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Evidence Based Managment > L5 > Flashcards

L5 Flashcards

1
Q

What are three predisposing factors to TOS?

A

work postures
whiplash
trauma

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2
Q

What is the most common TOS distrubition?

A

ulnar nerve distribution

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3
Q

What are 7 common etiology of TOS?

A

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

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4
Q

What are the three most common symptoms of TOS?

A

numbness/tingling
weakness/fatigue
swelling

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5
Q

Provide a brief overview of TOS evaluation (dont need to be 100% on this card)

A

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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6
Q

TOS is most specifically tested with:

A

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

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7
Q

What is the diagnostic criteria of TOS?

A

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

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8
Q

What are some medical management of TOS?

A

corticosteroids
botox
NSAIDS
referral to DC/PT
scalenectomy

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9
Q

What are some Chiropractic management of TOS?

A

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

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10
Q

What is T4 syndrome?

A

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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11
Q

What are some symptoms of T4 syndrome?

A

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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12
Q

What are some T4 evaluations?

A

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

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13
Q

What would be some chiropractic exam of T4 syndrome?

A

postural analysis
active ROM C and T spine
MRS
motion palpation
Tenderness of T3-T5
soft tissue palpation

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14
Q

What are some T4 syndrome medical management?

A

intramuscular injections
gabapentin
pain medication

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15
Q

what postural position hurts in T4 syndrome?

A

Extension

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16
Q

Give a brief description of the prognosis of thoracic disc herniations

A

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

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17
Q

myelopathy from T spine disc herniations are most likely in:

A

central thoracic disc hernations

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18
Q

MRI findings of thoracic disc herniations:

A

37% had herniation
usually asymptomatic
can be considered normal variant

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19
Q

What are the most common symptoms of thoracic disc herniation?

A

asymptomatic
thoracic pain
groin, flank, upper/lower extrem pain
chest pain, epigastric pain
paresthesias
bowel/bladder dysfunction and gait disturbance

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20
Q

What are some red flags of thoracic disc hernations?

A

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

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21
Q

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

A

shingles
rib fx
malignancy
NF1
scheuermanns
tietze syndrome

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22
Q

What is Brown-Sequard Syndrome?

A

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

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23
Q

What are some clinical exam of thoracic disc herniation?

A

active/passive ROM
thoracic spine MRS
cervical/lumbar exams to rule out radic
valsalva
flexion provocative
extension palliative

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24
Q

What are some medical management of thoracic disc herniation?

A

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

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25
Q

advanced neurological deficits are ____

A

contraindication for conservative management

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26
Q

What are some ethologies of costovertebral joint dysfunction?

A

trauma/spasm
severe trauma=dislocate

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27
Q

AS and thoracic spine presents with:

A

sternclavicular
sternomanubrial
costovertebral joints
all increase rigidity of the T spine w kyphosis

28
Q

What are some symptoms of costovertebral joint dysfunction:

A

“shot by an arrow”
sharp stabbing pain
radiating on anterior chest wall
unilateral
pain with deep inspiration
coughing sneezing laughing

29
Q

costovertebral joint dysfunction may be diagnosed as:

A

cardiac/pulmonary dysfunction

30
Q

clinical examination of costovertebral joint dysfunction:

A

active/passive ROM
rib motion test
adams test (Scolio)
shepelmanns
hypomobility of joints
palpate
rule out other causes

31
Q

What is intercostal neuritis?

A

sharp radiating, burning, stabbing pain along ribs, chest, abdomen
band like pain in dermatomal pattern

32
Q

What is the cause of causes of intercostal neuritis?

A

herpes zoster
disc herniation
post surgical
trauma
cancer

33
Q

What are some clinical exam of intercostal neuritis?

A

active/passive ROM
shepelmanns (towards)
thoracic MRS
rule out other red flag
CT/MRI may be needed

34
Q

What are some medical management of intercostal neuritis?

A

corticosteroids/NSAIDS
nerve blocks
treat underlying condition

35
Q

intercostal neuritis chiropractic management:

A

e stim
topical pain reliefs
ST
mobilization
acupuncture
rehabilitation exercises (spine and core)

36
Q

What is Costochondritis?

A

inflammation of the costal cartilage
(chest pain)

37
Q

What are some symptoms/evaluation of costochondritis?

A

chest pain worse with inhalation
sharp/dull
reproducible with palpation
normal vitals
rib motion test

38
Q

What is the criteria for scheuermanns dx?

A

5 degrees of anterior body wedging for 5 continuous segments
diagnosed in 12-17y/o
hunchback

39
Q

What is the etiology of scheuermann’s disease?

A

osteochondrosis of vertebral plates with disturbances in epiphyseal ring
associated with schmorls nodes, wedging, smooth kyphosis

40
Q

ddx of smooth kyphosis of scheurmanns:

A

ddx with gibbous deformity of TB

41
Q

Symptoms of Scheuermann’s disease:

A

tight hamstrings(lengthened)
hyperlordosis
20-60% painful

42
Q

What are some clinical eval of scheuermanns disease?

A

hyperkyphosis
increased lumbar and C spine lordosis
decrease ROM
adams test for accompanying scoliosis
tight pecs and hamstrings

43
Q

What are some medical management of scheuermanns?

A

<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

44
Q

chiropractic management of scheuermanns?

A

bracing
observe changes
postural exercises
strengthen extensors/hamstrings
stretch pecs
can adjust

45
Q

What are some compression fx facts?

A

T12/midthoracic mc
mc due to osteoporosis

46
Q

vertebrae plana vs compression fx

A

unstable and associated with mets and myeloma

47
Q

x ray findings of acute compression fx:

A

zone of condensation
step defect
paraspinal stripe

48
Q

chiropractors cannot manage what red flag mainly?

A

fx

49
Q

jewitt hyperextension brace is used for:

A

compression fx

50
Q

conservative management of compression fx
pain medication:

A

bracing
PT (aerobic, back strengthen)

51
Q

rest has been shown to do the following 2 things within the thoracic spine:

A

accelerate osteoporosis, pulmonary complications, circulatory problems

52
Q

surgery for compression fx:

A

vertebroplasty/kyphoplasty

53
Q

causes of scoliosis:

A

Idiopathic - 80%
Congenital
Neuromuscular
Acquired
(NF, klippel-feil, marfans)

54
Q

structural vs functional scoliosis:

A

structural- rib humping on forward bend
functional-disappears with forward bend
usually due to short leg

55
Q

clinical eval of scoliosis:

A

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

56
Q

best non-invasive test for scoliosis:

A

adams test

57
Q

monitors of progression of scoliosis:

A

cobbs method
nash moe(rotation)
rissers sign
tanner staging

58
Q

medical management of scoliosis:

A

milwaukee brace
harrington rods

59
Q

chiropractic management of scoliosis:

A

postural advice
strengthen intrinsic muscles
taping
adjust into convexity not concavity

60
Q

chiropractic and scoliosis:

A

you cannot correct the curve
you treat symptoms with ST and adjusting
add stability before mobility

61
Q

thoracolumbar syndrome:

A

maigne syndrome
T10-L2 segmental dysfunction
entrapment of cluneal nerves from thoracolumbar fascia

62
Q

referred pain in maignes syndrome:

A

hip
groin
LS
SI

63
Q

symptoms of maigne syndrome:

A

no pain at TL junction
pain in low back, groin, hip, abdomen
mimics trochanteric bursitis (not as severe)

64
Q

clinical evaluation of maigne syndrome:

A

palpation of TL reproduces pain
ROM
hypersensitivity over glutes and iliac crest
rule out nerve tension
rule out hip, SI, radiographic causes, abdominal exam

65
Q

medical management of thoracolumbar syndrome:

A

nerve block is diagnostic for maignes syndrome if pain goes away

66
Q

Chiropractic management of vertebroplasty:

A

Adjustments are tolerated and allowed following complete healing

Unless osteoporosis compression fx

Evidence Based Managment (8 decks)

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