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MSK 1 > T-Spine Common Clinical Presentation > Flashcards

T-Spine Common Clinical Presentation Flashcards

1
Q

List some common clinical presentations of T-Spine

A
  1. Pancoast Tumor
  2. Fracture
  3. Scheurmann’s Disease
  4. Costochondritis
  5. Disc disease
  6. Thoracic Myelopathy
  7. T4 syndrome
  8. Scoliosis
  9. Arthropathy
  10. Rib dysfunction
  11. Thoracic Outlet Syndrome (TOS)
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2
Q

what is a Pancoast tumor?

A

a tumor at the apex of the lungs

may involve C8 and first thoracic nerve structures

may present similiar to MSK origin (especially TOS)

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3
Q

list the s/s of a Pancoast tumor

A
  1. chronic cough
  2. bloody sputum
  3. unexplained weight loss
  4. malaise
  5. dyspnea
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4
Q

describe the physcial examination findings for Pancoast tumors

A
  1. fever
  2. wheezing
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5
Q

what types of disorders can have referral patterns around the T-Spine?

A
  1. MI
  2. Pericarditis
  3. Pneumothorax
  4. Pleuritis
  5. Pleuropulmonary disorders
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6
Q

what portion of the vertebrae are fractures most common in the T-Spine?

A

posterior component fractures

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7
Q

what 3 components describe the risk/need for surgery related to vertebral fracture?

A
  1. morphology
  2. integrity of PLC
  3. Neurologic status
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8
Q

vertebral fractures can be classified into what categories based on morphology?

A
  1. Compression
  2. translation/rotation
  3. distraction
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9
Q

compression fractures can be subclassified into what 2 categories?

A
  1. traditional compression fractures
  2. burst fractures
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10
Q

describe traditional compression fractures

A

stable injury

anterior column solely affected

spinal canal intact

common mechanism axial loading in flexed position

traumatic: high energy and osteoporotic

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11
Q

describe burst fractures

A

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)

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12
Q

describe rotational/translation fractures

A

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

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13
Q

describe distraction fractures

A
  • 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
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14
Q

list red flags for vertebral fractures

A
  1. Older age
  2. significant trauma
  3. corticosteroid use
  4. contusion/abrasion
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15
Q

name 2 clusters that can be used to detect a vertebral fracture

A

Roman (better in osteoporotic fractures)

Henschke (more concerning for traumatic type injuries)

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16
Q

list the factors on Henschke’s cluster

A
  1. Age > 70 yrs
  2. significant trauma
  3. prolonged corticosteroid use
  4. sensory alterations from the trunk down
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17
Q

list the factors found on Roman’s cluster

A
  1. Age > 52 years
  2. no presence of leg pain
  3. BMI = 22
  4. doesn’t exercise regularly
  5. Female gender
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18
Q

what is the clinical utility of Roman’s cluster?

A

QUADAS score of 8

<2/5 -LR is good making it good for elimination

4/5 has +LR of 9.6

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19
Q

list symptoms and physical exam findings of a rib fracture

A
  1. Symptoms
    1. focal pain, radiating pain
    2. pain with inspiration
    3. pain with coughing/sneezing
  2. Physical exam findings:
    1. focal tenderness
    2. possible palpable defect
20
Q

where is disc disease more common in the T-Spine?

A

lower T-Spine

21
Q

list the symptoms for disc disease in the T-Spine

A
  1. back or chest pain
    1. radicular: band-like pain in affected level’s dermatome, paresthesia/anesthesia, leg pain
    2. back pain at midline
  2. progressively/insidious (months to years)
22
Q

what is thoracic myelopathy?

what are related health conditions?

A

cord compression in the T-Spine

related health conditions: compression Frx, stenosis

23
Q

what are the symptoms and exam findings for thoracic spine myelopathy?

A
  1. symptoms
    1. sexual dysfunction
    2. bowel and bladder dysfunction
  2. Physical exam
    1. sensory/motor impairments
    2. UMN signs LEs
24
Q

what are some potential causes of intercostal neuralgia?

A
  1. infection (varicella zoster)
  2. mechanical compression
    • disc protrusion, osteophyte complex, neuroma, Frx
  3. following a thoracic surgery
25
Q

list symptoms and physical exam findings for intercostal neuralgia

A
  1. symptoms:
    1. burning pain/paresthesia along intercostal nerve path
  2. physical exam:
    1. focal tenderness of intercostal area
26
Q

T/F: T4 syndrome is more commen in men?

A

FALSE

women > men (4:1)

27
Q

describe the etiology of T4 Syndrome

A

unknown

theory → sympathetic reaction with hypomobile segment

28
Q

what are the primary pain generators in T4 syndrome?

A

thoracic IV discs

thoracic zygophyseal joints

29
Q

list the symptoms for T4 syndrome

A
  1. glove-like paresthesias unilateral/bilateral UEs
  2. neck/scapular/bilateral UE pain
    • constant or intermittent
    • worsens w/side-lying or supine position
  3. generalized HA
30
Q

list the physical exam findings for T4 syndrome

A
  1. tender spinous processes (can be T2-7)
    • thoracic slump test
    • Upper quarter neurodynamic tension test
  4. hypomobile thoracic segment
31
Q

what is scoliosis? describe its’ etiology

A

abnormal curvature of the spine

can be congenital or acquired

32
Q

how is scoliosis named/described?

A

by region of the spine and direction of CONVEXITY

33
Q

list the symptoms and physical exam findings for zygophysial arthropathies in the T-Spine

A
  1. Symptoms:
    1. local and/or referred pain
  2. Physical exam:
    1. painful movement with closing of z-joints (AROM and PROM)
    2. painful spring testing/hypomobility with joint mobility testing
34
Q

rib dysfunction can be broken down into what 3 subcategories?

A
  1. structural → subluxation of joint (anterior or posterior)
  2. torsional → rib held in rotated position
  3. respiratory → related to posture, may affect respiration
35
Q

list the symptoms and physical exam findings for rib dysfunction

A
  1. symptoms:
    1. aggravated with deep inspiration, trunk rotation, sneezing/coughing
  2. physical exam:
    1. diminished rib mobility (structural)
    2. pain/hypomobility with joint mobility testing
    3. limited/painful T-spine motion
36
Q

define thoracic outlet syndrome (TOS)

A

UE symptoms due to compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle

37
Q

list various structures that can be compressed in TOS

A

subclavian artery (ATOS)

subclavian vein (VTOS)

brachial plexus (NTOS) 90-95% of TOS

38
Q

list various areas of potential compression in TOS

A
  1. scalenes
  2. cervical rib
  3. pec minor
  4. first rib (hypertonic scalenes)
  5. clavicle
39
Q

describe the clinical presentation of TOS

A
  1. Hx of neck trauma
  2. cervical rib (incidence <1% of population)
  3. Raynaud’s phenomenon
40
Q

list symptoms of TOS

A
  1. UE pain, paresthesia, anesthesia/weakness (glove-like vs. particular distribution consistent with area of compression
  2. chest/anterior shoulder pain
  3. typically progressive/insidious onset
41
Q

describe physical exam findings in TOS

A
  1. guarding of cervicothoracic/scapulothoracic muscles
  2. provocation with contralateral cervical lateral flexion (and/or combined rotation)
  3. provocation with stretching any compressive muscles
  4. vascular TOS associated with:
    • edema, cyanosis, coldness of hand, and diminished pulses
  5. neurologic TOS associated with:
    • characteristics C8/T1 distribution LMN signs, possible atrophy abductor pollicis brevis
42
Q

list potentially positive special tests in TOS

A
  1. Roo’s Test
  2. Hyperabduction Test
  3. Adison’s Test
  4. Cervical Rotation lateral flexion test: restricted 1st rib
  5. First rib spring test: restricted 1st rib
43
Q

what is Scheurmann’s Disease?

A

a genetic condition in which there is a defective growth of the vertebral endplate and poor diffusion of nutrients to the unvascularized disc

44
Q

list risk factors for Scheurmann’s Disease

A

increased risk in:

  1. manual workers who begin at early age
  2. young high intensity athletes
  3. high BMI
  4. anatomical variation of short sternum
45
Q

list the diagnositc criteria for Scheurmann’s Disease

A
  1. thoracic kyphosis > 45 degrees
  2. wedging x 3 adjacent vertebrae > 5 degrees
  3. Thoracolumbar kyphosis > 30 degrees
46
Q

list the symptomology of Scherumann’s Disease

A
  1. thoracic pain
  2. commonly apex of curvature (muscular tension, IV disc bulging/spondylosis)
47
Q

list some physical exam findings in individuals with Scheurmann’s Disease

A
  1. Scoliosis (15-20%)
  2. Excessive thoracic kyphosis
  3. Vertebral wedging, Schmorl’s nodes (16-48%), disc space narrowing
  4. Limited thoracic ROM
  5. Neurologic Complications (less common)

MSK 1 (17 decks)

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