SPE #2 S&S Flashcards
Thoracic Spinal Cord Myelopathy S&S:
-slow gradual, and often progressive compression on the cord
-extreme spinal P!
-multi-segmental numbness and weakness/paralysis of extremities and trunk below the level of injury resulting in paraplegia
-spastic or retentive bowel and bladder
Thoracic Spinal Cord Myelopathy Etiology:
-MOST commonly due to degenerative spinal changes
-20% of the time with the only well-validated RED FLAG being hx of cancer
Thoracic Spinal Myelopathy
-PT Plan:
-emergency referral
What is the MOST common area of metastasis?
Risk factors: (1)
-lungs; it is the first organ to filter malignant cells in the vena cava
-long term smokers
Lung Cancer S&S:
Cough is the MOST common symptom along with other respiratory S&S (rare - apical region)
**May have shoulder P! (T2-4 shared innervation) associated with Pancoast Tumor
PT plan for lung cancer:
urgent referral
Male >50 yrs. of age and has a hx of smoking can you suspect a Pancoast tumor?
yes
Pancoast tumor S&S:
-lung cancer S&S
- Shoulder P! 90% of case
Growth may lead to compression on:
-subclavian vv. so TOS S&S or UE swelling with decreased venous return
-ribs, vertebrae which possibly mechanical P!
-brachial plexus, spinal nn. so parathesis along C8, T1 spinal n and/or medial/ulnar nn.
-may lead to horners syndrome
PT plan for Pancoast tumor:
urgent referral
The mean age is 60 yrs.
2nd MOST common primary tumor in children
MOST common intracranial metastatic tumor in adults
Brain Tumor
Brain tumor etiology:
compression of cerebral tissue
at times erosion of bone with tumor growth
leads to edema and increased intracranial pressure
Brain tumor S&S:
-Cancer S&S plus specific S&S related to are of brain
-HA that is increased with activities further increasing ICP, looking straining exercise, coughing
-UMN S&S including ataxia if cerebellum involved
-Cranial N. VI (abducens) susceptible to ICP - diplopia and painful eye motion may develop
-Seizures
-Speech Impairment
PT plan for Brain Tumor
urgent referral
Non traumatic spinal fracture S&S
-Thoracic P! w/ history of malignancy and/or osteoporosis
-Unfamiliar and severe P! possibly worsening
-TTP at fx
-Sudden change in spinal posture/shape
-Mechanical P!
-Coordination and bowel/bladder dysfunction
What levels are non traumatic spinal fractures most commonly between?
T8-L4 (lower thoracic, upper lumbar)
Non traumatic spinal fracture etiology:
Malignancy
Osteoporosis
Non traumatic spinal fracture involved system and objective
- PT Plan
Skeletal system
TTP
Test for possible fracture by performing percussion test
Test for possible fracture by performing vibration at SPs
- emergency referral
Non traumatic spinal fracture risk factors:
Prior osteoporotic or low impact spinal fx
>3 month corticosteroid use
Female – late menarche, early menopause
Older age – women >65, men >75
History of cancer
Non traumatic spinal fracture 1st choice for imaging:
x ray
angina:
myocardial infarction:
Angina: chest P!
—– stable – occurring with stress, physical, and/or emotional
—Unstable – occurring at rest
Myocardial infarction: heart attack
Angina/myocardial infarction risk factors:
Males 65 or older
Any condition that limits blood supply to or increases demand of the heart
o Smoking
o Metabolic syndrome: high cholesterol, HTN, diabetes, obesity
o Psychosocial disorders
o Standard American diet
Angina/myocardial infarction etiology:
Coronary artery disease (CAD)
Angina/myocardial infarction S&S:
- P!
o Sudden onset of chest pain, pressure, tightness, heaviness
o Additional pain in the jaw or left arm
—females: interscapular and right arm pain
o Referred pain C4-T4 dermatomal pattern due to shared innervation - SOB
- Sweating
- Nausea
- Fatigue
- Syncope
Atypical S&S:
- Less pain with diabetes due to neuropathy
- Pericarditis with autoimmune disease
- Most common in adults is SOB due to impaired ANS response and central P!
Angina/myocardial infarction
- PT Plan
Stable angina:
- < 20 minutes urgent
- > 20 minutes emergency
Unstable angina:
- Emergency referral
Thoracic metastasis S&S:
cancer S&S
spinal P! - most common
unfamiliar and severe P!, may be progressive
possible myelopathy S&S
bony alterations, including fractures and subsequent joint instability
may be unable to lie flat due to P!
mechanical P!
Thoracic metastasis risk factor:
history of cancer
thoracic metastasis
- PT Plan
urgent referral unless cord S&S - emergency referral
PT objective: Thoracic Myelopathy
- Test for postitive UMN
- Test for hyperactive DTRs
- Check vitals due to compression causing ischemia
PT objective: Lung Cancer With Pancoast Tumor
- Check ULTT in media/ulnar N.
- Check myotomes for fatiguing weakness @ C8 and T1
- Observe pupils for ptosis or mitosis
- Observe ipsilateral fascial flushing and sweating
- Perform Gillards cluster for TOS S&S
Plus cancer s&s
PT objective: Brain Tumor (Cancer)
- Check balance and coordination (cerebellum dysfunction)
- Palpate swollen NON-tender lymph nodes
- Observe speech impairment
- Check vitals (high temp)
PT objective: Thoracic Metastasis (Cancer)
- Palpate swollen NON-tender lymph nodes
- TTP due to possible fx
- Check vitals
PT objective: Angina/Myocardial Infraction (Cardiac)
- Check vitals
- Check ABI
- Observe SOB
- Observe sweating
PT objective: Non-Traumatic Spinal Fxs (skeletal due to Osteoposoros)
- Observe an increased kyphosis in thoracic spine
- TTP at Fx
- Tenderness w/vibration at SP
- Tenderness w/percussons due to fx
