Kyphosis Flashcards
Kyphosis can be a common source of what kind of pain?
musculoskeletal pain
Define kyphosis.
abnormally increased convexity in the curvature of the thoracic spine; hunchback
List two types of kyphosis
Arcuate (Kyphosis arcuata); Angulate (Kyphosis angulate, Gibbus deformity)
What is the normal Cobb angle for the kyphotic curve?
25-45 degrees
How is the kyphotic Cobb angle curved measured?
Parallel lines to T1 and T12, 90 degree line, measure angle
How can an increased kyphotic curve affect the respiratory system?
decreased chest wall mobility, impaired ventilation of lungs, decreased clearance of mucus (pulmonary infection), and increased load on diaphragm
How can an increased kyphotic curve affect the circulatory and lymph system?
decreased venous return to the heart and decreased lymphatic return to the venous system
What is the minimum number of flexed thoracic segments needed to increase the thoracic kyphosis?
one
What can cause increased antero-posterior diameter increase or”barrel chest” ?
inhaled ribs, asthma, emphysema, anterior failure of segmentation (congenital) , weak paraspinal musculature, postural collapse, increased lumbar lordosis, kyphoscoliosis
List some causes of weak paraspinal musculature
deconditioning, radiation, neurologic disease (polio), neurofibromatosis, muscular dystrophy, myopathies
List individuals who are prone to postural collapse.
office workers, students, surgeons, cyclists
In osteoporosis, trabecular microfractures lead to this…
vertebral wedging which leads to increased kyphosis
Osteochondrosis of the vertebral endplate growth plates
Sheurmann Disease
When does Scheuermann Disease develop
during adolescence ; 10-16 increased kyphosis
Can Scheuermann disease be straightened?
Not with muscular effort
Patient comes in with fatigue, increased kyphosis, back pain. During testing straight leg raising is limited by hypertonic hamstrings.
Scheuermann Disease
Treatment options include mild? moderate? severe?
OMT & excercise; bracing; surgery
What radiographic findings might be present in Scheurmann disease?
increased thoracic kyphosis; vertebral wedging, undulating endplate, Schmorl node formation; MUST affect THREE adjacent segments
Positive Adam’s test may indicate what disease?
Scheuermann Disease
Patient comes in bent forward to reduce pressure on painful joints. What may be the cause?
Facet joint arthritis
Upon radiographic imaging, disc narrowing is seen with shorter vertical height anteriorly. What is the cause and effect?
Degenerative disc disease; increased kyphosis
Genetic predisposition and an immune trigger could cause this.
Ankylosing Spondylitis
What is ankylosing spondylitis?
ligaments, disc and facet joints turn to bone
What is Paget’s disease, Osteitis deformans?
trabecular microfracturing with vertebral wedging
An elderly man with history of smoking comes in complaining of bone ache, headaches and vertigo. What could be a possible cause?
Osteitis deformans
Why is cardiac failure seen in many cases of osteitis deformans?
Adnormal bone is highly vascular and creates shunts. Heart cannot keep up.
What does this image show?
Osteitis deformans
How can osteitis deformans be treated?
•Disease may be suppressed with bisphosphonate class of medications
What disease has characteristic candle wax osteophytes?
DISH Diffuse Idiopathic Skeletal Hyperostosis
DISH
What are the signs of ochronosis?
spontaneous fractures, calcification of cartilage, osteoporosis
Urine lefrt to stand will turn from yellow to blue-gray, brown or black
What is the etiology of ochronosis?
Congenital defect in tyrosine and phenylalanine metabolism which causes alkaptonuria
What can cause angulate kyphosis?
vertebral compresion fracture, congenital failure of formation of vertebral body, osteoporosis, Pott disease, osteogenesis imperfecta “brittle bone disease”, metastic cancer
List the types of treatment for kyphosis.
OMT, exercise, postural reeducation, mattress & pillow, bracing, traction, pain mgmt, surgery
Pott Disease
What is the purpose of postural reeducation?
works to retrain proprioceptive input and interpretation
What type of mattress and pillow should be used?
firm mattress, low pillow
Which medications should be used in the pain management of kyphosis? Which are of no benefit?
Acetaminophen, NSAIDS
Muscle relaxants are of no benefit in lordosis/kyphosis
What types of surgery are available and what is the maximum age of effectiveness?
fusion surgery, osteotomy and instrumentation, balloon kyphoplasty (new fractures only)
Age 25
