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OMM M1T2 test 1 > Kyphosis > Flashcards

Kyphosis Flashcards

0
Q

Although some curve abnormalities may be asymptomatic, they may also be what?

A

They may be significant to the overall function of the organism.

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1
Q

Abnormal spinal curves are a common source of what?

A

Musculoskeletal pain

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2
Q

Define kyphosis.

A

Abnormally increased convexity in the curvature of the thoracic spine as viewed from the side. It is a deformity of the spine characterized by extensive flexion.

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3
Q

What are the 2 types of kyphosis, and which is more common?

A

Arcuate (kyphosis arcuata) - looks like “)”; more common one

Angulate (kyphosis angluata; Gibbus deformity) - looks like “>”

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4
Q

When can you see kyphosis angulata on a patient?

A

When the patient is bent over.

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5
Q

What is the Cobb angle normal measurement of kyphosis?

A

25-45 degrees; measure from start to end of thoracic vertebrae to find the angle where perpendicular angles meet.

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6
Q

What are the effects of increased kyphosis?

A

Decreased chest wall mobility
Impaired ventilation of lungs
Decreased venous return to the heart
Decreased lymphatic return to the venous circulation
Decreased clearance of mucus from the small airways
Increased load on diaphragm
Sympathetic nervous system disturbances

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7
Q

What will significantly increase the thoracic kyphosis?

A

The presence of multiple flexed thoracic segmental dysfunctions; a single flexed dysfunction increases the kyphosis slightly.

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8
Q

Can you palpate somatic dysfunction caused by flexed thoracic segments by running a hand lightly down the spinous processes?

A

Yes

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9
Q

What is an etiology of arcuate kyphosis?

A

Any condition which increases the antero-posterior diameter of the chest.

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10
Q

What is a somatic dysfunction that will increase the anteroposterior diameter of the chest and tend to flex the thoracic spine into a kyphotic posture?

A

Multiple rib dysfunctions held in a position of inhalation.

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11
Q

Name 2 air trapping conditions and what they result in.

A

Asthma & emphysema - barrel chest.

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12
Q

Name a congenital cause of kyphosis.

A

Anterior failure of segmentation.

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13
Q

Name conditions that can lead to acquired kyphosis.

A

Weak paraspinal musculature, postural collapse, increased lumbar lordosis, scoliosis, osteoporosis, Scheuermann disease, osteoarthritis, ankylosing spondylitis, osteitis deformans, diffuse ideopathic skeletal hyperostosis (DISH), ochronosis, Pott disease, osteogenesis imperfecta

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14
Q

What are some causes of paraspinal musculature?

A 
Deconditioning
Radiation therapy or exposure
Neurologic disease (polio)
Neurofibromatosis
Muscular dystrophy
Myopathies
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15
Q

What is the consequence of increased lumbar lordosis?

A

A secondary compensatory increase in the thoracic kyphosis (via a condition e.g. spondylolisthesis).

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16
Q

What is osteoporosis?

A

Diffuse vertebral wedging caused by trabecular microfractures. The best treatment is prevention.

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17
Q

What are trabecular microfractures?

A

Bone cracks internally, collapses into itself.

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18
Q

Define Scheuermann disease.

A

Osteochondrosis of the vertebral endplate growth plates. It’s a developmental illness in which growth plates don’t work as they should. Affects 1-2% of the population (females:males; 2:1). Appears during adolescence. Ages 10-16 progressive kyphosis. Curve cannot be straightened with muscular effort.

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19
Q

What are symptoms of Scheuermann disease?

A

Back pain (usually upper thoracic or neck, but can be lumbar); fatigue; long term increased incidence of thoracic, lumbar, and cervical degenerative disc disease.

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20
Q

Straight leg raising is limited by what?

A

Hypertonic hamstrings as a result of the increased pelvic tilt accompanying lordosis.

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21
Q

What is treatment for Scheuermann disease?

A

Mild - OMT & exercise
Moderate - bracing (Milwaukee type)
Severe - surgery (same as scoliosis)

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22
Q

What are radiographic findings of Scheuermann disease?

A 
Increased thoracic kyphosis
Vertebral wedging
Undulating endplate
Schmorl node formation
Must affect at least 3 adjacent vertebral segments
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23
Q

What is the Adams Test and what does a positive test indicate?

A

Stand straight, then flex forward. A positive test indicates Scheuermann disease - see kyphotic hump.

24
Q

What clinical manifestation might you see with a patient who has facet joint arthritis?

A

Patient will involuntarily bend forward to reduce pressure on painful joints.

25
Q

How might degenerative disc disease affect kyphosis?

A

Shape of kyphosis is determined by the shape of the vertebrae. If disc narrowing occurs with a shorter vertical height anteriorly, the kyphosis will worsen.

26
Q

What are the clinical manifestations of ankylosing spondylitis?

A

Rigid kyphosis despite the loss of lumbar lordosis; hip and knee flexion contractures.

27
Q

What is ankylosing spondylitis?

A

Swollen and inflamed joints that eventually fuse (at the affected vertebrae).

28
Q

Describe the 2011 study by Laura A. Passalent (Toronto Western Hospital; University of Toronto, Ontario, Canada) - “Physiotherapy for Ankylosing Spondylitis: Evidence and Application.”

A

32 patients with Ankylosing Spondylitis were either given home stretching exercises or manual spinal mobilization for relief of symptoms. Patients ossified between thoracic vertebrae were excluded. Outcome: saw gains in posture, mobility, and the BASMI index that were maintained over a 6 month time period.

29
Q

What treatments did the patients of Passalent’s study receive?

A

Warming soft tissues of back muscles
Active & passive spinal column mobility exercises
Stretching of tight muscles using post-isometric relaxation
Manual massage

30
Q

What were the outcomes of Passalent’s study?

A

Improved: chest expansion, vital capacity, posture, spinal mobility, BASMI Index (symptom index)

31
Q

What is Paget Disease of Bone Osteitis Deformans?

A

Trabecular microfracturing with vertebral wedging; seems to be common in smokers and alcoholics.

32
Q

Who is Paget disease named after?

A

Sir James Paget, M.D.; 1814-1899 London surgeon.

33
Q

Who is most likely to have Osteitis Deformans?

A

Common in elderly, mostly men. Etiology is unknown, but is believed to be an unidentified virus.

34
Q

What are symptoms of Osteitits Deformans?

A

Bone ache, back pain, headache, tinnitus/vertigo

35
Q

What are 2 potential clinical manifestations of osteitis deformans?

A

High output cardiac failure - abnormal bone is exceptionally vascular and acts as an arteriovenous shunt.
Osteosarcoma (< 3%) - increased pain & skin temperature overlying tumor, single bone enlargement, massive increase in serum Alkaline Phosphatase

36
Q

How does osteitis deformans present on film?

A

Cotton wool appearance; increased osteoclast & osteoblast activity.

37
Q

What is the treatment for osteitis deformans?

A

No known cure, but disease may be suppressed with bisphosphonate class of medications.

38
Q

What other condition should you check for if your patient has a positive diagnosis of DISH?

A

Diabetes

39
Q

What are some characteristics of DISH (diffuse idiopathic skeletal hyperostosis)?

A

Believed to be autoimmune; etiology unproven
More common in men
1% of population at age 50
Statistical association with Type II Diabetes Mellitus
Characteristic candle wax osteophytes

40
Q

What shape does the spine take with DISH?

A

Spine looks like a wine bottle.

41
Q

What is the etiology of ochronosis?

A

Congenital defect in tyrosine & phenylalanine metabolism
Alkaptonuria - gives a false (+) test for urine glucose on dip stick
Urine will turn from yellow to blue-grey/brown/black if left sitting out

42
Q

What are clinical manifestations of ochronosis?

A 
Arcuate kyphosis is rigid
Spinal arthritis
Osteoporosis
Spontaneous fractures
Calcification of cartilage
43
Q

What causes angulate kyphosis?

A

It is sometimes congenital, but most often caused by vertebral compression fracture - immediately think broken spine.

44
Q

What would be a congenital cause of angulate kyphosis?

A

Congenital failure of formation of vertebral body (fairly uncommon).

45
Q

What is osteoporosis?

A

Compression fracture; bone telescopes into itself with no displacement of fracture fragments. Not very painful; most patients just think they pulled a muscle.

46
Q

How do you check for osteoporosis?

A

Do serial heights. Any sudden height loss of an inch or more - suspect compression fracture.

47
Q

What is our height difference in a.m. compared to p.m.?

A

1 inch taller in morning

48
Q

What are other causes of compression fracture, besides osteoporosis?

A

Tuberculosis osteomyelitis - Pott disease. See a lot coming out of SE Asia, lower socioeconomic regions.
Metastatic cancer - breast, GI, kidney, lung, prostate, thyroid
Osteogenesis imperfecta

49
Q

What are the treatment options for kyphosis?

A 
OMT
Exercise
Postural Re-education
Mattress & pillow
Bracing
Traction in extension
Pain management
Surgery
50
Q

How is OMT used to treat kyphosis?

A

Used especially for any flexed dysfunctions or inhalation rib dysfunctions, but may also treat any restricted spinal segments or ribs in an effort to improve and maintain range of motion to aid the success of other interventions.

51
Q

How is exercise used to treat kyphosis?

A

Treatment/prevention - strengthen upper thoracic paraspinal muscles and/or stretch kyphosis over a foam roll/rolled up towel.
Abdominal strengthening - increased abdominal strength increases the pressure of the viscera against the diaphragm and lumbar spine, helping to prevent further collapse.

52
Q

How does postural re-education help with kyphosis?

A

Patients often accept their collapsed posture as normal, feeling off balance or backward-bent when placed in a correct position. Postural re-education works to retrain proprioceptive input and interpretation.

53
Q

What do a firm mattress and low pillow do for kyphosis?

A

Help prevent progression of it.

54
Q

What types of kyphosis are treated by bracing?

A

Adolescent or acute compression fracture

55
Q

What is the pain management regimen for kyphosis?

A

Acetaminophen or NSAIDs - most discomfort can be managed with these 2 drugs.
Muscle relaxants are of NO benefit.

56
Q

If you see no improvement with the use of acetaminophen and NSAIDs for kyphosis, what should you do?

A

Rethink your diagnosis.

57
Q

What types of surgery would you do to correct kyphosis?

A

Fusion surgery, osteotomy and instrumentation (same as scoliosis surgery).
Balloon kyphoplasty - for new fractures only.

OMM M1T2 test 1 (14 decks)

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