Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuromusculoskeletal > PT4 - Thorax - Abnormalities Of The Spinal Curvature > Flashcards

PT4 - Thorax - Abnormalities Of The Spinal Curvature Flashcards

1
Q

What are the functions of the thorax?

A
  • ventilation
  • protection of thoracic organs, SC + SNS (sympathetic nervous system)
  • aid efficient locomotion => rotation (primary) + flexion/extension + SB
  • support csp, shoulder girdle + lsp function and structure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What changes might occur in spinal curves?

A
  • AP + lateral changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How are AP + lateral changes in spinal curves caused?

A
  • compensation, posture, congential/developmental defect or disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are lateral changes caused in the spine?

A
  • scoliosis from compensation/developmental/congenital defect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How are AP changes caused in the spine?

A
  • kyphosis from O/C (ossification?), osteoperosis, disease, hyperlordosis may be a cause or effect (lsp)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the major categories of spinal curves?

A
  • functional (compensatory - short term) e.g. muscle spasm in lsp, altered weight balance in spine
  • structural (permanent - long term) e.g. PSLE (Paediactric Systemic Lumpur Erythematosus?), idiopathic scoliosis, congenital anomalies - hemi-vertebrae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does the csp link to the tlf (thoraco lumbar fascia?)?

A
  • longus colii + scalenii from csp => rib 1+2
  • ribs 2-6 = pump handle action
  • ribs 7-10 = bucket handle action
  • diaphragm = Xiphoid process + Lumbar vertebrae + Coastal cartilages of ribs 7 - 10 + ribs 11 - 12
  • arcuate ligament from lumbar + right crura (L1-L3 + IVD = surround oesophagus) + left crura (L1-L2 + IVD) => crura attach onto psoas and quadratus lomborum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where can inspiration lesions occur?

A
  • Rib 1 => posterior angle of rib held down => pain on forced inspiration
  • Rib 2-10 => angle close to rib above => pain on expiration
  • Rib 2-10 => rib moves up and out => pain on forced expiration
  • Rib 11-12 => exspiration lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the pathway of the embryonic Myofascial chain linking CSP with TLF?

A
  • QL + longus colli/scalenes + extraocular muscles
  • Influences of 2 of transverse diaphragm => central tendon + sibson’s fascia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the hueter -volkmann effect?

A
  • decreased load => increased growth
  • increased load => decreased growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What occurs during functional scoliosis?

A
  • adduction contracture of a hip
  • scoliosis
  • pelvic tilt
  • flexion of opposite hip
  • flexion of opposite knee
  • plantar flexion of ankle
  • short leg (apparent)
  • antalgic posture (shift to one side to avoid pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk factors of idiopathic scoliosis

A
  • female
  • degree of angle
  • age/developmental change to come (teenage years better outcome prognosis compared to early adolescence)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which populations are affected by structural scoliosis

A
  • idiopathic - 75-85% (Insidious IdS or Adolescent Idiopathic AIS)
  • often arise in children (hence name)
  • more prevalent in females (9:1)
  • progressive curvature for early onset (8 years), often rate of 5-10%
  • can ‘pause’ in teens and worsen again in later life
  • classified by age group: infantile (0-3), Juvenile (4-13), Adolescent (13-20)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is development of scoliosis measured?

A
  • The Cobb method uses AP x-ray view: superior border of vertebrae with greatest angulation - inferior border of vertebra with greatest angulation => cobb angle between
  • The Rib Angulation: PT flexed @ 90 degrees observed from behind: measurement taken from SP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What happens when PTs use breathing exercises with scoliosis?

A
  • improve functional patterns + relaxation
  • does not change tidal volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What theories are there behind scoliosis?

A
  • Burrell et al. 2016, Scoliosis & Spinal Disorders
  • Late Childhood: Low fat mass => low leptin => starts asynchronous neuro-osseous growth
  • Adolescence: backward vertebral tilt + axial vertebral rotation + torsion => contralateral cerebral hemisphere dysfunction + rib length asymmetry + shallow chest (cardio thoracic disproportion) + speech exhalation concept + Hueter-Volkmann effect
  • Relative anterior spinal overgrowth => 3D scoliosis deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is Scoliosis classified?

A
  • Extrinsic => asymmetry, scoliosis capitis, other
  • Intrinsic => Bony => congenital, acquired
  • Intrinsic => Myogenic => Disease, Adaptation, Injury
  • Intrinsic => Neurogenic => Developmental, Pain reflex, Degeneration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the Aetiology and Pathophysiology of Scheuermann’s Disease?

A
  • unknown - possibly ischemic effects during hyper-vascular phase of rapid growth with deformation
  • type of PID (prolapsed intervertebral disc) into the vertebral body + asymmetrical/scoliotic
  • criteria = 3 or more consecutive wedged thoracic vertebrae
19
Q

What are the radiological signs of Scheuermann’s Disease?

A
  • in general population, lumbar MRIs would meet diagnostic criteria of SD
  • in LBP, associated with:

—> increased rates of work absence
—> seeking medical care due to LBP episode
—> greater intensity of most severe LBP episode

  • having SD like spine => associated with severity and progressive nature of LBP in general population
  • tend not to see this while it’s happening
  • tends to occur in teenage boys e.g. rugby players
  • T11-T12-L1-L2 affected
20
Q

What happens to the bones/discs Scheuermann’s disease?

A
  • disc stronger than vertebrae
  • bone loses resilience due to loss of blood supply
  • damage to vertebral end plates occurs => higher risk of LBP => more angiogenesis (increased blood vessels)
21
Q

What advice can you give a PT with Scheuermann’s Disease?

A
  • advice: avoid contact sports (trampolining due to rebound/compression), fine to run on grass rather than track, football, swimming (make lifestyles manageable)
22
Q

How does the PT present with Scheuermann’s Disease?

A
  • paraspinal pain
  • MM causing most symptoms
  • Stretching should help
  • Txx won’t change anything
23
Q

What are the X-ray findings for diagnosis of Scheuermann’s Disease?

A
  • increased AP diameter of VB
  • 3 VB wedge shaped anteriorly + angled @ 5 degrees
  • irregular + narrow disc spaces
  • loss of lordosis + frank kyphosis
  • schmorl’s nodes (dips in V end plates) => think swiss cheese
  • flattened areas of superior surface of VB near epiphyseal ring
  • detached epiphyseal ring
24
Q

What is the active phase + management approach for Scheuermann’s Disease?

A
  • often discrete episodes of back pain
  • AGG during prolonged sitting/excessive activity
  • pain at site of condition e.g. T11-L2
  • explain + control pain + local TT of hypertonicity + BLT
25
Q

What is the post-active phase management approach for Scheuermann’s Disease?

A
  • emphasis on secondary compensating dysfunction above/below
  • emphasis on local changes to spinal curves => lateral plane
26
Q

What are the pathologies of respiration?

A
  • COPD
  • Bronchitis
  • TB
  • Flu
  • COVID
  • Breast Cancer
  • Asthma
27
Q

Where does the thoracic spine refer?

A
  • locally
  • neurology is local (intercostals)
  • rare to get a disc injury
  • can look like costalcondrosis (AGG by coughing)
  • stenosis unlikely in tsp due to size of VB
28
Q

What are the symptoms of annular tear?

A
  • back pain
  • neck pain
  • radiating pain
  • sciatic pain
  • burning sensation along spine or sciatic nerve
  • MM weakness in neck, back, arms, legs
  • limited flexibility
  • tingling + numbness in arms/legs
29
Q

What is an annular tear?

A
  • tear in the annulus fibrosus (ligament) connecting Vertebral end plate to disc
  • tears occur if the disc ruptures + ligament tears
  • nucleus pulposus (jelly) pushes through annular tear => herniated disc
  • when no disc material ruptured => annular tear
  • annular tear heals itself over time (suspectable to future weakness + tears)
  • common at TL + L4
30
Q

What are the cause of an annular tear?

A
  • trauma e.g. car accident/sports injury
  • improper lifting/movement
  • repetitive motions such as lifting/twisting
  • sitting for extended periods of time e.g. working at a desk
  • carrying excess body weight
31
Q

What other spine conditions are associated with an annular tear?

A
  • degenerative disc disease
  • herniated disc
  • spinal stenosis
  • Spondylosis
32
Q

What types of annular tears are there?

A
  • radial = begins @ centre + extends through other layers surrounding disc (caused by aging) => can cause disc herniation
  • peripheral tear (transverse tear) = begin on tough outside layers of ligament => caused by traumatic injury
  • concentric tear = develops in a ring that encircles nucleus of disc => caused by torsional injuries e.g. golf club
33
Q

What can cause an intercostal strain?

A
  • coughing
34
Q

What is a common presentation of Osteoperosis?

A
  • 75 yo, early onset menopause (<40 YO), experienced eating disorders (vegetarian/vegan/lactose intolerant), drinks alcohol (look for pitted fingers + acid damage on teeth + breath smell)
  • had bronchitis recently
  • acute spine pain
  • on examination TTP SPs + paraspinal tenderness
  • pain worse on coughing
  • no bruising or swelling
  • fasciculation
  • PT has experienced loss of fitness
  • suspect a spinal fracture => DO NOT TTT!!! => most settle on their own in 6 weeks, if they do not settle => orthopaedic surgeon may inject cement to assist stabilisation
35
Q

If PT does not drink milk, what do you need to check?

A
  • iron
  • folate
  • calcium
  • tough to get these substances from non-animal products, milk is a good source for us
36
Q

How to carcinomas/seconaries present in PTs?

A
  • localised pain
  • worse at night
  • won’t respond to over the counter meds
  • progressive
  • increased heat around tumour due to increased blood supply (tumours create their own blood supply)
37
Q

Where does CVS refer to?

A
  • jaw
  • neck
  • chest
  • abdominal cavity/stomach
38
Q

What organs may refer to right shoulder?

A
  • liver
  • gall bladder
39
Q

Which profession might see a reduced drainage in lymph under their armpits?

A
  • dancers, due to continually being lifted
40
Q

What happens in functional curvatures?

A
  • leg length difference
  • tends to be in older population
  • if you sit down the curve goes straight
  • adaptational
  • can result in LBP
  • can see in children 12-14 where their bodies are growing at different rates => proprioception doesn’t keep up
  • parents see child on beach in summer => PT brought into clinic in Sept/Oct => can be the start of idiopathic scoliosis
  • in these PTs usually by end of TTT PT is symmetrical again => review child regularly (every half term) to check => once growth spurt finished => should resolve
41
Q

What happens in structural curvatures of the spine?

A
  • idiopathic scoliosis => curves become more profound => more likely to see in 30s/40s due to decreased adaptability (ossification of tsp)
  • may develop profound HAs first
  • usually women => body develops high shoulder/low shoulder => drive by SB + rot
  • older mothers + breached babies higher incidence
  • neurogenically drive
  • rotation + counter rotation of VBs
42
Q

What is torticolis?

A
  • shortening of SCM, can occur in babies @ birth or adults as a result of MM trauma
43
Q

What other diagnosis may be a result of idiopathic scoliosis?

A
  • spondylolythesis => hip OA => bigger lordosis in sp => facets become weight bearing => spondylolysis => spondylolythesis (slippage)

Neuromusculoskeletal (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions