THORACIC Flashcards
Clinical pattern and presentation for - Ankylosing Spondylitis?
• Pain increases with rest, early am p &stiff+, reduces with exercise, walking
• May have had systemic illness
• Deep throb/ache lower back
• Stiff whole lumbar area
• Tend to be male and 40yrs+
Objective
• Reduced Lx lordosis-’ironed out’, flat, Tx kyphos
• Reduced range Lx E, LF, F; chest expansion
• +SIJ testslow back/buttock p
• Palp-spinous process tender,
• sharp local p on SIJ mobs
• Tender: enthesitis-iliac crest, ischial tub, PS, achilles, manubriosternal jt, heel, st/clav jt
• Differential diag-RA instability not stiff
management of ankylosing spondylitis ??
- Patient education
- NSAID/asprin
- rest, modalities, pain techs
- mob/ROM exs-LF, deep inspiration
- strengthen back E, deep Cx F, low Cx E, scapula retractors
- Hydro/swimming-E++
- Postural work, stretches
Clinical Pattern and presentation for Thoracic outlet syndrome?
• Diffuse and unlocalised dull ache
- Medial arm/hand, supraclavicular fossa
• Pins and needles/numbness C8/T1
• Cold hands and colour changes
• Heaviness, fatigue
• Aggravated by activities reducing costoclavicular space
Retract arms
Military position
Hyperabduct
• Eased
Activities that reduce pressure on A, V, N
Objective
• Elevation of arms may cause symptoms
• Weakness in hand muscles
• Tight scalenes/ pec min
• Adsons test
Cx rot, E, sh abd, deep insp
Will lead to reduced radial pulse or elicit symptoms
management of thoracic outlet syndrome?
- Stretch tight mm eg scaleni, pect minor
- Postural re-ed and mm strength eg retractors
- mob Cx, Tx, 1st rib/neural techs-restore painfree movt at site of compression
- advice re-support arms on chair before bedrelease phenomena.
- ?more supportive bra
- surgery-?remove 1st rib, ?scalenectomy
- treat the things found, don’t try to treat the whole condition- this will not work
Clinical pattern and presentation of - Scheuermann’s ?
Subjective
• 22 yr deep ache i/m-const+/-sharp p mid/low Tx EOR
• prolonged EOR F/E
• rest, am stiff
• X-ray-wedge body (front section grows slower than back section), endplate irreg, Schmorls nodes
• insid,. growing p, self limit at ossification
Objective
• Tx kyphosis
• All movts-dull ache, stiff
• Stiff 1-2 segmts Tx/Lx
• Rigid between stiff and non-stiff segments
• Stiff central cf unilat PAs bilat.
• Neurolog/Neural is fine
management of scheuermanns?
- Advice re-posture/ mobilising exs into E
- Strength/endurance exs
- Mob stiff (hypomobile) segments
- Brace if moderately severe deformity (55-80 degrees)
- Surgery if severe deformity (>80 degrees)
- Sports involving extension encouraged e.g. swimming
clinical pattern and presentation for cervical disc ?
Subjective
• Central/bilateral, suprascapular fossa, medial scapular
• pain sustained Flexion
• Pain reduced when non weight bearing (lying on back)
• unusual, sustained activity of neck, strain with arms eg lifting
• Symptoms not immediate; more next day
Objective
• Extension often quite stiff
All movements may be limited by pain
• Posterior glide also stiff (accessory passive movement)
• A lot of central soft tissue changes
Central thickening
• C4 depressed and C5 more prominent
• Neurological should be negative, but often issues occur together so nerve may be affected as well as disc
• No findings with PAIVMs
o However, C5 may be stiff while C4 is mobile
management of cervical disc?
Management • PAIVMs • If irritable: o Collar o Analgesics o NSAIDs o Bed rest o Cervical traction o Electrotherapy • Non-irritable o Central PAs into resistance o Posture correction o Muscle balance o Self-treatment o Stretches at home o Correct own posture o Muscle length and strength
clinical pattern and presentation of cervical PIV joint?
Subjective
• Pain may be referred to supraspinous fossa and scapula
• Local, bilateral not central
Med. Scapula may hurt
• INCREASE PAIN on stretch movements eg F, LF, rot away OR compression movements eg E, LF, rot toward
• Quick unguarded movement cause immediate symptoms and then improve rapidly
Objective
• Nil deformity
• Peri-articular-symptoms F, LF away, rot away, from side of symptoms
• Intra-articular- symptoms E, LF toward, rot toward side of symptoms
• Lateral interlaminar thickening
• Unilateral PA’s stiff
• Neurological not expected but may be present if other issue also
management of cervical PIV?
Management • Acute o Gentle passive mobs o unilat PA’s, lateral glide, rot away o Cx traction o Electrotherapy, collar o ROM exs • Chronic o strong EOR mobs (grade 3/4) o self Rx
clinical pattern and presentation of cervical postural pain ?
Subjective
• widespread diffuse ache with uni-bilat spread
• increase withsustained posture
decreases with movts, non weightbearing
• pre-disposing illness = rest and reduced mm control
Increase pace, hrs, activities
Objective • Forward head posture, Tx kyphosis • Full ROM, painfree • Mm imbalance tight-suboccipital E, upper traps, levator scapulae weak-short neck Fx/long neck Ex • Palp-tender over area • PAIVM’s = good • Neural= good
management of cervical postural pain?
Management
• Explain-mechanism, active role
• Advice-rest, regular curve reversal
• Home exs:
o endurance exs. for weak mm
o stretches for tight mm;
• Passive mobs for joint/neural signsclinical pattern and presentation of cervicogenic headache ?
0/C1 o Vice-like “ache” o TMJ pain o Ear pain/blocked o Patchy o Uni/bi-lateral o No neck pain below occiput C1/C2 o Uni/bi-lateral o Immediate SO pain o May describe a ‘head-band’ of pain o Rare and most difficult to treat o Commonly associated with trauma C2/C3 o Uni/bi-lateral, “face ache”+/- nuchal line pain o Nausea, dizziness, throbbing,“migraine-type” o Most common & often associated with O/C1 dysfunction
objective
• Forward head posture, poking chin
• Movements-no set pattern of restriction, may need combined upper Cx
• Reproduce H/A=diagnostic of Cx H/A
• VBI may be +ive
• Mm-tight suboccipital E, upper traps, loss endurance-deep Cx F
• Palp/PAIVM’s findings in upper Cx region O-C3
management of cervicogenic headache?
• Strong sustained mobs IV+ >oscillations stiff Cx
Home exs:
o Stretch tight mm-suboccip E, upper traps
o Posture: generalised/localised upper Cx retraction
o Increase endurance of deep Cx Fors +isometric strengthening other neck mm
o Ergonomics: desk, pillow, sleep position
• Check thoracic spine-mobilise if stiff
clinical pattern and presentation of carpel tunnel syndrome?
Subjective
• Common
• Numbness and tingling
• Aggravated by gripping
• Worse at night or AM
• May be eased by shaking/ flicking wrist
• “dropping things”
Objective
• Weakness or atrophy of wrist
• Reduced grip strength
• Boston Carpal Tunnel Questionnaire (potential OM)
• Phalen’s test (dorsum of hands held together, do for 1 minute)
o Will be +ve in CTS (Symptoms, tingling in thumb, index, middle or ring finger, pain)
