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S3- Musculoskeletal > T-Spine and Ribs Common Clinical Presentations > Flashcards

T-Spine and Ribs Common Clinical Presentations Flashcards

1
Q

INTRO

A

INTRO

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2
Q

List T-Spine Common Clinical Presentations

A
  • Pancoast Tumor
  • Referral from cardiovascular & pulmonary systems
  • Abdominal Referral
  • Fracture
  • Scheurmann’s Disease
  • Costochondritis
  • Disc Disease
  • Thoracic Myelopathy
  • T4 Syndrome
  • Scolisis
  • Arthropathy
  • Rib Dysfunction
  • Thoracic Outlet Syndrome
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3
Q

What is a Pancoast Tumor?

A

Tumor at the apex of the lung.

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4
Q

Pancoast Tumor may involve __ and __ structures.

A

C8 and T1

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5
Q

How does Pancoast Tumor clinically present itself?

A

May present similar to radicular pain/radiculopathy, thoracic outlet syndrome (especially), peripheral nerve entrapment.

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6
Q

What are the symptoms of a Pancoast Tumor?

A
  • Chronic cough
  • Bloody sputum
  • Unexplained weight loss
  • Malaise
  • Dyspnea
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7
Q

How will a Pancoast Tumor present during a physical examination?

A
  • Fever

- Wheezing

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8
Q

VERTEBRAL FRACTURES

A

VERTEBRAL FRACTURES

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9
Q

There can be ___________ ______ fractures or ________ component fractures or a combination of both.

A
  • vertebral body

- posterior component

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10
Q

What are some other bone abnormalities?

A
  • osteopenia (early), osteoporosis (late)

- other (Paget’s disease, etc.)

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11
Q

Osteoporosis is a loss of BMD (bone mineral density), is it painful?

A

No, not by itself

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12
Q

The vertebrae is divided into what 3 columns?

A
  • Anterior (anterior 1/2 of body)
  • Middle (posterior 1/2 of body)
  • Posterior (pedicles and back)
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13
Q

Hx of vertebral fractures is associated with what?

A
  • increased mortality
  • predictor for subsequent vertebral fracture (4-5x) and hip fracture (3x)
  • several classification systems
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14
Q

What does TLICS Classification stand for?

A

Thoraco-Lumbar Injury Classification and Severity

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15
Q

What are the 3 components describing the risk/need for surgery when it comes to the TLICS?

A
  1. ) Morphology
  2. ) Integrity of PLC (posterior ligamentous complex)
  3. ) Neurologic Status
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16
Q

What are the 3 types/categories of morphology?

A
  • Compression
  • Translation/Rotation
  • Distraction
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17
Q

What are the 4 parts of the PLC (posterior ligamentous complex)?

A
  • Supraspinous ligament
  • Interspinous ligament
  • Ligamentum flavum
  • Z-joint capsules
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18
Q

Describe the scoring system of the TLICS.

A
  • Nonsurgical = <4 points
  • Nonsurgical or Surgical = 4 points
  • Surgical = >4 points
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19
Q

What are the 2 types of compression fractures?

A
  • Traditional Compression Fractures

- Burst Fractures

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20
Q

Traditional Compression Fractures are ______ injuries affecting the _______ column with the spinal column _______.

A
  • stable
  • anterior
  • intact
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21
Q

What is a common MOI for Traditional Compression Fractures?

A

Traumatic axial loading in a flexed position.

  • High Energy
  • Osteoporotic
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22
Q

Burst Fractures affect the _______ and _______ columns and make up __-__% of all major vertebral body fractures. How many are there per year?

A
  • anterior and middle
  • 15-20%
  • 1/4 million/year in the U.S.
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23
Q

Where are Burst Fractures most common?

A

T/L junction

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24
Q

Can Burst Fractures have neural involvement?

A

Yes, fragments may be found in canal.

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25
What are common MOI for Burst Fractures?
High force axial (and/or flexion load) - MVC - Falls from heights - High speed sport injury
26
Rotation/Translation Fractures are associated with falls from a height or heavy objects falling on body with bent trunk and involve ______ and ______ forces.
torsion and shear
27
Rotation/Translation involves __________ displacement of one T/L vertebral body on another.
horizontal
28
Can dislocations happen with Rotation/Translation Fractures?
Yes, facet joints intact but dislocated
29
Can Rotation/Translation Fractures cause impingement on the spinal cord?
Yes
30
Distraction Fractures involve separation in the _________ axis. They can involve both anterior/posterior _________ and ____ structures.
- vertical | - ligament and bony structures
31
Vertebral Fracture Red Flags: - Studies show that looking for _________ can be more helpful than finding a single red flag. - ____ false positive rates when it comes to single red flags. - List off some red flag examples.
- clusters - high - Old age, significant trauma, corticosteroid use, contusion/abrasion
32
What is the Vertebral Fracture cluster?
- Age >70 - Significant Trauma - Prolonged corticosteroid use - Sensory alterations from the trunk down
33
-What are the parts of Roman's Cluster for Vertebral Compression Fractures?
- Age >52 - No presence of leg pain - BMI = 22 - Does not exercise regularly - Female gender - <2/5 - 4/5
34
RIB FRACTURES
RIB FRACTURES
35
Rib fractures can be _______ or _______ fractures.
trauma or stress
36
Are rib fractures commonly managed conservatively?
Yes, but it is important to get medically assessed for potential of jagged edges to pierce into tissues.
37
What are some areas that can be pierced/injured with rib fractures?
- Brachial plexus/vascular structures | - Laceration of pleura, lungs, abdominal organs.
38
What percentage of upper rib fractures are associated with brachial plexus/vascular structure injuries?
3-15%
39
Many simple rib fractures become stable after __ weeks.
6 weeks
40
Taping/strapping are avoided in the thorax, why?
They can increase the risk for other issues such as complications related to the fracture and cardiovascular and respiratory issues.
41
What are the symptoms associated with rib fractures?
- Focal pain, radiating pain - Pain w/ inspiration - Pain w/ coughing/sneezing
42
How will rib fractures present during a physical examination?
- Focal tenderness | - Possible palpable defect
43
Are x-rays good for finding rib fractures?
No, commonly missed on them.
44
DISC DISEASE
DISC DISEASE
45
Thoracic disc lesions make up __% of all surgically managed HNPs (herniation of nucleus pulposus).
1%
46
Disc Disease is more common in the _____ T-spine and can have potential __________ involvement. These are typically ___________ in nature.
- lower - neurologic (radicular vs myelopathy) - degenerative
47
Herniations mostly occur in the ______ T-spine and many of them are _____________.
- lower (T8-T12) | - asymptomatic
48
What are the symptoms of Disc Disease?
- Back or chest pain - Radicular: band like pain in affected dermatome, paresthesia/anesthesia, leg pain - Back pain at midline - Progressive/insidious (months to years)
49
How will Disc Disease present during a physical examination?
- ??? Not a well developed pattern | - possible myelopathic signs
50
Thoracic Spine Myelopathy: - Cord compression in the thoracic spine - Related health conditions: _________ Frx, ________
- compression frx | - stenosis
51
What are the symptoms of myelopathy?
- sexual dysfunction | - bowel and bladder dysfunction
52
How will myelopathy present during a physical examination?
- sensory/motor impairments | - UMN signs LEs
53
Intercostal neuralgia affects our ________ nerve. What are some things that can lead to this?
- intercostal nerve | - Infection, Mechanical Compression (disc protrusion, osteophyte complex, neuroma, Frx), following thoracic Sx
54
What are the symptoms of intercostal neuralgia?
Burning pain/paresthesia along intercostal nerve path (around the rib cage)
55
How will intercostal neuralgia present during a physical examination?
Focal tenderness of intercostal area
56
T4 SYNDROME
T4 SYNDROME
57
- Does T4 syndrome affect women or men more? | - The etiology of T4 Syndrome is _______, what is the theory?
- Women (4x) | - unknown, theory is that there is a sympathetic reaction with hypomobile segment
58
T4 syndrome can affect T_-T_.
T2-T7
59
What are the primary pain generators related to T4 syndrome?
- Thoracic IV discs | - Thoracic zygopophyseal joints
60
What are the symptoms of T4 syndrome?
- Glove-like paresthesias unilateral/bilateral UEs - Neck/scapular/bilateral UE pain (constant or intermittent) that worsens w/ side-lying or supine - Generalized headache
61
How will T4 Syndrome present during a physical examination?
- Tender spinous process - + Thoracic Slump Test - + Upper Quarter Neurodynamic Tension Tests - Hypomobile Thoracic Segment
62
SCOLIOSIS
SCOLIOSIS
63
Simply put, what is scoliosis?
Abnormal curvature of the spine.
64
The etiology of scoliosis is either _________ or ___________ and is named for _____________.
- congenital or acquired | - convexity
65
With scoliosis, there is a ________ and ___________________ component.
- rotational | - lateral flexion
66
What are the 2 categories of scoliosis?
- Adolescent idiopathic scoliosis (congenital or neuromuscular) - Degenerative scoliosis
67
Up to __% of adults >__ y/o present with degenerative scoliosis.
- 68% | - 70 yo
68
Scoliosis is described by the region of the spine and direction of ____________.
Convexity
69
THORACIC Z JOINT ARTHROPATHY
THORACIC Z JOINT ARTHROPATHY
70
Is Zygopophyseal Arthropathy more or less understood in the thoracic spine compared to the lumbar and cervical spine?
Less
71
Is Zygopophyseal Arthropathy more common unilateral or bilateral?
unilateral
72
What are the symptoms of Zygopophyseal Arthropathy?
local and/or referred pain
73
How will Zygopophyseal Arthropathy present during a physical examination?
- Painful movement with closing of z-joints (AROM/PROM) - Painful spring testing/ Hypomobility with joint mob testing - Hypomobility with PPIVM, Pain with PAIVM
74
RIB DYSFUNCTION
RIB DYSFUNCTION
75
Rib Dysfunction can be ___________ or __________.
inflammatory or degenerative
76
What are the 3 categories of Rib Dysfunction and what is each?
- Structural- Subluxation of joint (anterior or posterior) - Torsional- Rib held in rotated position - Respiratory- Related to posture, may affect respiration
77
What are the symptoms of Rib Dysfunction?
Aggravated with deep inspiration, trunk rotation, sneezing/coughing
78
How will Rib Dysfunction present during a physical examination?
- Diminished rib mobility (structural) - Pain/hypomobility with joint mobility testing - Limited/painful thoracic spine motion
79
THORACIC OUTLET SYNROME
THORACIC OUTLET SYNDROME
80
What is Thoracic Outlet Syndrome?
"Upper extremity symptoms due to compression of the neurovascular bundle by various structures in the area just above the firsts rib and behind the clavicle."
81
What are the structures that can be compressed with Thoracic Outlet Syndrome?
- Subclavian Artery (ATOS) - Subclavian Vein (VTOS) - Brachial Plexus (NTOS)
82
Brachial Plexus Compression makes up __-__% of all TOS.
90-95%
83
What are some potential areas for compression in Thoracic Outlet Syndrome?
- Scalenes - Cervical Rib - Pec Minor - First Rib (hypertonic scalenes) - Clavicle
84
What is the prevalence of Thoracic Outlet Syndrome?
estimated 10/100,000
85
What are the symptoms of Thoracic Outlet Syndrome?
- UE pain, paresthesia, anesthesia/weakness (glove-like vs particular distribution consistent with area of compression) - Chest/anterior shoulder pain - Typically progressive/insidious onset
86
What is the clinical presentation/Hx of Thoracic Outlet Syndrome?
- Hx neck trauma - Cervical rib (1% of population) - Raynaud's phenomenon
87
How will Thoracic Outlet Syndrome present during a physical examination?
- Guarding of cervicothoracic/scapulothoracic musculature - Provocation w/ contralateral c-spine lateral flexion (and/or combined rotation) - Provocation w. stretching any compressive musculature - Vascular TOS associated w/ edema, cyanosis, coldness of hand, and diminished pulses - Neurological TOS: characteristic C8/T1 distribution LMN signs, possibly atrophy abductor pollicis brevis
88
What are some potential positive test for Thoracic Outlet Syndrome?
- Roo's Test - Hyperabduction Test - Adison's Test - Cervical Rotation Lateral Flexion Test: Restricted 1st Rib - First Rib Spring Test: Restricted 1st Rib
89
SCHEUERMANN'S DISEASE
SCHEUERMANN'S DISEASE
90
What are the 3 criteria for diagnosis of Scheuermann's Disease?
- Thoracic kyphosis >45 degrees - Wedging x3 adjacent vertebrae > 5 degrees - Thoracolumbar kyphosis >30 degrees
91
What are the symptoms of Scheuermann's Disease?
-Thoracic pain, commonly at apex of curvature
92
How will a patient with Scheuermann's Disease present during a physical examination?
- Scoliosis (15-20%) - Excessive thoracic kyphosis - Vertebral wedging - Limited thoracic ROM - Neurological complications
93
COSTOCHONDRITIS
COSTOCHONDRITIS
94
What is Costochondritis?
Inflammation of the cartilage that connects a rib to the breastbone.
95
Costochondritis may be related to upward of __% of ED visits related to chest pain.
30%
96
- Costochondritis involves how many ribs? - What is the proposed pathophysiology? - How long does it take to resolve?
- >/= 1 rib - repetitive stress - within 1 year
97
What are the symptoms of costochondritis?
-Pain and local tenderness at costochondral or chondrosternal articulations.
98
How will a patient with Costochondritis present during a physical examination?
- Local tenderness | - Painful with chondrosternal joint mobility testing

S3- Musculoskeletal (27 decks)

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