Thoracic Flashcards
What are the red flags for thoracic pain that could indicate a serious cardiovascular disorder?
- palpitations
- SOB / dyspnoea
- pallor
- sweating
- mental state changes
- nausea / vomiting
- SSX agg. by activity and stress
What are the red flags for thoracic pain that indicate a serious respiratory disorder?
- SOB / dyspnoea
- tachycardia
- pallor / cyanosis
- persistent or productive cough
- SSX agg. by activity and deep inspiration
What are the red flags for thoracic pain that indicate a potential neoplasia?
- age over 50
- Hx malignancy
- pain at multiple sites
- pain at rest, night pain
- unexplained weight loss
- failure to improve
- vomiting
What are the signs of a Pancoast tumour?
Tumour that compresses both the brachial plexus and sympathetic trunk
- UL weakness, sensory deficit, paraesthesia
- Horner’s syndrome
Which substances are red flags with thoracic pain?
Cocaine
Amphetamines
Corticosteroids
Anticoagulants
What are the 8 serious conditions that need to be considered in thoracic pain presentations?
Myocardial ischaemia Aortic dissection Pneumonia Pneumothorax Osteomyelitis Tuberculosis Neoplasia Vertebral or rib fracture
What are the 7 musculoskeletal / discogenic conditions that need to be considered in thoracic pain presentations?
Muscle strain CV/CT sprain Cx / Tx facet sprain Osteoperosis Scheurmann's disease Costochondritis Tx discogenic pathology
Which viscera can refer pain to the thoracic region?
Heart (T1-6) Lungs (T1-6) GIT Gallbladder (Rt) Pancreas (Lt)
What is the best way to differentiate between a Tx facet sprain and a CV/CT sprain?
- similar presentations
- site of tenderness to palpation different
- tenderness of rib springing more indicative of CV/CT sprain, tenderness of PA springing of vertebrae more indicative of facet sprain
- agg. by breathing more indicative of CV/CT sprain
Describe the condition of a CV/CT facet sprain including presentation, pathology, risk factors, and prognosis
Mechanism:
- typically chronic overuse assoc. w/ sustained Tx kyphosis and/or repetitive or prolonged forces (ie: work with arms in front of body)
Pathology:
- Grade 1-3 sprain of the CV and/or CT ligaments (usually concurrent)
- may cause radiculopathy of spinal nerves
Presentation:
- unilateral posterior Tx pain, maybe radiating along rib line to chest, GH, HA, neck pain
- dull and aching constant pain, sharp on movement or palpation
Agg by:
- deep breathing, coughing, sneezing
- shoulder movement
- TL movement (esp. ipsilateral sidebending)
Findings:
- decreased Tx ROM & adj. rib ROM
- tenderness on palpation of affected joint and springing over affected rib
Prognosis:
- SSX reduction 1-3/52
- resolution and recovery 4-6/52
Describe the condition of a Tx facet sprain including mechanism, pathology, presentation, findings, and prognosis
Mechanism:
- typically chronic overuse assoc w/ sustained Tx kyphosis and/or repetitive overuse (ie: working with arms in front of body)
Pathology:
- Grade 1-3 sprain of intervertebral ligs
- may cause radiculopathy of spinal nerves
Presentation:
- unilateral posterior Tx pain
- may have radicular pain ina ffected dermatome
- pain is dull, aching and constant; and sharp on movement / palpation
Agg by:
- movement (esp. etension, ipsilateral SB & rotation)
Findings:
- decreased Tx ROM and pain with movement
- tenderness on palpation and PA springing of affected joint
Prognosis:
- SSX reduction 1-3/52
- resolution 4-6/52
What are risk factors and the typical mechanism of injury for Tx facet sprains and CV/CT sprains?
Mechanism: usually chronic overuse injury assoc w/ prolonged Tx kyphosis and/or overuse (ie: working with arms in front of body)
Risk factors:
- forward head posture, Tx kyphosis, obesity, heavy breasts, pregnancy, repetitive work with arms in front of body, degenerative conditions
What are the typical healing timeframes for a facet or CV/CT sprain?
SSX reduction 1-3/52
Resolution 4-6/52
Why are discogenic pathologies least common in the thoracic spine?
- the presence of the Tx cage lends rigidity, stability and protection to the Tx spine and makes discs less vulnerable to excessive forces and anterior shearing
What are the risk factors associated with discogenic herniations in the thoracic spine?
High risk of myelopathy in the thoracic spine (because of the narrow canal) - this is an emergency referral
SSX of thoracic myelopathy:
- decreased bilateral LL motor strength
- bilateral sensory disturbance LL
- bladder changes
- increased tone / spasticity
- hyper-reflexia
- clonus with reflex testing
- ataxia
