12
Q

Which vertebrae are at the highest risk for compression fractures? Why?

A

T11-L1 (due to the increase percentage of body weight that they carry)

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13
Q

What is kyphoplasty?

What patients are most likely candidates for kyphoplasty?

A

A procedure to alleviate pain from vertebral fractures resulting from osteoporosis and try to restore natural kyphosis of the spine

patients who recently suffered from a fracture from osteoporosis and have painful symptoms due to fractures (usually within 8 weeks of fracture)

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14
Q

What symptoms can sprout from the resulting change in height and spinal alignment after vertebral stress fractures?

A
  • chronic or severe pain
  • limited function and reduced mobility
  • loss of independence in daily activities
  • decreased lung capacity
  • difficulty sleeping
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15
Q

True or False: Kypho/vertebroplasty has no signifcant difference in outcomes compared to conservative care or placebo

A

True

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16
Q

What will be the cause of the greatest percentage of pts presenting with thoracic pain?

A

involved in a trivial accident such as a small fall or someone bumping into their rib cage

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17
Q

Roughly how many patients that present with acute chest pain in the ER are found to be due to MSK system?

A

1 in 4

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18
Q

True or False: Disc lesions in the T spine are probably very common and commonly asymptomatic.

A

True

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19
Q

what are some reasons for why disc lesions are so common?

A
  • the attachment of ribs to annulus fibers (blow to ribs may disrupt the disc)
  • higher viscosity of IVD in T spine
  • asymmetrical loading with segmental motion
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20
Q

Where are disc lesion most common?

A

Lower T spine or at thoracolumbar junction

disc lesion common on convex side of scoliosis or kyphosis (asymmetrical loading)

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21
Q

What are some common clinical presentations of pain from disc lesions?

A
  • pain is in blobs or patches (referred from vertebrae)
  • somewhat segmental pain
  • unilateral pain
  • deep ache
  • pain aggravated by coughing, sneezing or deep breathing
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22
Q

If nerve root pain is from a mechanical origin how might the pain present?

How does this change if the origin is chemical irritation?

A

mechanical: local discomfort w/ numbness and paresthesia

Chemical: severe pain with distal being more painful than proximal

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23
Q

True or False: In true nerve root pain proximal pain (back pain) will be greater than distal pain (anterior wall next to the sternum)

A

False, distal pain will be greater than proximal pain in true nerve root pain

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24
Q

What condition may closely simulate thoracic nerve root pain due to pain being located anteriorly at the sternum?

A

costochondritis

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25
Q

Where might the upper T spine refer pain to?

A

Upper extremity or axillary region

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26
Q

How does pain present in facet joint dysfunction?

What would provoke the pain?

A

usually sharp localized pain unilaterally which may become dull or aching pain in the chronic stages

pain would be provoked by closing down on facet joints via extension or by coughing and sneezing

27
Q

If you have referred pain that is more intense proximally than distally what may be the cause of your pain?

A

Facet joint dysfunction

28
Q

How does pain usually present from ligamentous injuries?

A

vague and ill defined that spread around the area but does not produce distal symptoms are neurological symptoms

29
Q

What nerve innervates the ALL and PLL?

A

sinuvertebral nerve, which can cause pain that spreads up and down spinal canal

30
Q

True or False: Muscle injuries to the thoracic spine are very common which is why most PT interventions focus on the muscles of the T spine

A

False, true muscle injuries to the spine are very uncommon but the MSK system does get affected through joint injuries and postural changes

31
Q

What is T4 syndrome?

What causes this syndrome?

A

dull aching symptoms covering the whole hand (non dermatome) and with or without pins and needles which are usually unilateral

precise etiology is unknown but current evidence suggests autonomic involvement

32
Q

What are common symtpoms with cervical uncovertebral joint issues?

A
  • very little pain, more of a vague discomfort
  • stiff more than painful
  • no referred or neurological symptoms
  • morning stiffness
33
Q

What are common red flags for thoracic pain?

A
  • unaffected by spinal movement
  • associated symptoms i.e heartburn
  • past medical history
  • insidious onset of symptoms
34
Q

What factors cause a significant increase of risk for visceral thoracic problems?

A

age (under 20 or over 50)
family history
past personal history
sudden, unexpected weight loss/gain

35
Q

How does cardiac pain usually refer or present clinically?

A

pain is from decreased blood flow build up of metabolites in ischemic segment of heart muscles and characterized as squeezing substernal sensation, tightness or pressure and pain in upper left arm and left side of jaw

36
Q

What is angina pectoris?

A

Increased pain with exertion (except variant) that is relieved with rest, regardless of location of pain

37
Q

If a patient has normal blood pressure but their distal pulses are decreased or absent and they have sudden unrelenting pain in their chest what disorder may they have?

A

aortic dissection

38
Q

What can cause pericarditis? (inflammation of the pericardium)

A

infection, systemic diseases (rheumatoid arthritis, connective tissue disease), metastatic tumors, drugs, or can be idopathic

39
Q

What usually aggravates pericarditis pain and what eases the pain?

A

Agg-respiration, coughing, or thoracic motion

Ease-sitting and forward bending

40
Q

If pain from pericarditis is in left trapezius what does that suggest?

A

irritation of the diaphragm

41
Q

What condition can present like an angina but can be heard with a stethoscope (mid-systolic non ejection clock and late holosystolic murmur) and the pain is non-exertional and momentary but can occasionally last for minutes to hours?

A

mitral valve prolapse

Pain typically more frequent during periods of emotional stress

42
Q

What position often causes the worst pain with esophageal disorders?

A

Supine position which allows reflux of stomach acid into the esophagus

43
Q

How common is scoliosis greater than 25 deg.?

A

1.5/1000 persons in the U.S

44
Q

True or False: Generally curvature of less than 30 deg will not progress after a child is skeletally mature

A

True

45
Q

What is the most common cause of scoliosis?

A

idiopathic genetics

most common type is adolescent idiopathic scoliosis

46
Q

What are the age ranges for idiopathic scoliosis types?

A

infantile-2 months to 3 yrs (least common)
juvenile- 3 yr to 10 yr
Adolescent- over 10 years (90% 0f causes)

47
Q

roughly how fast does the T1-S1 grow in children age groups?

A

0-5: 2.2 cm/yr
5-10: 1 cm/yr
Puberty: 1.8 cm/yr

48
Q

what are the 3 classifications for idiopathic scoliosis?

A

Failure of formation (hemivertebra)

Failure of segmentation (unilateral bar or block vertebra)

Combination

49
Q

What is the Cobb angle?

A

angle formed by the inclination of the upper end plate of the upper end vertebra and inclination of the lower end plate of the lower end vertebra

50
Q

Which gender is more affected by scoliosis? How big is the gap?

A

females

gap depends on severity of curve
mild scoliosis (10-25 deg)-4:1
moderate (25-50 deg)-7:1
Severe (over 50 deg)-10:1

51
Q

What mechanical process progresses the curve of scoliosis?

A

torsion with eccentric loading of the spine and vertebral growth modulation

52
Q

As scoliosis progress how does the vertebral body change?

What changes are seen in the muscles?

A

spinous process deviates towards concave side
vertebral body distorted toward convex side
“gibbus deformity” (knot like deformity)
kypho scoliosis

muscle weakness
hypertrophy
muscle imbalances
trigger points

53
Q

What are the common causes of neuromuscular idiopathic scoliosis?

A 
poliomyelitis
cerebral palsy
syringomyelia
muscular dystrophy
amyotonia congenita
friedrich's ataxia
spina bifida
spinal cord injury
54
Q

What are the mesenchymal disorders that can cause idiopathic scoliosis?

A 
Marfan's syndrome
Morquio's Syndrome
Rheumatoid Arthritis
Osteogenesis imperfecta
Dwarfism disorders
55
Q

What trauma can cause idiopathic scoliosis?

A

fractures
irradiation
surgery

56
Q

What two factors lead to a poor prognosis for scoliosis?

A

Young age and having a thoracic curve

57
Q

What movement clinical signs suggest scoliosis?

A
  • curve enlarges w/ flexion
  • limited extension movement
  • asymmetric side flexion
  • gibbus deformity in flexion
58
Q

If scoliosis curve is between 20 and 50 deg. what is the recommended treatment?

What if it is above 50 deg?

A

Brace

Surgery

59
Q

What are the PT goals for scoliosis?

A
  • slow progression of curve
  • maintain or improve general fitness and lung capacity
  • observe and monitor curve changes
  • self correction and stretches for posture
  • treat painful symptoms
  • motor control
  • education (reduce fear)
  • brace use
  • adapting ADL’s
60
Q

True or False: Through several years of research and discussion we have a clear path for treatment of scoliosis patients

A

False, there is still a lot of debate about proper treatment plans

61
Q

What are the pros and cons of bracing:

A

Pros-seems to stop curvature progression

Cons-not a lot of solid evidence and studies show no improvement in quality of life, a lot of questions about proper bracing habits

62
Q

What is the consensus about exercise for scoliosis?

A

Very little quality evidence for scoliosis specific exercise, a lot of research needs to be done

63
Q

What is the resurgery rate for adolescent idiopathic scoliosis?

A

40%

64
Q

What is currently the best evidence for treating scoliosis?

A
  • conduct a skilled physical exam
  • identify red flags
  • educate patient about the nature of the problem (reduces fear and makes the ‘unknown’ known)
  • provide prognostication
  • promote self-care (self help ideas, most do well with no surgery and no bracing, promote a home program)
  • get patients active and moving as earlt as possible and appropriately after injury (motion is lotion)
  • help patient experience success
  • use any measures possible to reduce pain (modalities, stretches, soft tissue work, mobs and manips, breathing techniques, aqua therapy, etc.)

MSK 3 (19 decks)

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