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Interventions II > Final - Clinical Conditions of Thoracic Spine > Flashcards

Final - Clinical Conditions of Thoracic Spine Flashcards

1
Q

Red flags of a fracture - medical history

A
  • Major trauma
  • Minor trauma or strenuous lifting in order (potentially osteoporotic) patents
  • metabolic risks for osteopenia (renal failure, hyperthyroidism, rheumatic disorders, debility)
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2
Q

Red flags of a fracture - exam/ diagnostic testing

A
  • percussion tenderness of SP

- Careful neurological exam for signs of neurological compromise

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3
Q

Tumor and neoplasia - medical history

A
  • severe localized pain over specific SP
  • history of cancer
  • constitutional sxs
  • pain worsens in supine
  • pain at night or at rest
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4
Q

Tumor and neoplasia - exam/ diagnostic testing

A
  • pallor, reduced BP, diffuse weakness
  • decreased ROM due to protective muscle spasm
  • C8 or T1 nerve root sxs, especially in smoker
  • other neuro impairment
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5
Q

Cancers that often reoccur

A

BLT with a kosher pickle and a side of mustard and mayonnaise

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6
Q

Infection- Medical History

A
  • risk factors of spinal infection: recent bacterial infection, IV drug use, DM, immune suppression
  • Constitutional sxs
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7
Q

Infection- Exam/Diagnostic testing

A
  • tenderness over SP
  • decreased ROM
  • vital signs consistent with systemic infection
  • pelvic or abdominal mass or tenderness
  • neurological impairment
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8
Q

Progressive neurologic deficit - Medical History

A
  • severe spinal pain

- progressive limb numbers or weakness, bowel or bladder control impairment, gait ataxia

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9
Q

Progressive neurologic deficit - Exam/diagnostic testing

A
  • significant and progressive myotomal motor weakness
  • significant increased sensory loss in anatomical distribution
  • radicular signs
  • corticospinal tract involvement (gait ataxia, babinski sign, etc)
  • other neurological impairment
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10
Q

Myelopathy - Medical history

A
  • gait ataxia, impaired upper limb coordination, poor or reduced finger movement, bowel or bladder impairment (DOWN)
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11
Q

Myelopathy - exam/diagnostic testing

A
  • hyerreflexia, ataxia, clonus, pathological reflex

- other neurological impairment

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12
Q

Pneumonia - medical history

A
  • fatigue
  • dyspnea
  • may have chest/ rib pain, usually pleuritic
  • sputum production
  • subacute onset without inciting event
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13
Q

Pneumonia- Exam/diagnostic testing

A
  • fever, tachypnea
  • decreased breath sounds, may have rhonchi
  • dullness to chest percussion
  • purulent sputum
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14
Q

what is the most common area for metastases?

A
  • Between T4-T11

- First indication on x-ray is usually pedicle changes

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15
Q

Flat back

A

decreased pelvic inclination, decreased kyphosis and a mobile thoracic spine

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16
Q

Round back

A

decreased pelvic inclination, excessive kyphosis

- becomes an issue as you age due to loss of disc height and extensor muscles

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17
Q

Dowagers Hump

A
  • severely kyphotic upper posterior region due to multiple anterior wedge compression fractures usually due to post menopausal osteoporosis or long term corticosteroid use
  • cant change it but can reduce sxs
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18
Q

Hump Back

A

localized chart posterior angulation (gibbus deformity) due to anterior wedging of 2 thoracic vertebras as a result of infraction, fracture or congenital anomaly

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19
Q

Barrel chest

A

forward and upward projecting sternum increase AP diameter, leading to respiratory difficulty, stretching of intercostal and anterior chest muscles, and adaptive shortening of scapular adductor muscles

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20
Q

pigeon chest (pectus carinatum)

A

forward and downward projecting sternum

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21
Q

funnel chest (pectus excavatum)

A

posterior projecting sternum

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22
Q

Thoracic disc lesions/ radicular pain syndrome

A
  • relatively uncommon in clinical presentation but common from post-mortem studies
  • sudden or insidious
  • traumatic (hard disc) or postural (soft disc)
  • larger IVF in tspine –> unilateral disc ex’s less common
  • smaller distribution of nerve roots in thoracic spine –> less serious problems than Cx or Lx
  • narrower central canal in thoracic spine –> more problematic if central bulge
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23
Q

Intervention strategies for thoracic disc lesions

A
  • rest relief positions/ pain control
  • maintain mobility
  • mobilize in preferred direction
  • postural ed/patient ed
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24
Q

What is a Myofascial Pain Syndrome

A

a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofacial trigger points

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25
Q

Active myofascial trigger points

A

direct stimulation reproduces sxs, partially or completely, and the reproduced sx is recognized as a familiar experience by the patient

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26
Q

latent myofacial trigger point

A

clinically quiescent with respect to spontaneous pain; it is painful only when palpated

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27
Q

Myofacial Pain syndrome take home message

A
  • often diagnosis of exclusion

- make sure there isn’t an underlying problem

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28
Q

Intervention strategies for myofascial pain syndrome

A
  • primary treatment is to identify cause for underlying overuse and address to prevent recurrence: postural, overuse, muscle imbalance/ motor control, other
  • stretching
  • STM (trigger point compression, manual therapy, transverse friction massage)
  • Trigger point dry needling
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29
Q

What is postherpetic neuralgia?

A
  • the most common complication of herpes zoster
  • first onset is only pain, tingling, or burning before a rash appears
  • Pain that persists in the area where the rash once was for more than 90 days after rash onset
  • Can last for weeks or months, and occasionally for years
  • PT is recommended Rx for symptom control
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30
Q

Zygapophyseal Joint Lesions

A
  • Commonly hypomobility problems
  • Chronic problems more common; if acute usually lower Thx spine
  • Costotransvere and costovertebral joints dysfunction may be present
  • pain occurs with tension > compression
  • cough/sneeze/deep inspiration can be painful
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31
Q

Intervention strategies for zygapophyseal joint lesions:

A
  • mobility
  • treat associated soft tissue and rib restrictions
  • functional exercises to promote mobility
  • postural education and patient education
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32
Q

What is Osteochondrosis (Scheuermann’s Disease)?

A
  • growth disturbance of the epiphyseal plates in the thoracic spine –> accentuation of the normal kyphotic curve affecting 3 or more segments
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33
Q

who does osteochondrosis (schuermann’s disease) typically affect?

A
  • most common cause of pain in adolescents: boys 2x > girls
  • typical age of onset 10-12 years with small subset of adult onset, gradual onset of pain in 20-30’s
  • M:F ratio between 2:1 and 7:1
34
Q

Osteochondrosis (Schuermann’s Disease) signs and symptoms

A
  • typically does not have radicular pain
  • Schmorl’s nodes: weakening of anterior epiphyseal plate –> vertical protrusion NP –> spondylosis
  • T7 and T10 most commonly involved
35
Q

Intervention for Osteochondrosis (schuermann’s disease) when kyphotic deformity is greater than 45 degrees:

A
  • postrual ed/patient ed
  • bracing, taping
  • mobility
  • stabilization
  • strengthening
  • flexibility
  • stretch pec major and minor, thoracic extensor and scapular adductor strengthening (seated rotation and extension in lying)
36
Q

when is surgical correction of osteochondrosis/Schuermann’s disease required?

A

when Cobb angle is greater than 60 degrees

37
Q

Compression fracture

A

caused by excessive flexion loading or due to osteoporosis

38
Q

burst fracture

A

caused by axial loading (fall from height)

39
Q

chance fracture

A

compression fraction to anterior vertebral body and transverse fracture through posterior elements caused by violent flexion

40
Q

where do most thoracic vertebral fractures occur?

A

T9-T11

41
Q

Intervention strategies for fractures

A
  • immediate medical management to stabilize fracture & management of concurrent internal injuries
  • no active treatment necessary unless for pain relief and positioning (compression fx’s usually have acute girdle like pain that resolves within 2-3 weeks) (breathing activities)
  • avoid trunk flexion activities/exercises and lifting
  • after healing, stretch antagonist muscles
  • long term exercise, stabilization exercises, postural education, lifting ed, and fall prevention
42
Q

is it contraindicated to perform a manipulation on a healed fracture?

A

no

43
Q

Rib fractures:

A
  • concern is laceration of pleura or lung

- fractures of ribs 10-12 can be associated with injury to liver, kidneys, or spleen

44
Q

Rib fracture interventions:

A
  • pain control
  • early aggressive respiratory care to prevent pulmonary complications
  • assistance with coughing
  • meds: intracostal nerve blocks, muscle relaxants
  • adhesive strapping not recommended (contributes to atelectasis)
45
Q

Rib dysfunctions

A
  • restricted motion of ribs and/or T spine
  • may c/o of cervical or scapular pain
  • tenderness at rib angles, TPs and intercostal muscles
46
Q

what are rib dysfunctions clinically classified as?

A
  • structural (subluxation)
  • Torsional
  • Respiratory
47
Q

Structural Rib dysfunctions

A
  • anterior or posterior rib subluxation/hypomobility
  • often due to trauma
  • usually painful and restricted rib motion during inspiration and expiration
  • diagnosis by changes in rib angle and intercostal pain
48
Q

Reparatory rib dysfunction

A
  • usually related to postural dysfunction and affect either inspiration (inspiratory lesion) or expiration (expiratory lesion)
49
Q

rib dysfunction - Inspiratory lesion

A
  • during inspiration, rib or group of ribs cease rising, more common in upper ribs
  • key rib is the top rib
  • presents as elevation of lower rib of a pair (everted lower edge, prominent angle, scalene tightness)
50
Q

Rib dysfunction- expiratory lesion

A
  • during expiration, rib or group of ribs that stops lowering; more common in lower ribs
  • key rib is bottom rib
  • lower ribs held down
51
Q

Slipping rib syndrome

A
  • not common
  • affect the false ribs
  • pain in the lower chest or upper abdomen with specific movement
  • pain may be attributed to intercostal nerve impingement due to unstable cost-cartilaginous attachment
  • may require nerve block in severe cases
52
Q

what is the gold standard for Slipping rib syndrome

A

hooking maneuver (anterior pull)

53
Q

interventions for rib dysfunction

A
  • address mobility via key ribs
  • always address structural rib disfunction before respiratory rib dysfunction
  • STM to intercostal muscles - techniques/position
  • Thx mobility
  • Cx spine mobility
  • pain management
  • posture/pt education
54
Q

Costochondritis

A
  • inflammation of the cartilage where ribs attach to the sternum
  • inflammation can involve multiple cartilage areas on both sides of the sternum but is usually is on one side only
  • pain WITHOUT swelling
  • typically, short duration of symptoms
  • can be due to acute onset or repetitive strain
55
Q

What is Tietze’s Syndrome (costochondrosis)?

A
  • local inflammation of the costosternal cartilage (most common at 2nd and 3rd costochondral junctions)
  • small swelling palpable at affected junction
  • pain increased with deep inspiration, coughing, sneezing
  • symptoms duration extended/chronic
56
Q

Differential diagnosis of Tietze’s Syndrome

A
  • costochondritis
  • rib fracture: pain persisting for > 1 mo indicated rib fracture not likely as cause of the pain
  • structural rib dysfunction
  • cardiac issues (not painful to palpation)
57
Q

Intervention strategies for Tietze’s syndrome

A
  • relative rest
  • anti-inflammatory medication or hydrocortisone injection
  • address any rib dysfunction
  • mobilize as indicated
  • education/reassurance
  • **Tietze’s syndrome is benign and generally resolves in about 12 weeks
58
Q

What is T4 syndrome?

A
  • can affect multiple motion segments T2-T7 but always includes T4
  • one level of motion segment stiffness > than others
  • upper thoracic joint dysfunction around T4 suspected to be the major case of the UE sxs
  • sympathetic reaction to a hypo mobile segment (sympathetic trunks lie on or just lateral to CV joints in thorax)
59
Q

what are the sxs of T4 syndrome?

A
  • paresthesia, numbness, or UE pains associated with/without HA and upper back stiffness
  • glove like distribution of hand or forearm pain
  • does not follow dermatomes, not segmental distribution
  • often misdiagnosed as TOS
  • no hard neurological signs
  • non traumatic onset common
60
Q

T4 Syndrome exam

A
  • tenderness bony points, prominence or depression of one or more SP, positive slump and or ULTT, stiffness of one segment, gross ROM WNL, glove-like sensory
61
Q

Interventions for T4 Syndrome

A
  • MOBILITY: MOBILIZATION MOBILIZATION MOBILIZATION
  • emphasis on upper thoracic flexibility (rotation/SBing)
  • neural mobilization
  • postural education
62
Q

there is evidence to support use of thoracic spine manipulation in patients with…

A
  • neck pain

- shoulder pain/shoulder impingement and/or rib pain, and cervical pain

63
Q

What is TOS?

A
  • deep aching pain in the neck and shoulder region, paresthesia, muscle atrophy/weakness, stiffness, coldness, swelling, skin changes
  • combination of neurological and vascular signs with pain
64
Q

diagnosis of TOS is usually one of…

A

exclusion

65
Q

Common sites of compression causing TOS

A
  • costoclavicular space
  • interscalene triangle
  • beneath pectorals minor tendon and coracoid process
66
Q

intervention strategies for TOS

A
  • addressing any contributing factors
  • mobilization
  • postural education and training
  • control of any inflammatory process
  • strengthening
67
Q

Contributing factors to TOS

A

pg 12

68
Q

Criteria for diagnosis of ankylosing spondylitis

A
  • LBP > 3 months improved by exercise, not relived by rest
  • limitation of Lx motion, sagittal and frontal planes
  • limitation of chest expansion relative to normal values for the age and sex
69
Q

initial complaint of ankylosing spondylitis

A

typically chronic pain and stiffness in the mid spine or whole spine, often with unilateral or bilateral buttock/posterior thigh pain from the SIJ
(marked SB limitation)

70
Q

intervention strategies for ankylosing spondylitis

A
  • Lx fuses < Tx
  • goal is to maintain upright posture prior to full fusion
  • activity modification (avoid high impact)
  • postural ed/pt ed
  • breathing exercises for chest expansion
  • stretching, strengthening, stabilization
  • *****Joint mobs grade I-II for pain modulation at non-fused segments
71
Q

Scoliosis

A
  • defined as a spinal curvature of greater than 10 degrees in upright posture (deformity in frontal and sagittal planes)
  • most common: R thx, L thx curve can be a sign of a hidden problem
72
Q

3 types of scoliosis

A
  • congenital
  • neuromuscular
  • idiopathic
73
Q

congenital scoliosis

A
  • atypical vertebral development (around 45-60 days gestation)
  • may be associated with other congenital anomalies
74
Q

neuromuscular scoliosis

A
  • curves due to muscular or neurological disorders (low/weak tone)
  • starts at an early age, progressive from flexible to structural
75
Q

idiopathic scoliosis

A

70-80% of all cases

later onset and self limiting

76
Q

Characteristics of idiopathic scoliosis

A
  • More common in girls than boys
  • small curves affect boys/girls equally (<10)
  • curves >20- 10:1 female dominance
  • deformity usually progresses until bone growth ceases (age 16-18)
  • remains static until middle age when disc degeneration on concave side leads to pain
77
Q

Rib hump exam

A

rotation of the vertebra toward the convex side

78
Q

intervention strategies for scoliosis

A
  • exercise: strengthen convex side, stretch concave side, schroth method
  • bracing
  • surgery
79
Q

Non-structural scoliosis

A

can be caused by:

  • leg length discrepancy
  • muscle guarding
  • lateral shift
  • habitual postures
80
Q

Review differential diagnosis man chart thing

A

pg 16

81
Q

Check you understanding slides!!!

A

Interventions II (8 decks)

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