L5 Flashcards
What are three predisposing factors to TOS?
work postures
whiplash
trauma
What is the most common TOS distrubition?
ulnar nerve distribution
What are 7 common etiology of TOS?
repetitive overhead activities
cervical rib
clavicle fx
trauma
scar tissue
upper cross
scalenes
What are the three most common symptoms of TOS?
numbness/tingling
weakness/fatigue
swelling
Provide a brief overview of TOS evaluation (dont need to be 100% on this card)
Cervical, shoulder, thoracic ROM
allens (not true test)
adson, edens, wrights
ROOS (EAST)
hostage
bakody/reverse
C5-T1 MRS
rule out cervical radiculopathy
rule out peripheral neuropathy
TOS is most specifically tested with:
3-5 tests
adson, wrights and roos (EAST) are best when combined
What is the diagnostic criteria of TOS?
aggravated w elevated arms
C8/T1 dermatome paresthesia
tenderness over brachial plexus
Positive ROOS/EAST test
What are some medical management of TOS?
corticosteroids
botox
NSAIDS
referral to DC/PT
scalenectomy
What are some Chiropractic management of TOS?
rehab (non-surgical)
Patient education
activity modification
manipulation
MSTM of hypertonic muscles
postural needs
What is T4 syndrome?
diagnosis of exclusion
originally theorized from sympathetic nerve fibers
head- T1-T4
trunk-T2-T5
head neck and upper extrem symptoms
What are some symptoms of T4 syndrome?
unremarkable history
paresthesia in glove like pattern
interscapular pain
upper quad pain (DDx cardiac)
sub occipital pain
non dermatomal and vague
What are some T4 evaluations?
radiographs do not help
no validated clinical criteria
subjective and objective findings may help
What would be some chiropractic exam of T4 syndrome?
postural analysis
active ROM C and T spine
MRS
motion palpation
Tenderness of T3-T5
soft tissue palpation
What are some T4 syndrome medical management?
intramuscular injections
gabapentin
pain medication
what postural position hurts in T4 syndrome?
Extension
Give a brief description of the prognosis of thoracic disc herniations
rare and usually asymptomatic
<4.5% all disc ruptures
most occur T11/T12
myelopathy from T spine disc herniations are most likely in:
central thoracic disc hernations
MRI findings of thoracic disc herniations:
37% had herniation
usually asymptomatic
can be considered normal variant
What are the most common symptoms of thoracic disc herniation?
asymptomatic
thoracic pain
groin, flank, upper/lower extrem pain
chest pain, epigastric pain
paresthesias
bowel/bladder dysfunction and gait disturbance
What are some red flags of thoracic disc hernations?
myelopathy
gait disturbance
paralysis
history of cancer, trauma, infection, weight loss
night sweats
The following 6 FACTORS MUST BE RULED OUT with Thoracic Disc Herniation
shingles
rib fx
malignancy
NF1
scheuermanns
tietze syndrome
What is Brown-Sequard Syndrome?
Hemisection of spinal cord:
Ispi loss of vibration and spastic below
contra loss of P+t below and down
What are some clinical exam of thoracic disc herniation?
active/passive ROM
thoracic spine MRS
cervical/lumbar exams to rule out radic
valsalva
flexion provocative
extension palliative
What are some medical management of thoracic disc herniation?
narcotic pain medication (severe short time)
NSAIDS
injections of anti-inflammatory
surgical
advanced neurological deficits are ____
contraindication for conservative management
What are some ethologies of costovertebral joint dysfunction?
trauma/spasm
severe trauma=dislocate
AS and thoracic spine presents with:
sternclavicular
sternomanubrial
costovertebral joints
all increase rigidity of the T spine w kyphosis
What are some symptoms of costovertebral joint dysfunction:
“shot by an arrow”
sharp stabbing pain
radiating on anterior chest wall
unilateral
pain with deep inspiration
coughing sneezing laughing
costovertebral joint dysfunction may be diagnosed as:
cardiac/pulmonary dysfunction
clinical examination of costovertebral joint dysfunction:
active/passive ROM
rib motion test
adams test (Scolio)
shepelmanns
hypomobility of joints
palpate
rule out other causes
What is intercostal neuritis?
sharp radiating, burning, stabbing pain along ribs, chest, abdomen
band like pain in dermatomal pattern
What is the cause of causes of intercostal neuritis?
herpes zoster
disc herniation
post surgical
trauma
cancer
What are some clinical exam of intercostal neuritis?
active/passive ROM
shepelmanns (towards)
thoracic MRS
rule out other red flag
CT/MRI may be needed
What are some medical management of intercostal neuritis?
corticosteroids/NSAIDS
nerve blocks
treat underlying condition
intercostal neuritis chiropractic management:
e stim
topical pain reliefs
ST
mobilization
acupuncture
rehabilitation exercises (spine and core)
What is Costochondritis?
inflammation of the costal cartilage
(chest pain)
What are some symptoms/evaluation of costochondritis?
chest pain worse with inhalation
sharp/dull
reproducible with palpation
normal vitals
rib motion test
What is the criteria for scheuermanns dx?
5 degrees of anterior body wedging for 5 continuous segments
diagnosed in 12-17y/o
hunchback
What is the etiology of scheuermann’s disease?
osteochondrosis of vertebral plates with disturbances in epiphyseal ring
associated with schmorls nodes, wedging, smooth kyphosis
ddx of smooth kyphosis of scheurmanns:
ddx with gibbous deformity of TB
Symptoms of Scheuermann’s disease:
tight hamstrings(lengthened)
hyperlordosis
20-60% painful
What are some clinical eval of scheuermanns disease?
hyperkyphosis
increased lumbar and C spine lordosis
decrease ROM
adams test for accompanying scoliosis
tight pecs and hamstrings
What are some medical management of scheuermanns?
<60 and non-symptomatic: NSAIDS, PT, exercise
60-80 and asymptomatic:
malkwaukee brace 12-24 months
>75 degree and symptomatic: fusion due to neurological deficit
chiropractic management of scheuermanns?
bracing
observe changes
postural exercises
strengthen extensors/hamstrings
stretch pecs
can adjust
What are some compression fx facts?
T12/midthoracic mc
mc due to osteoporosis
vertebrae plana vs compression fx
unstable and associated with mets and myeloma
x ray findings of acute compression fx:
zone of condensation
step defect
paraspinal stripe
chiropractors cannot manage what red flag mainly?
fx
jewitt hyperextension brace is used for:
compression fx
conservative management of compression fx
pain medication:
bracing
PT (aerobic, back strengthen)
rest has been shown to do the following 2 things within the thoracic spine:
accelerate osteoporosis, pulmonary complications, circulatory problems
surgery for compression fx:
vertebroplasty/kyphoplasty
causes of scoliosis:
Idiopathic - 80%
Congenital
Neuromuscular
Acquired
(NF, klippel-feil, marfans)
structural vs functional scoliosis:
structural- rib humping on forward bend
functional-disappears with forward bend
usually due to short leg
clinical eval of scoliosis:
non-pathological before 20 degree with rib hump
spinal cord displaced toward concave side and does not rotate
convex side nerve roots are tractioned and intrinsic spine muscles get weaker
best non-invasive test for scoliosis:
adams test
monitors of progression of scoliosis:
cobbs method
nash moe(rotation)
rissers sign
tanner staging
medical management of scoliosis:
milwaukee brace
harrington rods
chiropractic management of scoliosis:
postural advice
strengthen intrinsic muscles
taping
adjust into convexity not concavity
chiropractic and scoliosis:
you cannot correct the curve
you treat symptoms with ST and adjusting
add stability before mobility
thoracolumbar syndrome:
maigne syndrome
T10-L2 segmental dysfunction
entrapment of cluneal nerves from thoracolumbar fascia
referred pain in maignes syndrome:
hip
groin
LS
SI
symptoms of maigne syndrome:
no pain at TL junction
pain in low back, groin, hip, abdomen
mimics trochanteric bursitis (not as severe)
clinical evaluation of maigne syndrome:
palpation of TL reproduces pain
ROM
hypersensitivity over glutes and iliac crest
rule out nerve tension
rule out hip, SI, radiographic causes, abdominal exam
medical management of thoracolumbar syndrome:
nerve block is diagnostic for maignes syndrome if pain goes away
Chiropractic management of vertebroplasty:
Adjustments are tolerated and allowed following complete healing
Unless osteoporosis compression fx
