MS1: Affectation of Spine and Thorax Flashcards
how many vertebrae are there and what are the divisions
33
- cervical: 7
- thoracic: 12
- lumbar: 5
- sacral: 5 fused into 1
- coccyx: 3-4
what are the curves in the VC
primary
- kyphotic: thoracic and sacral
secondary
- lordotic: cervical and lumbar
what is the normal thoracic kyphotic angle
AROUND 35 DEGREES or 20-45 deg
> 45 deg is hyperkyphosis
what is the normal lumbar lordotic angle
AROUND 60 DEGREES or 40-80
dec w age
60-70% of lordosis is at L4-S1
what are the causes of kyphosis
faulty posture
degen of IV discs
atrophy
collapse of vertebral body < postmenopausal and senile osteoporosis
what are the pathologic causes of kyphosis
chronic arthritis
osteitis deformans
poliomyelitis
fracture
TB
tumor
myeloma
myelomeningocele; children > lumbar or lumbosacral
what are the clinical features of kyphosis
deformity w or w/o pain, weak back and fatigue
- pain and tiring below apex
- tenderness if there is compression fracture is senile osteoporosis
- pain if tumor or infection
what is the treatment for kyphosis
maintain to correct posture
brace or corset
excersise > strengthen back and abdominals
rest on straight na higaan
treat the cause kung infection or tumor
what is dowagers hump
rounded hump > multiple anterior wedge compression fractures in middle to upper thoracic
due to post menopausal osteoporosis or steroids abuse
what is hump back
more steep bc single vertebra lang > anterior wedging of 1-2
due to infection - TB, fracture or congenital anomaly
what is scheuermann’s kyphosis
structural sagittal plane deformity on thoracic or thoracolumbar
common in male; 7:1
12-16 yo.
what are the criterias for scheuermann’s kyphosis
thoracic kyphosis > 45 deg
wedging > 5 deg of 3 adjacent vertebrae
thoracolumbar kyphosis > 30 deg
- smaller kase pa lordosis na dapat
what is the clinical presentation of scheuermann’s kyphosis
fatigue and pain; many are asymptomatic
curve is only partly correctable
present compensatory lumbar lordosis
pain and discomfort more severe in lumbar type
what is the cause of scheuermann’s kyphosis
growth disturbance of vertebral epiphyses bc of vascular disturbance
end plate abnormality
what is the management for scheuermann’s kyphosis
PT and observation: < 50 deg and no evidence of progression; adolescent
bracing: 50-70 deg in skeletally immature; milwaukee for 1-2 yrs
surgery: >70 deg w pain or failure of brace
- harrington rods
- for severe > fusion
what is vertebra plana
calves or eosiniphilic granuloma
2-12 yo.
vertebral lesion in only one vertebra > pathologic fracture bc of eosiniphilic granuloma
SSx of vertebra plana
clinical
pain, fatigue, mild angular kyphosis
muscle spasm and tenderness
pwd spinal cord compression
radiological
eroded or fragmented body
flattened or wedged
may regain height as child grows
management of verterba plana
rest in recumbent pos
brace
what is the apex
area of greatest curvature
what are the types of curve in scolio
primary > structural
- large cobbs angle
secondary: nonstructural, compensatory
- lesser cobbs
if 2 angles are equal > 2 primary curves
what is the curve progression in scolio
affected by age and how early treatment started
40-50 should be observed for progression > 1 deg per yr.
thoracic curve of 60-90 > cardiopulmo compromise; RLD
compare structural and nonstructural scoliosis
structural > non functional
- morphologic abnormality
- PT most concerned
- fixed lateral curve w rotaton
- spine rotated to concave
- LOM side bending
non structural > functional
from temporary postural influence
no rotational or assymetric change
resolvable
nawawala upon side bending
what is the etiology for scolio
structural
- idiopathic
- congenital
- neuromuscular: polio, cerebral palsy, muscle imbalance
- disease of vertebrae: tumor, infection, arthritis, potts
nonstructural
- postural
- leg length discrepancy
- nerve root irritation
- hip contractures
what is idiopathic scolio
unknown cause; most common
what is infantile idiopathic scolio
detected during 1-3 yo. but curves develop in first 6 mo.
more common in boys
left thoracic most common
85% regress if appeared before 12 mo.
treatment
- observe
- cast
- surgery if progresses
what is adolescent idiopathic scolio
10-16 yo. > skeletal maturity
more common in females
inc incidence if mother has scolio
most common type 80%
right thoracic most common
risk of progression
- if < 12 yo.
- female
- larger curve
- risser 0-1
what is juvenile idiopathic scolio
3-10
equal sex occurence
right thoracic most common
does not resolve on its own
treatment
- less than 20 - no brace
- 20-25 w 5 progression or >25 = brace
- rapid progression or failed brace - surgery
what is congenital scolio
failure of formation, segmentation or abnormal spinal canal
what are the grades of risser index
1 - lateral 25% ossified
2- 50%
3 - 75%
4 - 100%
5 - complete fusion
1 and 2 are high progression of curve
> 3o before maturity = surgery
tanner whitehouse
measure of maturity using boob and penis
what is the clinical presentation of scolio
shoulder not level
trunk tilt
flexibility test
structural
- post rib hum on convex side; adams
- shortening of intrinsic muscles on concave; lengthen on convex
- ribs closer on concave; farther on convex
- canal wider on convex and narrow on concave
what is the management of scolio
bracing for minimum 12 hrs a day until skeletal maturity
- succes if > 5 deg progression
apex above T7 - milwaukee
apex at or below T7 - boston or charleston
surgical
- rods para ma straight
- fusion to maintain sagittal and coronal balance ehile preserving motion
when is skeletal maturity
risser 4; <2cm change in height in 6 months apart
2 yrs post menarchal
what is lordosis
hollow back; obese, weak back muscles
treat > back support
what is pigeon breast
pectus carinatum; premature dev of emphysema or cor pulmonale
sternum projects forward > impairs cough and volume of ventilation; AP diameter is inc
mild: inc size of pecs
surgery: remove of sternum pero cosmetic lng
what is funnel chest
pectus excavatum; marfans syndrome and arthrogryposis
sternum pushed pst > AP diameter is dec > heart on left site
- result in kyphosis, respi infection, wheezing, arrythmia and premature emphysema
mild: palakihin chest
SWIMMING
surgery: resection of CC and sternum
what is costal chondritis
painful inflammatory lesion in manubriosternal and sternoclav > localized tenderness of CC junction
younf and middle aged adullt; no sex
good prognosis and consrvative
activity modification
NSAID
sterioid
local anesthesis
PT
what is tietze’s syndrome
DD for costal chondritis; if may swelling > tietze’s
hereditary, visruses and trauma
redness, tenderness, warmth, swelling
- pain is sharp and DD for chest pain bc may swelling
- pain for hours to weeks
NSAIDS
compare sacralization and lumbarization
scaralizaton - 4 lumbar bc 5th is naging sacral
lumbarizaation - 6 lumbar bc S1 becomes lumbar
what is pars interarticularis
betw lamina and sup inf articular process; site of stress fracture bcs subjected to large bending force
what are the innervated strucutres of spine
vertebrae
facet joints; zygopophyseal
external annulus
anterior and post longitudinal ligament, interspinous ligament
muscles and fascia
nerve root
what are the non innervated strucutres of spine
ligamentum flavum
internal annulus
nucleus pulposus
compare nucleus pulposus and annulus fibrosus
NP: water, proteoglycan and TYPE 2 collagen
- 90% water and dec w age
AF: concentric layers of fibers at oblique angles; TYPE 1
- resists tensile forces
- more collages and less proteoglycans and water
what is lumbar spondylosis
common cause of back pain in elderly; degen of IV discs and zygap joints > slipping or spurring; degenerative disk disease
pain reffered to buttock and legs; L4-L5 AND L5-S1
moderate: no impingement/fracture > conservatice
severe: muscle weakness and bladder prob > surgery
what us shcmorl node
nuclear materials protrude to VB bc of osteomalacia/prosis
what is spondylolisthesis
forward slippage of one VB
most common with L5 slip or L4 slip
what are the gradings for spndylolisthesis
conservative
1: 0-25
2: 25-50
nerve pulles > surgery
3: 50-75
4: 75-100
what is isthmic spondylolisthesis
most common type; absence of bony continuity at isthmus; ununited fracture or hereditary
often bilat; L5-S1
severe, mod or no pain; localized on lumbosacral joint or radiate to legs
worse w exercise and strain
what is degenerative spondylolisthesis
via arthritis; 50 yo. women
- long standing LB, buttocks and thigh relieved by sitting or reclining
LOM forward felxion; inc hip flexion
no neurologic findings
what is spondylolysis
pa start pa lang yung shift; sclerosis of pars interarticularis; scottie dog
most common cause of back pain in children and adolescents; 4-6%
activity related from hyperextension and 47% in gymnasts, weightlifters and football linemen
treatment for spondylolysis
non-op
- observe and no activity limit: asymptomatic and low grade
- PT and limit: symtomactic
- bracing for 6-12 wks: failed PT
surgery: fusion or laminectomy
- neuro deficits
- instability of spine
- pain after conservative
- severe progress of slip
what is canal stenosis
narrowing of spinal canal > compression of cauda equina > LBP
cause
- local bone deform
- congenital or acquired
- achondroplasis; short pedicles; pagets
- degenerative spinal disease; MOST COMMON
clinical presentation
- > 40 yo.
- pain, paresthesia and numbness of legs during exercise relieved by rest
- LBP
- LE has weakness, wasting and ankle jerk
what are the causes of SI disorder
inflammatory arthritis; seronegative spondyloarthropaties
preggy in latter weeks or after delivery; SI strain and hormonal relax of symphysis pubis
osteomyeletis, infectious arthritis
manlgaigne fractuer: disruption of SI joint due to severe pelvic fracure
SSx of SI disorder
tenderness over one or both SI joints
assoc tendrness of symhpysis pubis
+ gaenslen’s: pt hugs knee and other knee is is extreme flexion > pain = +
NSAID PT HEAT
what is coccygodynia
pain on coccyx and lower sacrum
cause
sprain in sacrocox lig from direct blow na naka upo
- prolonged sitting on hard surface
SSx
- aching, nagging pain w shooting pains in buttocks to legs
- pain when sitting sa matigas and pag tayo
- pain on defecation
treatment
- deformed > gentle manipulation of coccyz
- hot baths
- adhesive strapping across buttocks
- soft cushion
- surgical - not relieved by conservatiice > removal of coccyx
what is dysplastic spondylolisthesis
congenital anomalis to lumbosacral junction
what is traumatic spondylolisthesis
fracture causing displacement
what is pathologic spondylolisthesis
deforming or destrciton of bone or facets via tumor or infection
