T-Spine/Ribs Common Presentations

Question 1

integrity of what ligaments/structues is involved with vertebral fractures? (Hint: SIZL)

Answer 1

Supraspinous ligament
Interspinous ligament
Z-joint capsules
Ligamentum flavum

Question 2

traditional compression fractures involve which column(s) of the vertebra?

Answer 2

anterior

Question 3

common mechanisms of injury for traditional compression fx

Answer 3

-Axial loading in flexed position
-Traumatic: high energy flexion (axial load like a fall)

Question 4

burst fractures involve which column(s) of the vertebra?

Answer 4

anterior and middle

Question 5

what are the common mechanisms of injury for a burst fx?

Answer 5

-Vertebral segment subjected to high axial force (and/or flexion load)
-Ex: MVC, fall from a height, high-speed sports injury

Question 6

where is the most common area to see burst fx?

Answer 6

thoracolumbar junction (T12-L1)

Question 7

rotation/translation fractures are associated with what mechanisms of injury?

Answer 7

-Torsion/shear force
-Fall from a height
-Heavy object falling on body w bent trunk

Question 8

which vertebral column(s) are usually involved in rotation/translation fx?

Answer 8

all 3 columnns (ant, middle, post)

Question 9

dislocation (type of rotation/translation fx): the facet joints are intact, but dislocated.. what are the consequences of this?

Answer 9

-Can cause damage elsewhere
-Articular processes and/or superior vertebral body often get fractured

Question 10

what can potentially be fractured with a distraction fx?

Answer 10

posterior elements

Question 11

typical MOI of distraction fx

Answer 11

forced flexion or extension

Question 12

what red flags should you be on the lookout for with vertebral fx?

Answer 12

Older age
Significant trauma
Corticosteroid use
Contusion/abrasion

Question 13

what is the Roman cluster used for?

Answer 13

-Identifying the presence of an osteoporotic vertebral compression fx
-Can be used for screening or confirmation

Question 14

what 5 things are included in the Roman cluster?

Answer 14

Age > 52
No presence of leg pain
BMI 22 or less
No regular exercise
Female

Question 15

what is the Henschke cluster used for?

Answer 15

identifying the presence of a burst fx

Question 16

what 4 things are included in the Henschke cluster?

Answer 16

Age > 70
Significant trauma
Prolonged corticosteroid use
Sensory alterations from trunk down

Question 17

upper rib fx: what structures are you concerned about?

Answer 17

brachial plexus and vascular structures

Question 18

lower rib fx: what structures are you concerned about?

Answer 18

pleura, lungs, abdominal organs

Question 19

many simple rib fractures become stable in how many weeks?

Answer 19

6

Question 20

who is at high risk for Scheurmann’s disease?

Answer 20

Manual workers who begin at early age
High intensity athletes
High BMI
Short sternum

Question 21

what is the diagnostic criteria for Scheurmann’s disease?

Answer 21

Thoracic kyphosis > 45 deg
Wedging x 3 adjacent vertebrae > 5 deg
Thoracolumbar kyphosis > 30 deg

Question 22

costochondritis typically resolves within how many years?

Answer 22

1

Question 23

what gender/age is commonly associated with costochondritis?

Answer 23

older females (40-60)

Question 24

is disc disease more common in the upper or lower T-spine?

Answer 24

lower

Question 25

75% of disc herniations happen at what part of the T-spine?

Answer 25

T8-T12

Question 26

why is disc herniation less common in the T-spine than other areas?

Answer 26

less movement, lots of structural stability

Question 27

T4 syndrome: what gender is most common?

Answer 27

women (4:1)

Question 28

what parts of the T-spine can be involved with T4 syndrome?

Answer 28

T2-T7

Question 29

what is structural rib dysfunction?

Answer 29

anterior/posterior subluxation (partial dislocation) of costovertebral joint

Question 30

what is torsional rib dysfunction?

Answer 30

rib is held in upward or downward rotation

Question 31

what is respiratory rib dysfunction?

Answer 31

related to posture, may affect respiration

Question 32

what is the most painful movement for someone with rib dysfunction?

Answer 32

rotation

Question 33

T/F: costovertebral and costotransverse joints can refer pain to the chest

Answer 33

FALSE! These joints DO NOT refer pain to the chest

Question 34

if you take BP on both sides and see this much of a difference, you’re gonna suspect VTOS

Answer 34

20 mmHg

Question 35

what muscle can become atrophied with NTOS?

Answer 35

ABD pollicis brevis