Exam II Flashcards
Compartment Syndrome (5 Ps)
Pain: Deep, poorly localized
Paresthesia: of the sensory nerve passing through compartment
Paralysis: Permanent damage likely
Pallor: distal to the compartment involved
Pulselessness
Paget’s disease
chronic disorder that can result in enlarged and misshapen bones. Paget’s disease typically is localized, affecting just one or a few bones, as opposed to osteoporosis, for example, which affects all the bones in the body.
Cleidocranial dysplasia
condition that primarily affects development of the bones and teeth. Signs and symptoms of cleidocranial dysplasia can vary widely in severity, even within the same family. usually have underdeveloped or absent collarbones.
11 Predictor Variables of Bone Tumors
- Behavior of the lesion
- Bone/ joint involved
- Locus within a bone
- Patient demographics: age, gender, ethnicity
- Margin of the lesion
- Shape of the lesion
- Joint space involvement
- Bony reaction
- Matrix production
- Soft tissue changes
- Patient history
Bone Tumor characteristics (shape)
Longer than it is wide suggests slow growth/ benign
Wider than it is long suggests fast growth/ malignant
Cortical breakthrough = malignant
No cortical breakthrough = benign
Emergency referral
same day referral
Urgent referral
within 5 days (blood sugar running high recently, progressive weakness while doing PT)
Watchful waiting
Close surveillance while undergoing PT treatment as indicated; use of time before a medical intervention or other strategy is used. Referred as: “treat and refer”
Safety netting
safety netting is a management strategy used for people who may present with possible serious pathology. These strategies should include advice on which signs/symptoms to monitor, what action to take, and the time frame the action needs to be taken.
Red Flag Screening
Categorization approach
I = Suggests serious pathology outside of MSK disorder, possible immediate intervention by a specialist
II = Further patient questioning/adoption of selected examination methods/development of clusters of signs/symptoms
III = Common, require further physical examination, may alter treatment
Components of TIM VaDeTuCoNe
Trauma
Inflammation (Aseptic or Septic)
Metabolic condition
Vascular (Arterial or Venous or Lymphatic)
Degenerative
Tumor (Malignant Primary or Malignant Metastatic or Benign)
Congenital
Neurogenic/Psychogenic
Diaphragmatic irritation referral sites
Shoulder, low back
Heart referral site
Shoulder, neck, upper back, TMJ
Urogenital tract referral site
Back, inguinal region, and genitalia
Pancreas, liver, spleen, gallbladder referral site
Shoulder, midthoracic or low back
C7, T1–5 referral site
Interscapular, posterior shoulder
Shoulder referral site
Neck, upper back
L1, L2 referral site
SI joint and hip
Hip joint referral site
SI joint and knee
Pharynx referral site
ipsilateral ear
TMJ referral site
Head, neck, heart
Red Flags: Associated Signs and Symptoms
Report of confusion
-Neurologic vs drug induced vs infection
Constitutional symptoms or unusual vital signs
-Example: body temp >100 deg F
Proximal muscle weakness with change in DTRs
Joint pain with skin rashes or nodules
Clustered signs/symptoms of a particular organ system
Unusual menstrual cycle/symptoms
Fatigue and Malaise
A change resulting in fatigue that interferes with ADLs, work, school, social settings for >2-4 weeks
Fever, chills, sweats
Common in infection, cancers, connective tissue disorders such as RA
Fever of 99.5 – 101 deg of unknown origin for 3 weeks = consult
Older adults have impaired thermoregulatory systems that can result in no presence of fever with infection (pneumonia)
SBAR (S)
Situation: a concise statement of the problem
SBAR (B)
Background: pertinent and brief information related to the situation
SBAR (A)
Assessment: analysis and considerations of options, what you found/think
SBAR (R)
Recommendation: action requested/recommended, what you want
AP view of neck
Best view for alignment and to observe oblique fractures
Lateral view of neck
Best initial view to Evaluate Alignment, also termed “lines of life”
- Slight lordotic curve, smooth and without step-offs.
- Any malalignment in any degree of neck motion should be considered evidence of bony or ligamentous injury.
Oblique view of neck
Done only after fracture or dislocation injuries are ruled out, can assist with identification of neural foramina narrowing
Open mouth view
Axis and atlas projected between upper and lower teeth
Demonstrates C1-2 alignment
Stable injury
intact posterior spinal ligaments
Unstable injury
displacement
Lower c-spine
higher frequency of injury in adults
Upper c-spine
higher frequency of injury in children
Computed Tomography: Indications
Acute trauma in adults
Degenerative conditions
Infections of the spine
Image guidance for injections
Neoplasms
Congenital abnormalities
Developmental abnormalities
Intrathecal masses
Degenerative Disk Disease (DDD)
presents on radiograph in most persons older than 60 years. Changes in the disk include dehydration, nuclear herniation, annular protrusion, and fibrous replacement of the annulus, all of which result in decrease in disk height, vertebral endplate approximation, and uncovertebral joint friction, which leads to osteophyte formation around the entire osseous margin of the endplates.
Degenerative Joint Disease (DJD)
osteoarthritic changes of the facet joints.
Foraminal encroachment
results from degenerative changes in adjacent structures, including DDD and DJD, that diminish the size of the intervertebral foramina.
Spondylosis
the formation of osteophytes in response to DDD, but before there is obvious disk space narrowing. Osteophyte formation has been shown to be most predominant at C4–C5 and C5–C6, as a result of greater segmental mobility at these levels.
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
condition characterized by bony proliferation at sites of tendinous and ligamentous insertion of the spine affecting elderly individuals. On imaging, it is typically characterized by the flowing ossification of the anterior longitudinal ligament
Spondylolisthesis
forward slippage of one vertebra on the stationary vertebra below it. Increased athletic activity in adolescence or heavy labor in adulthood is often an instigating factor.
Spinal columns assist in determining stability of fractures
1 column disrupted = stable spine. 2 columns disrupted = potentially unstable spine (depends on degree of injury and if middle column is intact). 3 columns disrupted = instability.
The “big 3” signs of a compression fracture
step defect, wedge deformity, linear zone of impaction
Scheuermann’s Disease
Adolescent boys/girls
Backache, thoracic kyphosis
Schmorl’s nodes
Tuberculous osteomyelitis
aka Pott’s Disease,
Occurs secondary to tuberculous
Thoracic back pain
Kyphosis
Weight loss, fever, fatigue
Infection progresses to several vertebra
Lumbar Spine: Signs of Degenerative Changes
Loss of disc space
Hypertrophic spurs
Disk calcification
Herniated/protruding disks
Spinal Stenosis
Spinal stenosis is a narrowing of the spinal canal caused by degenerative joint and disk changes.
Classified into three anatomic regions:
-Stenosis of the central canal
-Stenosis of the intervertebral foramen
-Stenosis of the lateral or subarticular recesses.
More than one region may be involved at the same intervertebral level.
Spondylosis deformans
Anterior disc herniation that disrupts ALL creating osteophyte formation at the anterior and lateral joint margins
Signs of Spinal Infection
Destructive process that involved or crosses a disk space
Tumor will typically not involve the disc space
MRI>CT scan
Indicated
Localized pain
Elevated ESR and WBCs
Fever
+ blood culture
Cauda Equina Syndrome
Compression of the 20 nerve roots that originate from the conus medullaris at the base of the spinal cord
Cauda Equina Syndrome symptoms
unilateral/bilateral radicular pain, dermatomal reduced sensation, myotomal weakness with progression to changes in bowel/bladder and saddle anesthesia
Risk Factors for insufficiency spinal fractures
Excessive alcohol consumption (>3 units per day)
Vitamin D deficiency
Long-term corticosteroid use (> 5 or 7.5 mg/day over a 3-month period)
Rheumatoid arthritis, diabetes, smoking (> 20 cigarettes per day)
Dietary restriction, eating disorders, and absorption problems from the gut
Spinal Fracture clinical picture
Sudden onset of pain in the thoracolumbar region after a low impact trauma (slip/fall)
Severe pain, localized to area of the fracture, needs strong analgesics
Increased prominence of spinous process at the affected level, and increased kyphosis
Tender to percussion at the affected level
Most spinal fractures occur between the T8 and L4 levels.
Spinal Malignancy
Bone is common site for metastases, spine is one of the earliest affected. Cancers include breast, prostate, lung, kidney, and thyroid.
Metastatic spinal cord compression can occur leading to irreversible neurological damage
Early warning signs for metastatic spinal cord compression (could be from spinal malignancy)
band like back pain, escalating pain with poor response to medication, heavy legs or funny feelings, lying flat increases back pain, gait disturbances, sleep disturbances due to pain being worse at night.
Spinal infection
Unlike malignancy, where symptoms wax and wane, spinal infection has a more linear progression, with back pain being the most common presenting symptom, which can progress to neurological symptoms. Spinal surgery is key risk factor.
The classic triad of clinical features comprises back pain, fever, and neurological dysfunction
Cardiothoracic Ratio
Estimate of heart size on the PA radiograph.
In adults, the width of the heart should be less than half the width of the chest.
Silhouette Sign
Localize water-based lesions to a specific lobe of the lung.
Refers to a loss of the normal heart or diaphragm border when a lesion is in a lobe adjacent to it.
Lung fields abnormally white
pneumonia, atelectasis, pleural effusion
Lung fields abnormally black
pneumothorax, COPD
Mediastinum abnormally wide
aortic dissection, lymphadenopathy
Heart abnormally shaped
congestive heart failure, mitral valve stenosis
Nexus criteria
No posterior midline cervical spine tenderness
No evidence of intoxication
Normal level of alertness
No focal neurologic deficit
No painful, distracting injuries
If pt meets all criteria, then no radiograph, if not, radiograph
