L5 Flashcards by Deleted Deleted

What are three predisposing factors to TOS?

work postures
whiplash
trauma

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What is the most common TOS distrubition?

ulnar nerve distribution

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What are 7 common etiology of TOS?

repetitive overhead activities
cervical rib
clavicle fx
trauma
scar tissue
upper cross
scalenes

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What are the three most common symptoms of TOS?

numbness/tingling
weakness/fatigue
swelling

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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

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TOS is most specifically tested with:

3-5 tests
adson, wrights and roos (EAST) are best when combined

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What is the diagnostic criteria of TOS?

aggravated w elevated arms
C8/T1 dermatome paresthesia
tenderness over brachial plexus
Positive ROOS/EAST test

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What are some medical management of TOS?

corticosteroids
botox
NSAIDS
referral to DC/PT
scalenectomy

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What are some Chiropractic management of TOS?

rehab (non-surgical)
Patient education
activity modification
manipulation
MSTM of hypertonic muscles
postural needs

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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

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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

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What are some T4 evaluations?

radiographs do not help
no validated clinical criteria
subjective and objective findings may help

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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

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What are some T4 syndrome medical management?

intramuscular injections
gabapentin
pain medication

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what postural position hurts in T4 syndrome?

Extension

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Give a brief description of the prognosis of thoracic disc herniations

rare and usually asymptomatic
<4.5% all disc ruptures
most occur T11/T12

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myelopathy from T spine disc herniations are most likely in:

central thoracic disc hernations

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MRI findings of thoracic disc herniations:

37% had herniation
usually asymptomatic
can be considered normal variant

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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

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What are some red flags of thoracic disc hernations?

myelopathy
gait disturbance
paralysis
history of cancer, trauma, infection, weight loss
night sweats

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The following 6 FACTORS MUST BE RULED OUT with Thoracic Disc Herniation

shingles
rib fx
malignancy
NF1
scheuermanns
tietze syndrome

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What is Brown-Sequard Syndrome?

Hemisection of spinal cord:
Ispi loss of vibration and spastic below
contra loss of P+t below and down

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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

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What are some medical management of thoracic disc herniation?

narcotic pain medication (severe short time)
NSAIDS
injections of anti-inflammatory
surgical

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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?

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