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ms 1 - 2nd shift > scolio and thorax > Flashcards

scolio and thorax Flashcards

1
Q

an older term that refers to an abnormal bending of the spine but gives no reference to the coupled rotation that also occurs

A

scoliosis

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2
Q

describes the curve of the spine by detailing how each vertebra is rotated and side flexed in relation to vertebra below

A

rotoscoliosis

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3
Q

spine curves (convex) to the left; commonly affects lumbar region

A

levocoliosis

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4
Q

spine curves (convex) to the right; commonly affects thoracic region; more common

A

dextroscoliosis

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5
Q

it refers to the vertebra that is located at the farthest point out laterally from the midline of the body (convex side)

A

apex of curve

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6
Q

vertebra w the greatest distance from the midline with most rotation

A

apical vertebra

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7
Q

apex of curve in cervical scoliosis

A

c1-c6

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8
Q

apex of curve in cervicothoracic

A

c7-t1

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9
Q

apex of curve in thoracic scoliosis

A

t2-t11

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10
Q

apex of curve in thoracolumbar scoliosis

A

t12-l1

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11
Q

apex of curve in lumbar scoliosis

A

l2-l4

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12
Q

apex of curve in lumbosacral scoliosis

A

l5 or lower

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13
Q

discuss cobb angle and how to measure scoliosis

A

cobb angle - standard measurement used to quanitfy scoliosis

measured on PA (post-ant) or AP (ant-post)

  • draw a line above the vertebra w greatest lateral tilt and another line at the bottom vertebra w greatest lateral tilt
  • extend the lines to the margin of the image
  • draw perpendicular lines on the two lines u drew
  • cobb angle is where the 2 perpendicular lines intersect
  • measure the angle
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14
Q

type of curve considered as structural and has a larger cobb angle

A

primary curve

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15
Q

type of curve considered as compensatory curve; lesser in magnitude, more flexible and less rotated; allows head to be centered over the pelvis; may or may not be structure curves, depending on flexibility

A

secondary curve

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16
Q

discuss structural scoliosis (based on rigidity)

A
  • also called non-functional
  • definite morphologic abnormality
  • therapeutic effort is concerned
  • has a fixed lateral curvature w rotation

on radiographs
- spinous process rotated to concavity
- lack of normal flexibility on side bending or traction radiograph

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17
Q

discuss non structural scoliosis (based on rigidity)

A
  • also called as functional scoliosis
  • results from temporary postural influence
  • no rotational or asymmetric change in the individual structures of the spine
  • curve is not fixed
  • if problem is corrected, scoliosis resolves
  • corrects or overcorrects on spine side bending radiograph or traction films
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18
Q

discuss structural scoliosis based on etiology

A
  • idiopathic
  • congenital
  • neuromuscular (neuropathic, myopathic)
  • neurofibromatosis with scoliosis
  • scoliosis with disease of vertebrae (tumor, infection, metabolic, arthritis)
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19
Q

discuss non structural scoliosis based on etiology

A
  • postural
  • leg length inequality
  • nerve root irritation
  • contracture about the hip
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20
Q

this type of structural scoliosis has an unknown cause and is the most common type

A

idiopathic scoliosis

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21
Q

idiopathic scoliosis - infantile

A

under 3 years of age

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22
Q

idiopathic scoliosis - juvenile

A

3-10 years of age

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23
Q

idiopathic scoliosis - adolescent

A

above 10 years old to skeletal maturity

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24
Q

discuss infantile idiopathic scoliosis

A
  • detected during1-3 years old
  • common in boys
  • curves develop within the first 6 months
  • 85% of curves regress spontaneously (usual if curve appeared before 12 months)
  • left thoracic curve most common
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25
Q

treatment of infantile idiopathic scoliosis

A
  • observe
  • serial cast
  • surgery (if curve progresses); posterior growing rod until 10-11 yrs old; posterior spinal fusion after skeletal maturity
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26
Q

discuss juvenile scoliosis

A
  • 3-10 yrs of age
  • of equal sex predilection
  • right thoracic curve most common
  • curves do not resolve spontaneously
27
Q

treatment of juvenile scoliosis

A
  • less than 20 deg, observe. follow up after 6-8 mos
  • braces: 20-25 deg with > 5 deg progression or > 25 deg curve
  • surgery: rapid progression or failure of braces; w/o fusion before puberty followed by fusion at puberty
28
Q

discuss adolescent idiopathic scoliosis

A
  • 10-16 years old (skeletal maturity)
  • common in females
  • increases incidence in children who are daughters of mothers with scoliosis (familial)
  • most common type (80%)
  • right thoracic curve most common
29
Q

risk of progression in adolescent idiopathic scoliosis

A
  • age < 12 yrs old
  • female gender
  • maturity- father from skeletal; maturity (risser 0-1) higher risk
  • larger curve at detection, higher risk
    -larger curve at detection, higher risk
30
Q

discuss congenital scoliosis

A
  • failure of vertebral formation (hemivertebrae)
  • failure of segmentation (partial or complete bar)
  • abnormal spinal canal or cord (myelodysplasia)
31
Q

this is used to grade skeletal maturity based on the level of ossification and fusion of iliac crest apophyses

A

risser classification

32
Q

stage 0 of risser

A

no ossification center at the level of iliac crest apophysis

33
Q

stage 1 of risser

A

apophysis under 25% of iliac crest

34
Q

stage 2 of risser

A

apophysis over 25-50% of the iliac crest

35
Q

stage 3 of risser

A

apophysis over 50-75% of iliac crest

36
Q

stage 4 of risser

A

apophysis over > 75% of the iliac crest

37
Q

stage 5 of risser

A

complete ossification and fusion of iliac crest apophysis

38
Q

physical examination of scoliosis

A
  • shoulder not leveled
  • tilt of trunk
  • decompensation is measured by plumb bomb from c7 where it falls w respect to gluteal line
  • flexibility test
39
Q

clinical presentation of scoliosis (structural or functional)

A
  • produce a fixed deformity
  • rib hump occuring on convex side
  • persistent scoliosis during forward bending (adam’s sign)
  • adaptive shortening of intrinsic trunk muscles on the concave side; lengthening of intrinsic muscles on convex side
40
Q

characteristics present on convex side of scoliosis

A

-ribs pushed posteriorly forming post rib hump
- vertebral body rotate towards convex side
- ribs are farther apart
- lamina thicker
- vertebral canal wider
- iv discs spaced wider

41
Q

characteristics present on concave side of scoliosis

A
  • ribs pushed anteriorly
  • spinous process rotates concavity
  • ribs are closer
  • lamina is thinner
  • vertebral canal is narrower
  • iv disc spaced narrower
42
Q

duration of hours required in wearing a brace

A

-16-23 hours/day until skeletal maturity or surgical intervention deemed necessary (actual wear min of 12 hrs required to slow progression)

43
Q

type of brace used of curves with apex above T7

A

milwaukee brace

44
Q

type of brace used of curves w apex T7 or below

A

TLSO
boston style brace (underarm)
charleston bending brace

45
Q

bracing success is defined if

A

<5 deg curve progression

46
Q

bracing failure is defined if

A
  • 6 deg or more curve progression at skeletal maturity
  • absolute progression to >45 deg either before or at skeletal maturity in favor of surgery
47
Q

skeletal maturity is defined as

A
  • risser 4
  • < 1cm change in heigh over 2 visits 6 mos apart
  • 2 years postmenarcal
48
Q

this recommends one level above and two levels below the end vertebrae if these levels fall within the stable zone

A

harrington technique

49
Q

this recommends fusion to the neutral vertebrae

A

moe technique

50
Q

this recommends including all major curves and minor curves that are not flexible or are kyphotic

A

lenke technique

51
Q

known as hallow back; anteroposterior curvature of the spine in which the concavity is directed posteriorly; cervical and lumbar lordosis exhibits this

A

lordosis

52
Q

sternum projects forward and down like a keel of a boat; increases AP diameter of thorax; impairs the effectiveness of cough and restricts volume of ventilation

A

pigeon breast (pectus carinatum)

53
Q

cause of pigeon breast

A

premature development of emphysema or cor pulmonale

54
Q

management of pigeon breast

A

mild deformities can be less noticeable w exercises that increase strength of pectorals

surgery if severe deformity

55
Q

treatment of funnel chest

A
  • mild- exercises to improve posture and build up shoulder girdle and pectoral muscle
  • swimming
  • surgery for severe cases
56
Q

sternum is pushed posteriorly be overgrowth of ribs; ap diameter of thorax is decreased; heart displaced to left side; shortening of central tendon, seen in marfan’s syndrome

A

funnel chest (pectus excavatum)

57
Q

tenderness of costochondral junction of ribs or chondrosternal joint of anterior chest (2nd to 5th)

A

costochondritis

58
Q

cause of costochondritis

A

localized inflammation; may precede upper respiratory infection and excessive coughing, local trauma, arthritis (ra, as)

59
Q

symptoms of costochondritis

A

chest pain - sharp, associated w deep breathing or coughing

tenderness on the area

no observed swelling

60
Q

treatment of costochondritis

A

non surgical:
- activity modification
- nsaids
-corticosteroid injection
-local anesthesia patch
- pt

-good prognosis and responds to conservative management

61
Q

painful inflammation of the costochondral cartilages of upper front of chest (usually 2nd-3rd)

A

tietze’s syndrome

62
Q

causes of tietze’s syndrome

A

heredity (genetic predisposition); viruses; trauma

63
Q

tietze’s syndrome vs costochondritis

A

tietze’s syndrome
- rare, more common in females
- < 40 yrs old
- no of sites affected: one in 70% of cases; usually unilateral
- 2nd-3rd costochondral junction
- (+) local swelling
- no associations w other conditions

costochondritis
- more common
- > 40 yrs old
- no of sites affected: more than once (90% of cases)
- 2nd-5th costochondral junction
- no swelling
- associated w seronegative arthropathies, anginal pain

ms 1 - 2nd shift (13 decks)

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