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MJ- F3 E2: MSK/Rheum > Thoracic > Flashcards

Thoracic Flashcards

1
Q

Presentation of lower thoracic back pain:

  • 12 y/o M
  • Dull ache w/ sitting
  • Sharp pain with leaning back
  • No radiation
A

Scheuermann’s Kyphosis

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2
Q

What condition?

  • 12-15y/o M
  • From rapid bone growth (developmental)
  • Wedge shaped vertebra
  • Structural kyphosis
A

Scheuermann’s Kyphosis

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3
Q

How do you dx Scheuermann’s Kyphosis?

A

Anterior wedging

(>5deg in >3 adjacent vertebral bodies)

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4
Q

What is used to guide tx of Scheuermann’s Kyphosis?

A

Cobb angle

(measures whole curvature of spine in order to determine overall impact of anterior wedging)

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5
Q

What is the Cobb Angle?

A

Used to determine the maximum angle of curvature= overall impact of antior wedging

–> guides tx of Scheuermann’s Kyphosis

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6
Q

How do you tx Scheuermann’s Kyphosis? (3)

A
  1. Stretching/strengthening
  2. Bracing (if kyphosis >55-60deg until skeletally mature)
  3. +/- surgery (rarely used)
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7
Q

What condition?

A

Scheuermann’s Kyphosis

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8
Q

What are the 5 indications for surgical correction of Scheuermann’s Kyphosis?

(sx rarely utilized)

A
  1. Skeletal maturity
  2. Rigid deformity

3. Kyphosis >75deg

  1. Pain unresponsive to conservative care
  2. Unacceptable appearance
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9
Q

What condition?

  • Insidious onset anterior CP
  • Pain increases w/ inspiration
  • Breathing restricted due to pain
  • “Knife through chest into back”
  • No other assoc. sxs
A

Costovertebral Dysfunction

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10
Q

What is Costovertebral Dysfunction?

A

Rib hypomobility/ “subluxation”

(functional disruption of the costovertebral and costosternal articulations)

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11
Q

Which condition?

  • Sharp stabbing pain
  • Unilateral
  • Anterior and posterior (“knife stabbing through chest to back”)
  • +/- radiate laterally along dermatome
  • Increased pain w/:
    • deep breathing
    • Coughing/sneezing/laughing
A

Costovertebral dysfunction

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12
Q

What 4 things are seen on PE in a pt w/ Costovertebral Dysfunction?

A
  1. Reproducible pain
  2. PA mobilization of adjacent vertebra (inc. pain, hypomobility)
  3. Protective mm. spasm
  4. Restricted trunk ROM
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13
Q

How do you manage Costovertebral Dysfunction? (4)

A
  1. NSAIDs
  2. Acetaminophen
  3. Muscle Relaxants
  4. Manual therapy (PT/DC/massage therapy)
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14
Q

What condition?

  • >40y/o
  • Idiopathic
  • Unilateral
A

Costochondritis

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15
Q

What is the MCC of MSK anterior chest pain?

A

Costochondritis

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16
Q

What ribs are most commonly affected in costochondritis?

A

2nd-5th ribs

17
Q

What is costochondritis?

A

Inflammation of costochondral or chrondrosternal junction

18
Q

Which condition?

  • Sharp, aching or pressure like pain
  • Anterior (NOT posterior)
  • +/- radiate laterally
  • Reproducible pain
  • No overlying discoloration/swelling
  • NO ROM restriction
A

Costochondritis

19
Q

What condition?

  • <40y/o
  • Idiopathic (h/o of preceding illness w/ coughing)
  • 2nd-3rd ribs MC
A

Tietze syndrome

20
Q

What is Tietze Syndrome?

A

Inflammation of costochondral or costosternal junction

21
Q

H&P of what condition?

  • Sharp, aching or pressure
  • Anterior
  • +/- radiate laterally
  • Reproducible pain
  • _Swelling overlying involved joints**_
  • NO ROM restriction
A

Tietze Syndrome

22
Q

What is unique about Tietze Syndrome?

A

Swelling overlying the involved joints

23
Q

How do you tx both Costochondritis and Tietze Syndrome?

A

1. NSAIDs

2. Acetaminophen

3. Activity modification

  1. Refractory= Lidocain/Corticosteroid injection
24
Q

What is the course of Costochondritis and Tietze syndrome?

A

Variable course (usually <1yr, CW tenderness tends to linger)

25
Q

How do you tx refractory cases of Costochondritis and Tietze Syndrome?

A

Lidocaine/Corticosteroid injection

26
Q

Which condition is idiopathic but most likely has a h/o of preceding illness w/ coughing

A

Tietze Syndrome

27
Q

Which condition is idiopathic but most likely has a h/o of preceding illness w/ coughing or recent strenuous exercise

A

Costochondritis

(Tietze Syndrome will just have h/o preceding illness w/ coughing)

MJ- F3 E2: MSK/Rheum (7 decks)

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