L18 Thoracic Disorders Flashcards
where do most thoracic spine fractures occur?
lower thoracic spine
70% at TL junction
anterior wedge compression fracture moi
hyperflexion
axial load
fall or MVA, can be minor in pt w bone compromise like older pt
burst fracture moi
axial load from fall landing on bottom or LE
thrust/manip in pt with OP?
contraindication to T/S and ribcage in prone or supine
precaution in seated, consider degree of OP
diagnosing OP
need two area of altered bone mineral density w a DEXA scan
commonly hip, back, arm
T scores of osteoporosis
normal - within 1 SD of normal
osteopenia - 1-2.5 SD below normal adult
osteoporosis - 2.5 SD+ below normal adult
severe - 2.5 or more below normal adult
OP risk factors
alcohol
smoking
weight - low BMI
coexisting disease
drug treatment
How can PT intervention help OP?
exercise to build bone or decrease loss
proper posture
improve balance to reduce fall risk
provide weight bearing and resistance at appropriate level for pt
30 min daily weight bearing exercise
strength 2-3x week
balance/posture: daily
prevent wedge/compression fracture
promote spinal extension
discourage sleeping w multiple pillows in flexion
sustain erect posture
log roll to minimize flexor moment
walking
weight bearing
spinal brace pain
resistance training: important muscle groups
hip abduction
hip extension
quads
back extensors
shoulder musculature
activities to avoid in OP pts
avoid twisting, forward bending, sit ups, posterior pelvic tilt
heavy lifting, poor posture, sedentary
expected benefit of PT on OP
small if any effect on gaining bone mass (1-2%), prevent bone loss
reducing muscle mass loss
may reduce fall risk by improving strength/balance
decrease hip fx risk
scoliosis definition
3d deformity in sagittal, coronal, and transverse planes
>10 degrees lateral deformity
multiple planes due to coupled motion
types of idiopathic scoliosis
infantile, juvenile, adolescent, or adult
causes include familial, hormonal changes, change in cell structure
known etiologies of scoliosis
congenital: asymmetrical vertebral growth
geneitc: marfan’s, connective tissue disorder
neuromuscular: CNS like syrinx, chiari, spina bifida
neuropathic
tumor
trauma
how to name a scoliosis curve
name by convexity - whichever side it curves towards
part of spine - t/s, l/s, TL
name apex of curve - segment level
dextro = right, levo = left
shapes of scoliosis curves
C curve
S curve
angle of scoliosis is called
cobb measurement
scoliosis prevalence - population
2-3% have >10 degree curve
right curve more common
C curve more common
males more commonly get infantile/juvenile
females get adolescent
what structures are affected in scoliosis
vertebrae are wedge shaped
poorly developed concave side
rotated pedicles
wedge shaped disc
spinous process deviates
rib pushed postioer and narrower on convex side
structural vs non structural scoliosis
structural: spine has lateral curvature and rotation
non structural: spine has lateral curve but not due to structural abnormality, but habit or disease process
correcting non structural scoliosis
forward or side bending
disappears in supine/prone
muscle contraction
positional changes to spinal or pelvic alignment
correction of leg length discrepancy
causes of non structural scoliosis
postural
compensatory - leg length
sciatic
inflammatory
hysterical
king’s classification
double curve crossing midline
l/s or t/s could be larger
t/s crossing midline, lumbar curve not crossing midline
long thoracic curve w L5 centered over sacrum and L4 tilting
t/s with T1 tilting to upper curve
s/s of scoliosis
back pain
leg length discrepancy
abnormal gait
uneven hips
clothes not fitting correctly
one shoulder higher than other
findings on physical exam of scoliosis
uneven shoulder height
1 prominent shoulder bladder
increased space between arm and body
uneven hips
one breast larger than other
chest/rib prominence
one leg longer than other
appearance of leaning
adam’s test
bend forward and assess for spinal alignment and rib hump
pt puts their hands together with feet together
can measure angle here
pathophys based on cobb angle
10: normal curve
25+ echo evidence of pulm artery pressure
40+ surgical intervention
65+ restrictive lung disease
100+ dyspnea on exertion
120+ alveolar hypoventilation
treatment: observation, is appropriate for what angles?
<20 degrees with monitoring every 6 mo
bracing is appropriate treatment for what degrees?
25-40
control progression but don’t reverse
must be used in children who are growing
types of scoliosis bracing
milwaukee brace - up to c spine, sits on pelvix
boston brace - most common
charleston brace - bending brace
success rate of correctly worn braces
74%
boston brace
worn 16-23 hours a day
prevent curve progression to avoid surgery
milwaukee brace
indicated for scoliosis or schuermann disease to stop curve progression
worn 23 hours a day in growing children
charleston brace
over corrects a curve by bending to the other side
for small lumbar or small TL curve
worn only while sleeping 8-10 hours
single curve
providence brace
best for single curves
less effective
worn 8-10 hours at night
surgery is best option for what scoliosis
best option for severe curves
fuse vertebrae and address risk to lung and heart function
indications for surgery scoliosis
spinal curves >45
trunk deformity
pain
deteriorating cardiopulm function
family history of severe scoliosis
cosmetic appearance
goals of surgery for scoliosis
correct curve
prevent progression
relief of back pain
maintain posture
prevent cardiopulm dysfunction
surgical options for scoliosis
spinal fusion: posterior, anterior, thoracoscopic
spinal intrumentation without fusion
crank shaft phenomenon
progression and rotation of curve due to growth of anterior part of spine and fused posterior part
ther ex for scoliosis
symmetrical exercises - strengthen back and abs
breathing
asymmetrical exercise - lengthen shortened muscles, strengthen lengthened muscles
static body weight hanging/traction to release spinal tension
PT intervention for scoliosis can include
derotation exercise
QP exercise
breathing
balance
aerobic
education on posture
schuermann kyphosis
hyperkyphosis/hyperflexion of t/s due to shape of vertebrae being wedged forward
anterior wedging with possible end plate cracking
schuermann disease population
pubescent athletes
male and female
schuermann disease presentation
pain w extension and rotation or movements correcting curve
pain w PA
schuermann disease treatment
postural reed
mod aggravating activity
regain motion
bracing
stretching pecs
strengthening t/s extensors and scap retractors
T4 syndrome
upper thoracic syndrome
pattern of upper extremity paresthesia
can be caused by hypomobility or sympathetic origin
s/s of T4 syndrome
upper extremity paresthesia
pain with/without head/neck symptoms
glove like distribution
without neurovascular symptons
rule out thoracic outlet, nerve root compression
+ ULTT
limited T/s mobility
improves with mobilization
early morning symptoms
headache
temp, swelling, clumsiness
T4 syndrome treatment includes
RICE
HVLAT/mobs to t/s
trigger point release
postural reed
stretching and strengthening
tietze syndrome
local inflammation to costosternal junction, cartilaginous attachment
self limiting
worse w breathing, cough, sneeze
2nd/3rd costochondral
tietze syndrome treatment
local injections
joint mobs
slipping rib syndrome
hypermobility of rib cage
most commonly 11/12th ribs
slipping rib syndrome treatment
pt edu
pain management
HVLAT
MWM
mobs
taping
