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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
Q

What are common MOI for Burst Fractures?

A

High force axial (and/or flexion load)

  • MVC
  • Falls from heights
  • High speed sport injury
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26
Q

Rotation/Translation Fractures are associated with falls from a height or heavy objects falling on body with bent trunk and involve ______ and ______ forces.

A

torsion and shear

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27
Q

Rotation/Translation involves __________ displacement of one T/L vertebral body on another.

A

horizontal

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28
Q

Can dislocations happen with Rotation/Translation Fractures?

A

Yes, facet joints intact but dislocated

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29
Q

Can Rotation/Translation Fractures cause impingement on the spinal cord?

A

Yes

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30
Q

Distraction Fractures involve separation in the _________ axis. They can involve both anterior/posterior _________ and ____ structures.

A
  • vertical

- ligament and bony structures

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31
Q

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.
A
  • clusters
  • high
  • Old age, significant trauma, corticosteroid use, contusion/abrasion
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32
Q

What is the Vertebral Fracture cluster?

A
  • Age >70
  • Significant Trauma
  • Prolonged corticosteroid use
  • Sensory alterations from the trunk down
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33
Q

-What are the parts of Roman’s Cluster for Vertebral Compression Fractures?

A
  • Age >52
  • No presence of leg pain
  • BMI = 22
  • Does not exercise regularly
  • Female gender
  • <2/5
  • 4/5
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34
Q

RIB FRACTURES

A

RIB FRACTURES

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35
Q

Rib fractures can be _______ or _______ fractures.

A

trauma or stress

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36
Q

Are rib fractures commonly managed conservatively?

A

Yes, but it is important to get medically assessed for potential of jagged edges to pierce into tissues.

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37
Q

What are some areas that can be pierced/injured with rib fractures?

A
  • Brachial plexus/vascular structures

- Laceration of pleura, lungs, abdominal organs.

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38
Q

What percentage of upper rib fractures are associated with brachial plexus/vascular structure injuries?

A

3-15%

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39
Q

Many simple rib fractures become stable after __ weeks.

A

6 weeks

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40
Q

Taping/strapping are avoided in the thorax, why?

A

They can increase the risk for other issues such as complications related to the fracture and cardiovascular and respiratory issues.

41
Q

What are the symptoms associated with rib fractures?

A
  • Focal pain, radiating pain
  • Pain w/ inspiration
  • Pain w/ coughing/sneezing
42
Q

How will rib fractures present during a physical examination?

A
  • Focal tenderness

- Possible palpable defect

43
Q

Are x-rays good for finding rib fractures?

A

No, commonly missed on them.

44
Q

DISC DISEASE

A

DISC DISEASE

45
Q

Thoracic disc lesions make up __% of all surgically managed HNPs (herniation of nucleus pulposus).

A

1%

46
Q

Disc Disease is more common in the _____ T-spine and can have potential __________ involvement. These are typically ___________ in nature.

A
  • lower
  • neurologic (radicular vs myelopathy)
  • degenerative
47
Q

Herniations mostly occur in the ______ T-spine and many of them are _____________.

A
  • lower (T8-T12)

- asymptomatic

48
Q

What are the symptoms of Disc Disease?

A
  • 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
Q

How will Disc Disease present during a physical examination?

A
  • ??? Not a well developed pattern

- possible myelopathic signs

50
Q

Thoracic Spine Myelopathy:

  • Cord compression in the thoracic spine
  • Related health conditions: _________ Frx, ________
A
  • compression frx

- stenosis

51
Q

What are the symptoms of myelopathy?

A
  • sexual dysfunction

- bowel and bladder dysfunction

52
Q

How will myelopathy present during a physical examination?

A
  • sensory/motor impairments

- UMN signs LEs

53
Q

Intercostal neuralgia affects our ________ nerve. What are some things that can lead to this?

A
  • intercostal nerve

- Infection, Mechanical Compression (disc protrusion, osteophyte complex, neuroma, Frx), following thoracic Sx

54
Q

What are the symptoms of intercostal neuralgia?

A

Burning pain/paresthesia along intercostal nerve path (around the rib cage)

55
Q

How will intercostal neuralgia present during a physical examination?

A

Focal tenderness of intercostal area

56
Q

T4 SYNDROME

A

T4 SYNDROME

57
Q
  • Does T4 syndrome affect women or men more?

- The etiology of T4 Syndrome is _______, what is the theory?

A
  • Women (4x)

- unknown, theory is that there is a sympathetic reaction with hypomobile segment

58
Q

T4 syndrome can affect T_-T_.

A

T2-T7

59
Q

What are the primary pain generators related to T4 syndrome?

A
  • Thoracic IV discs

- Thoracic zygopophyseal joints

60
Q

What are the symptoms of T4 syndrome?

A
  • Glove-like paresthesias unilateral/bilateral UEs
  • Neck/scapular/bilateral UE pain (constant or intermittent) that worsens w/ side-lying or supine
  • Generalized headache
61
Q

How will T4 Syndrome present during a physical examination?

A
  • Tender spinous process
    • Thoracic Slump Test
    • Upper Quarter Neurodynamic Tension Tests
  • Hypomobile Thoracic Segment
62
Q

SCOLIOSIS

A

SCOLIOSIS

63
Q

Simply put, what is scoliosis?

A

Abnormal curvature of the spine.

64
Q

The etiology of scoliosis is either _________ or ___________ and is named for _____________.

A
  • congenital or acquired

- convexity

65
Q

With scoliosis, there is a ________ and ___________________ component.

A
  • rotational

- lateral flexion

66
Q

What are the 2 categories of scoliosis?

A
  • Adolescent idiopathic scoliosis (congenital or neuromuscular)
  • Degenerative scoliosis
67
Q

Up to __% of adults >__ y/o present with degenerative scoliosis.

A
  • 68%

- 70 yo

68
Q

Scoliosis is described by the region of the spine and direction of ____________.

A

Convexity

69
Q

THORACIC Z JOINT ARTHROPATHY

A

THORACIC Z JOINT ARTHROPATHY

70
Q

Is Zygopophyseal Arthropathy more or less understood in the thoracic spine compared to the lumbar and cervical spine?

A

Less

71
Q

Is Zygopophyseal Arthropathy more common unilateral or bilateral?

A

unilateral

72
Q

What are the symptoms of Zygopophyseal Arthropathy?

A

local and/or referred pain

73
Q

How will Zygopophyseal Arthropathy present during a physical examination?

A
  • Painful movement with closing of z-joints (AROM/PROM)
  • Painful spring testing/ Hypomobility with joint mob testing
  • Hypomobility with PPIVM, Pain with PAIVM
74
Q

RIB DYSFUNCTION

A

RIB DYSFUNCTION

75
Q

Rib Dysfunction can be ___________ or __________.

A

inflammatory or degenerative

76
Q

What are the 3 categories of Rib Dysfunction and what is each?

A
  • Structural- Subluxation of joint (anterior or posterior)
  • Torsional- Rib held in rotated position
  • Respiratory- Related to posture, may affect respiration
77
Q

What are the symptoms of Rib Dysfunction?

A

Aggravated with deep inspiration, trunk rotation, sneezing/coughing

78
Q

How will Rib Dysfunction present during a physical examination?

A
  • Diminished rib mobility (structural)
  • Pain/hypomobility with joint mobility testing
  • Limited/painful thoracic spine motion
79
Q

THORACIC OUTLET SYNROME

A

THORACIC OUTLET SYNDROME

80
Q

What is Thoracic Outlet Syndrome?

A

“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
Q

What are the structures that can be compressed with Thoracic Outlet Syndrome?

A
  • Subclavian Artery (ATOS)
  • Subclavian Vein (VTOS)
  • Brachial Plexus (NTOS)
82
Q

Brachial Plexus Compression makes up __-__% of all TOS.

A

90-95%

83
Q

What are some potential areas for compression in Thoracic Outlet Syndrome?

A
  • Scalenes
  • Cervical Rib
  • Pec Minor
  • First Rib (hypertonic scalenes)
  • Clavicle
84
Q

What is the prevalence of Thoracic Outlet Syndrome?

A

estimated 10/100,000

85
Q

What are the symptoms of Thoracic Outlet Syndrome?

A
  • UE pain, paresthesia, anesthesia/weakness (glove-like vs particular distribution consistent with area of compression)
  • Chest/anterior shoulder pain
  • Typically progressive/insidious onset
86
Q

What is the clinical presentation/Hx of Thoracic Outlet Syndrome?

A
  • Hx neck trauma
  • Cervical rib (1% of population)
  • Raynaud’s phenomenon
87
Q

How will Thoracic Outlet Syndrome present during a physical examination?

A
  • 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
Q

What are some potential positive test for Thoracic Outlet Syndrome?

A
  • Roo’s Test
  • Hyperabduction Test
  • Adison’s Test
  • Cervical Rotation Lateral Flexion Test: Restricted 1st Rib
  • First Rib Spring Test: Restricted 1st Rib
89
Q

SCHEUERMANN’S DISEASE

A

SCHEUERMANN’S DISEASE

90
Q

What are the 3 criteria for diagnosis of Scheuermann’s Disease?

A
  • Thoracic kyphosis >45 degrees
  • Wedging x3 adjacent vertebrae > 5 degrees
  • Thoracolumbar kyphosis >30 degrees
91
Q

What are the symptoms of Scheuermann’s Disease?

A

-Thoracic pain, commonly at apex of curvature

92
Q

How will a patient with Scheuermann’s Disease present during a physical examination?

A
  • Scoliosis (15-20%)
  • Excessive thoracic kyphosis
  • Vertebral wedging
  • Limited thoracic ROM
  • Neurological complications
93
Q

COSTOCHONDRITIS

A

COSTOCHONDRITIS

94
Q

What is Costochondritis?

A

Inflammation of the cartilage that connects a rib to the breastbone.

95
Q

Costochondritis may be related to upward of __% of ED visits related to chest pain.

A

30%

96
Q
  • Costochondritis involves how many ribs?
  • What is the proposed pathophysiology?
  • How long does it take to resolve?
A
  • > /= 1 rib
  • repetitive stress
  • within 1 year
97
Q

What are the symptoms of costochondritis?

A

-Pain and local tenderness at costochondral or chondrosternal articulations.

98
Q

How will a patient with Costochondritis present during a physical examination?

A
  • Local tenderness

- Painful with chondrosternal joint mobility testing

S3- Musculoskeletal (27 decks)

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