Brainscape's Knowledge GenomeTM

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


See full index

MSK II FINAL > Spine managementSpecial topics > Flashcards

Spine managementSpecial topics Flashcards

1
Q

Functional scoliosis –

A

typically reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Structural scoliosis –

A

fixed

most commonly idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Scoliosis Pathophysiology:

A

Congenital

Neuromuscular: muscular dystrophy, spina bifida or CP

Syndromic: Marfan’s, Ehlers-Danlos syndrome, neurofibromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Scoliosis = Relatively benign

A

2-3% of the population

10% of adolescents have some degree of scoliosis but only 1% need Rx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is scoliosis?

A

“Lateral curvature” of the spine > 10 dg

Three-dimensional curvature with a torsional component – vertebra rotate toward the convexity

Rib hump – vertebral bodies rotate toward the convexity

Described by the side of the convexity (right or left)

Named at the level of the apex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Early-onset scoliosis (EOS)

A

refers to onset at younger than 10 years of age

Infantile onset < 3 years old

Juvenile onset 3-9 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Infantile idiopathic –

A

younger than 3 years

80-90% spontaneously resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Juvenile idiopathic –

A

children 3-9 years

Girls > boys (8:1 ratio)

Generally, at high risk for progression to more severe curves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Adolescent idiopathic scoliosis (AIS)

A

refers to onset between 10-18 years of age

manifesting at or around the onset of puberty

Accounts for 80% of all cases of idiopathic scoliosis

The most common orthopedic structural anomaly in children during puberty (80-85% of cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Scoliosis - Essentials of diagnosis

A

Adam’s forward bending test – reveals a rib hump

Plain radiographs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Adam’s forward bending test =

A

Functional: during fwd bending, rib hump disappears with ipsilateral side-bending

Structural: during fwd bending, rib hump persists with ipsilateral side-bending

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Plain radiographs =

A

Occiput to sacrum

AP view with Cobb angle measurement, lateral view identifies hyperkyphosis and/or lordosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Scoliosis: Clinical signs and symptoms

A

> Typically, painless in early stages
Head tilt
Uneven shoulders
Unlevel hips
Clothes appear uneven (neckline, hemlines)
Breasts appear unequal in size
Protruding shoulder blade
Limited rib mobility
Pain in later stages

> Functional deficits: asymmetric reaching and twisting ability, cardiopulmonary compromise in advanced curves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cobb angle
< 10 dg

A

normal variation, unlikely to progress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cobb angle
10-35 dg

A

often treated conservatively, depending on rate of progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cobb angle
> 35 dg

A

considered for surgical intervention but guidelines and outcomes vary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cobb angle
> 50 dg

A

surgical to prevent cardiopulmonary compromise, rib motion restriction, pain, cosmetic deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Main factors that increase risk of scoliosis progression:

A

The younger the patient at diagnosis

Double-curve patterns

Curves with greater magnitude

Sex – females are at higher risk of progression

Risk increases when curves develop before menarche

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Scoliosis management

A

Bracing and casting can be used to delay or prevent surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Casting =

A

done under anesthesia

Spine is elongated and derotated in traction

Cast is replaced every 2-3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Bracing =

A

often used to maintain correction

Custom thoracolumbosacral orthosis

Bracing has been shown to be beneficial with a dose-response curve with 12.9-17.6 hrs, achieving 90% success

Skeletally immature children with curves 25-45 dg are typically prescribed orthoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Theoretically, curve progression is prevented by:

A

muscle contractions responding to the presence of the orthosis

Exercises are often taught to improve active forces, although there is little evidence to support this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Milwaukee brace:

A

has a neck ring and can be used with any level curve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Boston brace:

A

thoracolumbosacral (TLSO) or lumbosacral (LSO)

an underarm brace that can only be used with apex below T8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Conservative Management Goals

A

Stop curve progression at puberty

Prevent or treat respiratory dysfunction

Prevent or treat spinal pain

Improve aesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Primary Benefits of Exercise

A

Optimize self-correcting posture

Maintain flexibility/muscle length

Maintain proper respiration and chest mobility

Improve overall spinal mobility

Maximize functional skills

Maintain or improve muscle strength

27
Q

The Schroth Method =

A

Suffering from moderate scoliosis

Inspired by a balloon, she tried to correct by breathing away the deformities of her own trunk by inflating the concavities of her body selectively in front of a mirror

Institute in Meissen late 30’s and early 40’s

First prospective controlled trial from a patient group 1989-1991

28
Q

Goals of the Schroth method =

A

To derotate, elongate and stabilize the spine in a 3-dimensional plane

Physical Therapy focuses on:
> Restoring muscular symmetry and postural alignment
> Breathing into the concave side of the body
> Teaching postural awareness

29
Q

Scientific exercises approach to scoliosis (SEAS)

A

Based on a specific active self-correction and incorporated into functional exercises

Goal: improvement in the spine stability, prevention of curve progression

Physical Therapy focuses on:
> Increasing patient’s awareness of the deformity
> Emphasizing an independent auto-correction by the patient
> Use of exercises in which balance reactions are elicited
> Bracing is used for at least some of the exercises

30
Q

SEAS results

A

“Average Cobb angle was reduced by 3 dg in the SEAS group (including spinal stabilization, strengthening and muscular retraction and motor coordination), whereas it stayed unchanged in the traditional physiotherapy group.”

Reported many non-specific effects associated with the benefits of exercise (decreased pain, improved self-confidence)

31
Q

Scoliosis Surgical interventions

A

Surgery depends on a number of factors

> Severity of the curve
cause of the curve
pulmonary function
progression or change per year
curve type
remaining growth

For AIS, typically spinal fusion is the operative Rx

32
Q

Three types of implants:

A

Distraction-based strategy

Guided growth

Compression-based strategy

33
Q

Distraction-based strategy

A

Most commonly used in EOS, included expandable rods (magnetically controlled growing rods)

34
Q

Guided growth

A

Hardware is placed in a vertebra that is wrapped around rods to permit linear growth

35
Q

Compression-based strategy

A

A device is placed across growth plates of a vertebra on the convex side to stop it from growing

36
Q

Osteoporosis

A

Metabolic disease process that leads to decreased mineral content and weakening of the bone tissue

Affects approximately 10 million Americans, 80% women (3 million males affected)

May lead to fractures (pathological) – spine, hip, wrist

Typically measured by dual-energy x-ray absorptiometry (DEXA)

37
Q

Osteoporsis and T scores

A

T score (est. by the WHO) of a bone mineral density (BMD) scan

T score is the # of SD’s above or below a reference value (young, healthy Caucasian women)

Normal = -1.0 or higher, Osteopenia = -1.1 to -2.4, Osteoporosis = -2.5 or less

38
Q

Osteoporosis: Metabolic disease process

A

Bone – living tissue, continually remodeling and replacing itself

Osteoclasts resorb bone, especially if Ca+ is needed (resorption is accelerated in women during menopause owing to the decrease in estrogen)

Osteoblasts build bone

39
Q

Primary osteoporosis

A

occurs as the result of the natural aging process

Post-menopausal (assoc. with estrogen def.)

Caucasian or Asian descent

Family history

Low BMI

Little or no physical activity

Prolonged bed rest

Advanced age (women 65 and older, men 70 and older)

40
Q

Secondary osteoporosis

A

results from certain underlying medical conditions or the use of particular medications

Long-term use of glucocorticoids

GI diseases (malabsorption syndromes)

Hyperthyroidism with long-term thyroid replacement therapy

Chronic renal failure

Excessive alcohol consumption

Smoking

41
Q

Osteoporosis Prevention

A

Diet rich in calcium and vitamin D

Weight-bearing exercise

Healthy lifestyle with moderate alcohol consumption and no smoking

42
Q

Osteoporosis Pharmacologic therapies =

A

Bisphosphonates

Calcitonin

Selected receptor molecules

Strontium ranelate

42
Q

Bisphosphonates:

A

antiresorptive agents that decrease osteoclastic bone resorption

43
Q

Calcitonin:

A

Ca+ lowering hormone secreted by the thyroid, inhibits osteoclast activity

44
Q

Selected receptor molecules:

A

nonhormonal med that acts as an estrogen agonist in the bone to suppress bone remodeling

45
Q

Strontium ranelate:

A

offers dual mechanisms of action combining the antiresorptive effect with the anabolic effect of new bone formation

46
Q

Osteoporosis & exercise =

A

Bone – living tissue, continually remodeling and replacing itself

Osteoblasts build bone

Physical activity – affects bone remodeling, muscle contractions and mechanical loading deform bone, which stimulates osteoblastic activity and improves BMD

47
Q

National Osteoporosis exercise recommendations:

A

Weight-bearing ex: walking, jogging, climbing stairs

NWB ex: stationary bike

Resistance training – 2-3x/week, 1-day rest in between sessions

Intensity – 80% 1RM with resistance training for the UE’s, 1-3 sets, 8-12 reps, 16/20 on the Borg scale of perceived exertion for trunk exercise

48
Q

Osteoporosis Exercise – Precautions/Contraindications

A

Trunk flexion ex’s (e.g. supine curl ups) should be avoided d/t increased wedge shape of vert bodies (increased kyphosis) – increases the risk of fx

Avoid combining flexion and rotation of the trunk to reduce stress on disc

Increase intensity progressively but within the structural capacity of the bone]

49
Q

Other sources of thoracic spine and rib pain

A

Thoracic disc lesion
Costochondral sprain
TOS
T4 (not common)

Postural dysfunction (upper crossed syndrome)

Thoracic muscle strain
Thoracic facet arthropathy
Rib fracture (frank or stress)
Intercostal muscle strain

Costochondritis or Tietze syndrome (ribs 2 & 3)

Inflammation of the costosternal cartilage

50
Q

Axial spondyloarthritis/ Ankylosing spondylitis
(axSpA)

A

Inflammatory arthritis (chronic inflammatory disease) that causes back pain and stiffness

Affects 1% of the US population (comparable to RA prevalence worldwide), often UNDERDIAGNOSED

Need to improve primary care provider recognition

51
Q

Axial spondyloarthritis/ Ankylosing spondylitis
(axSpA)

Two categories:

A

Radiographic axSpA, otherwise known as ankylosing spondylitis (AS) and

non-radiographic axial spondyloarthritis (nr-axSpA)

52
Q

Radiographic axSpA or ankylosing spondylitis (AS)

A

Structural changes identified on plain radiographs

Sacroiliitis

53
Q

Non-radiographic axSpA

A

Same symptoms and other clinical features as AS but lack obvious radiographic changes of sacroiliitis

Sacroiliitis can be evident on MRI in this population

In 5-10% of patients, nr-axSpA will evolve to r-axSpA or AS over 2 years

Rate increases to 5-30% over 10 years

54
Q

Ankylosing spondylitis =

A

affects males > females, 15-40 y.o. (peak onset between 20-30 years)

More common in Caucasians than African Americans

Inspection reveals flat lumbar spine, capsular pattern at the lumbar spine and hips

Affects larger peripheral joints: shoulders, hips, knees

55
Q

Ankylosing spondylitis ossification =

A

Ossification of ALL, intervertebral disc, costovertebral and facet jts, costovertebral, manubriosternal jts (check chest expansion!), progressed to whole spine and hips, causing fixed flexed posture (SIJ fusion in later stages)

56
Q

Ankylosing spondylitis: Medical diagnosis

A

(+) human leukocyte antigen (HLA-B27) and 2 other SpA features:

Inflammatory back pain – hallmark sign**

peripheral inflammatory arthritis

Enthesitis – inflammation of site of attachment of tendon, ligament, fascia, or capsule to bone

Uveitis – acute, unilateral eye pain, photophobia, blurred vision*

Dactylitis – diffuse swelling of a whole finger or toe (“sausage digit”)

Psoriasis – seen in about 10% of patients with axSpA

Crohn disease or ulcerative colitis

good response to NSAIDS

family hx of SpA

elevated C-reactive protein (CRP)

57
Q

inflammatory back pain =

A

<40-45y

insidious

> 3 months

worse at night

improvement with activity

minimally affected by position changes

persisting for >30 minutes
may be severe

LBP common but may affect any area of the spine

may cause alternating buttock pain

good response to NSAIDS

does not radiate to legs

58
Q

mechanical back pain =

A

any age

variable, but acute

variable duration and night pain

worse with activity
improvement with rest

may worsen or improve with position change

short-lived

anywhere in spine
may radiate to legs

variable response to NSAIDS

numbness, burning, or tingling

59
Q

Ankylosing spondylitis
factors contributing to delay in diagnosis =

A

limited access to rheumatology care

good response to NSAIDs

slow disease progression

lack of specific physical examination findings or biomarkers

low awareness by primary providers

inadequate guidelines for referral to rheumatology

referral to orthopedists, chiropractors

60
Q

Ankylosing spondylitis – management Pharmacologic:

A

NSAIDS (specifically Indomethacin), DMR’s (methotrexate), analgesics

61
Q

Ankylosing spondylitis – Physical therapy management:

A

Postural strengthening emphasizing extension

Energy conservation, low impact aerobic exercise

High impact and flexion-based ex’s are contraindicated

62
Q

Ankylosing spondylitis – Rx (Dutton):

A

maintain mobility of joints to prevent stiffening- positioning exercises in spine and hip/knee extension, breathing exercises, prone lying 3 times/day (education re: sleeping postures and surfaces), swimming (highly recommended – several sources)

63
Q

Ankylosing spondylitis – prognosis

A

Physical therapy can not modify the progression of AS

Can reduce pain and optimize function, breathing capacity

MSK II FINAL (13 decks)

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