T-spine

Question 1

What are the shapes of the spine

Answer 1

C: Lordosis
T: Kyphosis
L: Lordosis

Question 2

Alteration of thoracic kyphosis can be due to

Answer 2

Congenital (infant)
Developmental (pre-teen)
Poor posture (teen-adult)
Degeneration (adult+)

Question 3

Examples of congenital alteration of thoracic kyphosis is

Answer 3

Failure of segmentation: two+ vertebrae do not split, stay fused
Failure of formation: a vertebrae doesn’t fully form, so the body is wedge shaped instead of round

Question 4

What is an example of developmental alteration

Answer 4

Scheuermann’s disease: rapid bone growth with anterior part of vertebrae growing slower leads to wedge shape, and a rigid kyphosis deformity
M>F
MC: 12-15 y/o

Question 5

What can impact poor posture

Answer 5

hunched shoulders 
lumbar unsupported 
chin thrust forward 
no support beneath thighs 
bent knee (cuts off circulation of leg) 
feet flexed, not flat on ground 
head tilts beyond neutral range

Question 6

What tests are used to measure Scheuermann’s angle

Answer 6

• Anterior wedging: 5+ degrees in 3+ adjacent vertebral bodies- used for Dx
• Cobb angle: end plates of vertebrae and distal ends of curve used to determine max curve angle -this is only to assess severity of deformity

Question 7

How can you treat Scheuermann’s kyphosis

Answer 7

Stretching, strengthening
Bracing until skeletal maturity if kyphosis >55-60 degrees
-Surgery rarely used

Question 8

When would surgery be an acceptable Tx for Scheuermann’s kyphosis

Answer 8

When skeletally mature 
Non responsive to pain meds 
Rigid deformity 
Kyphosis >75 degrees 
Unacceptable appearance

Question 9

Example Scheurmann’s clinical scenario

Answer 9

12 year old male presents with mid-lower thoracic pain x 6 months
Insidious onset
Pain more towards end of school day
Pain with sitting is dull ache, when leaning back it is a sharp pain
No pain radiation

Question 10

What is Costochondritis

Answer 10

MSK rib/chest wall pain that is reproducible upon palpation

Question 11

What is Tietze syndrome

Answer 11

benign, painful, localized swelling of costosternal, SC, and costochondral joints
Rare
This has the inflammatory aspect where as regular costochondritis does not

Question 12

Example for presentation Costochondritis

Answer 12

16 y/o male presents with anterior chest wall pain x 7 days
No trauma
Has been working out a lot in the weight room
Pain is constant, and worse with deep breath
Pain is reproducible with palpation of breast bone
NO n/v, hemoptysis, SOB, or wheezing

Question 13

What infectious disease can cause an insidious onset chest pain with associated fever and chills

Answer 13

Shingles!
Pain will progressively increase
Area may feel tingly BEFORE the pain sets in
they do NOT cross the midline, they follow the unilateral dermatome

Question 14

Complications of shingles include

Answer 14

post-herpetic neuralgia (rash clears but pain persists)

Question 15

How do you treat shingles

Answer 15

Acyclovir (5xday) is cheaper than valacyclovir (TID)

Question 16

What is herpetic ophthalmagia

Answer 16

Shingles or herpes outbreak along facial dermatome
Vesicles on the tip of the nose (Hutchinson’s sign) is BAD- at risk for herpetic keratitis! Do a fluorescein stain of the eye (dendritic pattern)

Question 17

What is herpetic whitlow

Answer 17

MC seen in healthcare providers; herpes on the tip of the finger

Question 18

What is costovertebral dysfunction

Answer 18

Can occur 2/2 sleeping in a weird position, or sleeping on uneven ground (like camping)
Pain to anterior chest, increases with inspiration and trunk movement
Breathing feels restricted because you can’t take a deep breath
Feels like a knife is being stabbed through chest to back
NO n/v, hemoptysis, or left arm pain
Vitals will all be normal, No murmurs, etc.
Pain will be reproducible