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pt momints ver 2.0 > MS1: Affectation of Spine and Thorax > Flashcards

MS1: Affectation of Spine and Thorax Flashcards

1
Q

how many vertebrae are there and what are the divisions

A

33
- cervical: 7
- thoracic: 12
- lumbar: 5
- sacral: 5 fused into 1
- coccyx: 3-4

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2
Q

what are the curves in the VC

A

primary
- kyphotic: thoracic and sacral

secondary
- lordotic: cervical and lumbar

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3
Q

what is the normal thoracic kyphotic angle

A

AROUND 35 DEGREES or 20-45 deg

> 45 deg is hyperkyphosis

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4
Q

what is the normal lumbar lordotic angle

A

AROUND 60 DEGREES or 40-80

dec w age

60-70% of lordosis is at L4-S1

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5
Q

what are the causes of kyphosis

A

faulty posture
degen of IV discs
atrophy
collapse of vertebral body < postmenopausal and senile osteoporosis

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6
Q

what are the pathologic causes of kyphosis

A

chronic arthritis
osteitis deformans
poliomyelitis
fracture
TB
tumor
myeloma
myelomeningocele; children > lumbar or lumbosacral

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7
Q

what are the clinical features of kyphosis

A

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

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8
Q

what is the treatment for kyphosis

A

maintain to correct posture
brace or corset
excersise > strengthen back and abdominals
rest on straight na higaan
treat the cause kung infection or tumor

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9
Q

what is dowagers hump

A

rounded hump > multiple anterior wedge compression fractures in middle to upper thoracic

due to post menopausal osteoporosis or steroids abuse

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10
Q

what is hump back

A

more steep bc single vertebra lang > anterior wedging of 1-2

due to infection - TB, fracture or congenital anomaly

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11
Q

what is scheuermann’s kyphosis

A

structural sagittal plane deformity on thoracic or thoracolumbar

common in male; 7:1
12-16 yo.

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12
Q

what are the criterias for scheuermann’s kyphosis

A

thoracic kyphosis > 45 deg

wedging > 5 deg of 3 adjacent vertebrae

thoracolumbar kyphosis > 30 deg
- smaller kase pa lordosis na dapat

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13
Q

what is the clinical presentation of scheuermann’s kyphosis

A

fatigue and pain; many are asymptomatic
curve is only partly correctable
present compensatory lumbar lordosis
pain and discomfort more severe in lumbar type

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14
Q

what is the cause of scheuermann’s kyphosis

A

growth disturbance of vertebral epiphyses bc of vascular disturbance

end plate abnormality

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15
Q

what is the management for scheuermann’s kyphosis

A

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

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16
Q

what is vertebra plana

A

calves or eosiniphilic granuloma

2-12 yo.

vertebral lesion in only one vertebra > pathologic fracture bc of eosiniphilic granuloma

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17
Q

SSx of vertebra plana

A

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

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18
Q

management of verterba plana

A

rest in recumbent pos
brace

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19
Q

what is the apex

A

area of greatest curvature

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20
Q

what are the types of curve in scolio

A

primary > structural
- large cobbs angle

secondary: nonstructural, compensatory
- lesser cobbs

if 2 angles are equal > 2 primary curves

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21
Q

what is the curve progression in scolio

A

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

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22
Q

compare structural and nonstructural scoliosis

A

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

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23
Q

what is the etiology for scolio

A

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

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24
Q

what is idiopathic scolio

A

unknown cause; most common

25
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
26
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
27
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
28
what is congenital scolio
failure of formation, segmentation or abnormal spinal canal
29
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
30
tanner whitehouse
measure of maturity using boob and penis
31
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
32
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
33
when is skeletal maturity
risser 4; <2cm change in height in 6 months apart 2 yrs post menarchal
34
what is lordosis
hollow back; obese, weak back muscles treat > back support
35
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
36
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
37
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
38
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
39
compare sacralization and lumbarization
scaralizaton - 4 lumbar bc 5th is naging sacral lumbarizaation - 6 lumbar bc S1 becomes lumbar
40
what is pars interarticularis
betw lamina and sup inf articular process; site of stress fracture bcs subjected to large bending force
41
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
42
what are the non innervated strucutres of spine
ligamentum flavum internal annulus nucleus pulposus
43
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
44
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
45
what us shcmorl node
nuclear materials protrude to VB bc of osteomalacia/prosis
46
what is spondylolisthesis
forward slippage of one VB most common with L5 slip or L4 slip
47
what are the gradings for spndylolisthesis
conservative 1: 0-25 2: 25-50 nerve pulles > surgery 3: 50-75 4: 75-100
48
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
49
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
50
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
51
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
52
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
53
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
54
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
55
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
56
what is dysplastic spondylolisthesis
congenital anomalis to lumbosacral junction
57
what is traumatic spondylolisthesis
fracture causing displacement
58
what is pathologic spondylolisthesis
deforming or destrciton of bone or facets via tumor or infection

pt momints ver 2.0 (14 decks)

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