T-Spine Common Clinical Presentation Flashcards
List some common clinical presentations of T-Spine
- Pancoast Tumor
- Fracture
- Scheurmann’s Disease
- Costochondritis
- Disc disease
- Thoracic Myelopathy
- T4 syndrome
- Scoliosis
- Arthropathy
- Rib dysfunction
- Thoracic Outlet Syndrome (TOS)
what is a Pancoast tumor?
a tumor at the apex of the lungs
may involve C8 and first thoracic nerve structures
may present similiar to MSK origin (especially TOS)
list the s/s of a Pancoast tumor
- chronic cough
- bloody sputum
- unexplained weight loss
- malaise
- dyspnea
describe the physcial examination findings for Pancoast tumors
- fever
- wheezing
what types of disorders can have referral patterns around the T-Spine?
- MI
- Pericarditis
- Pneumothorax
- Pleuritis
- Pleuropulmonary disorders
what portion of the vertebrae are fractures most common in the T-Spine?
posterior component fractures
what 3 components describe the risk/need for surgery related to vertebral fracture?
- morphology
- integrity of PLC
- Neurologic status
vertebral fractures can be classified into what categories based on morphology?
- Compression
- translation/rotation
- distraction
compression fractures can be subclassified into what 2 categories?
- traditional compression fractures
- burst fractures
describe traditional compression fractures
stable injury
anterior column solely affected
spinal canal intact
common mechanism axial loading in flexed position
traumatic: high energy and osteoporotic
describe burst fractures
impacts anterior and middle columns
most common at TLJ
potential neural involvement; fragments may be found in canal
vertebral segment subjected to high force axial (and/or flexion load)
describe rotational/translation fractures
associated with fall from a height or heavy object falling on body with bent trunk
torsion and shear forces
horizontal displacement of one T/L vertebral body on another
dislocation: facet joints intact, but dislocated
describe distraction fractures
- separation in the vertical axis
- impacts:
- anterior and posterior ligaments
- anterior and posterior bony structures
- all of the above
- potential frx to posterior elements
- must do neuro testing in this population
list red flags for vertebral fractures
- Older age
- significant trauma
- corticosteroid use
- contusion/abrasion
name 2 clusters that can be used to detect a vertebral fracture
Roman (better in osteoporotic fractures)
Henschke (more concerning for traumatic type injuries)
list the factors on Henschke’s cluster
- Age > 70 yrs
- significant trauma
- prolonged corticosteroid use
- sensory alterations from the trunk down
list the factors found on Roman’s cluster
- Age > 52 years
- no presence of leg pain
- BMI = 22
- doesn’t exercise regularly
- Female gender
what is the clinical utility of Roman’s cluster?
QUADAS score of 8
<2/5 -LR is good making it good for elimination
4/5 has +LR of 9.6
list symptoms and physical exam findings of a rib fracture
- Symptoms
- focal pain, radiating pain
- pain with inspiration
- pain with coughing/sneezing
- Physical exam findings:
- focal tenderness
- possible palpable defect
where is disc disease more common in the T-Spine?
lower T-Spine
list the symptoms for disc disease in the T-Spine
- back or chest pain
- radicular: band-like pain in affected level’s dermatome, paresthesia/anesthesia, leg pain
- back pain at midline
- progressively/insidious (months to years)
what is thoracic myelopathy?
what are related health conditions?
cord compression in the T-Spine
related health conditions: compression Frx, stenosis
what are the symptoms and exam findings for thoracic spine myelopathy?
- symptoms
- sexual dysfunction
- bowel and bladder dysfunction
- Physical exam
- sensory/motor impairments
- UMN signs LEs
what are some potential causes of intercostal neuralgia?
- infection (varicella zoster)
- mechanical compression
- disc protrusion, osteophyte complex, neuroma, Frx
- following a thoracic surgery
list symptoms and physical exam findings for intercostal neuralgia
- symptoms:
- burning pain/paresthesia along intercostal nerve path
- physical exam:
- focal tenderness of intercostal area
T/F: T4 syndrome is more commen in men?
FALSE
women > men (4:1)
describe the etiology of T4 Syndrome
unknown
theory → sympathetic reaction with hypomobile segment
what are the primary pain generators in T4 syndrome?
thoracic IV discs
thoracic zygophyseal joints
list the symptoms for T4 syndrome
- glove-like paresthesias unilateral/bilateral UEs
- neck/scapular/bilateral UE pain
- constant or intermittent
- worsens w/side-lying or supine position
- generalized HA
list the physical exam findings for T4 syndrome
- tender spinous processes (can be T2-7)
- thoracic slump test
- Upper quarter neurodynamic tension test
- hypomobile thoracic segment
what is scoliosis? describe its’ etiology
abnormal curvature of the spine
can be congenital or acquired
how is scoliosis named/described?
by region of the spine and direction of CONVEXITY
list the symptoms and physical exam findings for zygophysial arthropathies in the T-Spine
- Symptoms:
- local and/or referred pain
- Physical exam:
- painful movement with closing of z-joints (AROM and PROM)
- painful spring testing/hypomobility with joint mobility testing
rib dysfunction can be broken down into what 3 subcategories?
- structural → subluxation of joint (anterior or posterior)
- torsional → rib held in rotated position
- respiratory → related to posture, may affect respiration
list the symptoms and physical exam findings for rib dysfunction
- symptoms:
- aggravated with deep inspiration, trunk rotation, sneezing/coughing
- physical exam:
- diminished rib mobility (structural)
- pain/hypomobility with joint mobility testing
- limited/painful T-spine motion
define thoracic outlet syndrome (TOS)
UE symptoms due to compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle
list various structures that can be compressed in TOS
subclavian artery (ATOS)
subclavian vein (VTOS)
brachial plexus (NTOS) 90-95% of TOS
list various areas of potential compression in TOS
- scalenes
- cervical rib
- pec minor
- first rib (hypertonic scalenes)
- clavicle
describe the clinical presentation of TOS
- Hx of neck trauma
- cervical rib (incidence <1% of population)
- Raynaud’s phenomenon
list symptoms of TOS
- UE pain, paresthesia, anesthesia/weakness (glove-like vs. particular distribution consistent with area of compression
- chest/anterior shoulder pain
- typically progressive/insidious onset
describe physical exam findings in TOS
- guarding of cervicothoracic/scapulothoracic muscles
- provocation with contralateral cervical lateral flexion (and/or combined rotation)
- provocation with stretching any compressive muscles
- vascular TOS associated with:
- edema, cyanosis, coldness of hand, and diminished pulses
- neurologic TOS associated with:
- characteristics C8/T1 distribution LMN signs, possible atrophy abductor pollicis brevis
list potentially positive special tests in TOS
- Roo’s Test
- Hyperabduction Test
- Adison’s Test
- Cervical Rotation lateral flexion test: restricted 1st rib
- First rib spring test: restricted 1st rib
what is Scheurmann’s Disease?
a genetic condition in which there is a defective growth of the vertebral endplate and poor diffusion of nutrients to the unvascularized disc
list risk factors for Scheurmann’s Disease
increased risk in:
- manual workers who begin at early age
- young high intensity athletes
- high BMI
- anatomical variation of short sternum
list the diagnositc criteria for Scheurmann’s Disease
- thoracic kyphosis > 45 degrees
- wedging x 3 adjacent vertebrae > 5 degrees
- Thoracolumbar kyphosis > 30 degrees
list the symptomology of Scherumann’s Disease
- thoracic pain
- commonly apex of curvature (muscular tension, IV disc bulging/spondylosis)
list some physical exam findings in individuals with Scheurmann’s Disease
- Scoliosis (15-20%)
- Excessive thoracic kyphosis
- Vertebral wedging, Schmorl’s nodes (16-48%), disc space narrowing
- Limited thoracic ROM
- Neurologic Complications (less common)
