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thoracic spine > part 2, pathology > Flashcards

part 2, pathology Flashcards

1
Q

Describe the limiting factors associated with flexion of the T spine?

A

Posterior static stabilizers

  1. interspinous ligament
  2. LF
  3. capsular ligament
  4. PLL
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2
Q

What limits SB of the tspine

A
  1. impact of the articular processes
  2. LF opposite
  3. intertransverse ligament
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3
Q

How does flexion of the T spine change the thorax?

A

it opens the various mechanical angles

  1. costovertbral angle
  2. superior sternocostal
  3. interior sternocostal
  4. chondrocostal
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4
Q

What is the axis of motion for the costovertebral joint?

A
  1. mechanically linked to the costotransverse ligament
  2. since it is a two joint structure the only movement available is rotation with the axis passing directly through both joints
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5
Q

What is the axis of motion of the UPPER ribs?

A
  1. the axis is nearly parallel to the frontal plane

2. motion of the ribs is in saggital plane

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6
Q

Describe the movement of the sternochondral joint

A

the tightly interlocking joint allows some vertical and lateral movement but no rotation

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7
Q

what is sternochondral joint?

A
  1. formed by the medial end of the cartilage and sternal edge
  2. tighly interlocking joint, forming a solid angle completely filled by the cartilage
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8
Q

What is costochondral joint?

A
  1. formed by the lateral end of the cartilage that is shaped like a cone flattened antero-posteriorly
  2. that anterior rib fits snugly
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9
Q

What is scoliosis?

A

lateral curve in excess of 10 degree

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10
Q

When does scoliosis typically reach its maximum?

A

typically reaches it maximum in adolescent years and stops progressing at the end of spinal growth

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11
Q

what are the five typical patterns of scoliosis?

A
  1. thoracic curve with small lumbar compensation with apex at the mid thoracic
  2. thoracolumbar
  3. double primary
  4. double thoracic primary
  5. lumbar with small thoracic compensation
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12
Q

what variable appear to affect the progression of the scoliotic curve?

A
  1. age and degree of curvature
  2. less than 10 years old curves greater than 20 degree have a 100% progression
  3. older than 10 curves greater than 20 degree have a 50% progression
  4. 14 y.o. curve greater than 20 degree 37% chance of progression
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13
Q

What are the different bracing methods for controlling scoliosis?

A
  1. end-point loading
  2. transverse loading
  3. curve correction
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14
Q

What types of braces are typically used with scoliosis?

A
  1. Milwaukee
  2. low profile Boston
  3. Rosenberger
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15
Q

What pathologies contribute to increased thoracic kyphosis?

A
  1. trauma
  2. infection (usally TB)
  3. osteoporosis
  4. scheuermann’s
  5. congential or developmental
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16
Q

That is the definition of pathological thoracic kyphosis?

A

cobb angle greater that 50 degrees
-angle formed between a line drawn parallel to the superior endplate of one vertebra and a line drawn parallel to the inferior endplate of the vertebra one level below

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17
Q

How does tuberculosis effect the spine?

A
  1. usally effects the spine by causing an infection between T6 and L4
  2. vertebral body most likely to be effected
  3. usually limited to 2 continuous vertebrae but can occur in up to 5
  4. usally a slow onset of symptoms and does not effect the disc
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18
Q

How do pyogenic infections effect the T-spine?

A
  1. acute and quick onset
  2. localized symptoms
  3. valveless vasculature of the vertebral body contributes to process
  4. disc material is quickly destroyed
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19
Q

What area does shingles usually effect?

A
  1. t spine: 50%
  2. c-spine: 15-20%
  3. L spine: 10-15%
  4. cranial nerves: 10-15%
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20
Q

Shingles most often effects what age group?

A

60 plus

21
Q

What is shingles?

A
  1. late complication of varicella infection
  2. remains latent in the nerve cell bodies and, less frequently, the non-neuronal satellite cells of the dorsal root, cranial nerve or autonomic ganglia, without causing any symptoms
  3. the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve
22
Q

How does RA effect the T-spine?

A
  1. it rarely involves the T spine

2. respiration and rib function may be affected secondary to diffuse interstitial fibrousis

23
Q

Who does ankylosing spondylitis effect?

A

1-2% of the Caucasians

  1. men more than women
  2. usall effects ages 15-40
24
Q

What is the pathogenesis of ankylosing spondylitis?

A
  1. unkown

2. although infections, trauma and heredity are thought to be involved

25
Q

What does ankylosis spondylitis do?

A
  1. it is an inflammitory process characterized by chondritis and osteitis
  2. enthopathy
  3. anklyosis of joints
  4. ossication of ligaments
26
Q

what areas of the spine are most often effected by ankylosising spondylitis?

A
  1. SI
  2. facets
  3. disc
  4. costovertebral
27
Q

How does ankylosis spondylitis effect respiration?

A

chest expansion decreases to less than 2.5-3.0 cm

28
Q

What is scheurmann’s vertebral osteochondritis?

A
  1. condition that shows irregular ossification and endochondral growth with pathologic changes appearing at the junctions of the vertebral bodies and intervertebral discs
  2. may occur as a result of damage to the cartilage end plates allow disc material into the vertebral body
29
Q

Who usally get Scherumanns’

A
  1. 13-16 years old
  2. males to female 1:2 in thoracic spine and 2:1 in lumbar spine
  3. increased kyphosis in thoracic spine 75%, TL junction 20% and lumbar 5%
30
Q

How long is Scherumann’s active

A

the active stage is usually 1-2 years

31
Q

What is Clave’s vertebral osteochondritis?

A
  1. vertebra plana
  2. usually involves a single vertebrae with no impact on the disc
  3. estreme flattening of the vertebral body
  4. mos likely caused by an eosinophilic granuloma
  5. occurs in child 2-10 years old
  6. non progressing and good prognosis
32
Q

How many types of neoplasm occur in the spine?

A

three based on location

  1. extradural
  2. intradural-extramedullary
  3. intramedullary
33
Q

How do the symptoms of neoplasm vary?

A
  1. extradural- extreme pain especially at night
  2. intradural-extramedullary- radicular symptoms because it is close to the roots
  3. intramedullary- often pain less
34
Q

What are some examples of extradural masses?

A
  1. metastisis
  2. lymphoma
  3. chordoma
  4. meningioma
  5. fibroma
  6. lipoma
  7. vascular malformation with bleeding
  8. abcess
35
Q

What are some examples of intramural-extramedullary masses?

A
  1. neurofimbroma
  2. neurilemmoma
  3. meinigioma
  4. neurinoma
  5. lipoma
  6. arachnoid cyst
  7. leptomeningeal met
36
Q

What is the ratio of malignant to benign cancer in the spine?

A

25:1

37
Q

What is the incidence rate of metastasis to the spine?

A

70% of that…

  • 49% to T spine
  • 46% L spine
  • 6% c spine
38
Q

who do benign tumors of the trunk effect

A

people 20-30 and are usually found in the posterior element

39
Q

Where are bengin spinal tumors usally found?

A

posterior element

40
Q

What is the OGI description of fibromyalgia?

A
  1. chronic pain in discrete tender points
  2. usally accompanied by disorder of non restorative sleep
  3. 50% more electrical activity in affected musculature
  4. source of pain my be localized hypoxia
41
Q

what are the classifications of osteoporosis?

A
  1. primary-
    - involutional (post menopausal)
    - idiopathic (juvenile or adult)
  2. secondary- caused by endocrine abnormalities, nutritional deficits, drug therapy, genetic disorder
42
Q

How does osteoporosis effect the bone?

A

1 the horizontal trabecular are thinned

2.this accentuates the vertical trabeculae and is evident once 30% of the bone mass is lost

43
Q

How is osteoporosis treated nutritionally?

A
  1. 3-1.5 calcium
  2. quick bounding type exercises
  3. vitiam D
  4. avoid excessive protein, alcohol, smoking and caffeine
44
Q

what is costochondritis?

A
  1. inflammation of one or two anterior costocartilages
  2. typically effects multiple segments
  3. minimal to no swelling
  4. most commonly 3-5 segments
  5. male to female 1:3
45
Q

What is Tietze’s syndrome?

A
  1. inflammation of one anterior costocartilages
  2. usually the first or second rib
  3. males and females about the same
  4. marked swelling around the joint
46
Q

What is iliocostal friction syndrome?

A

painful condition caused by friction of the lower ribs against the illiac crest

47
Q

What is spondyloarthopathy?

A

a group of related inflammatory joint diseases that share clinical features and an association with the major histocompatability complex class I molecule

48
Q

What are the five subgroups of spondyloarthropathy?

A
  1. anklosing spondylitis
  2. reactive arthritis
  3. psoriatic arthritis
  4. arthritis associated with inflammatory bowel
  5. undifferentiated SpA
49
Q

What are thoracic ROM expectations?

A
  1. SB total ROM 23 degree
  2. Rotation total ROM 26 degree
  3. AP not sure

thoracic spine (2 decks)

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