Thoracic conditions Flashcards
Thoracic outlet syndrome
Group of disorders that occur when blood vessels or nerves in the space between your clavicle and first rib are compressed
Epidemiology of thoracic outlet syndrome
Vascular TOS- develop secondary to repetitive upper limb activities that lead to claudication (pain in legs/arms when walking/using)
Same condition can develop spontaneously, unrelated to trauma
Neurogenic TOS commonly develops following micro trauma to neck or shoulder girdle areas (e.g., car accident, work related repetitive stressful activities)
Age groups affected by TOS
Most cases diagnosed between 20 and 50 years
Can occur in teenagers
Women 3x more likely to develop neurogenic TOS
Risk factors of TOS
Car accident
Repetitive injury job or sport-related injuries
Pregnancy
Anatomical defects (e.g., having extra rib)
Clinical presentation of TOS
Diagnosing TOS can be challenging because symptoms vary between patients
Vascular TOS easier to diagnose, venous has no objective test to confirm
Diagnosis of exclusion
Symptoms range from mild pain and sensory changes to limb –> life-threatening complications
Uni or bilateral
Record position of Pt head, shoulders, scapulae, and arms in seating and standing
Shoulder/neck pain
Upper arms- oedema (venous compromise), atrophy in hand, hand palpated for temp changes and moistness to detect sympathetically mediated symptoms
Prognosis for TOS
Treatable, resolution of around 90%
Exercises to strengthen and stretch shoulder muscle to open thoracic outlet, improve posture and ROM
Intercostal neuralgia
Characterised by neuropathic pain in distribution of affected intercostal nerves (along chest, ribs and abdomen)
Epidemiology of intercostal neuralgia
Pregnancy
Compression of nerves
Inflammation in intercostal nerves
Groups affected by intercostal neuralgia
Tends to affect women 1.5 times more than men
Clinical presentation of intercostal neuralgia
Manifest as sharp, aching, radiating, burning or stabbing pain
May be associated with numbness and tingling
Follows dermatomal patterning
Involuntary contraction of muscles
Colour changes of skin above affected area and loss of sensitivity
Prognosis for intercostal neuralgia
Variable- some Pt achieve resolution of symptoms over time, while some develop chronic pain
Tietze syndrome
Rare, inflammatory disorder characterised by chest pain and swelling of one or more upper rib (costochondral junction)
Epidemiology go tietze syndrome
Exact cause unknown, suggested that multiple microtrauma to anterior chest way may develop into TS
Age groups affected by tietze syndrome
Older children or young adults
Tietze syndrome risk factors
Excessive coughing
Severe vomitting
Upper respiratory tract infections
Higher cases in winter/spring period
Clinical presentation of tietze syndrome
Unilateral chest pain
Tenderness upon palpation and swelling of upper costochondral joints
Tietze syndrome prognosis
Usually goes away after treatment
Treatment- rest, avoidance of strenuous activity, application of heat to affected are, pain meds
Precordial catch syndrome
Non-serious condition causing sharp stabbing pains in chest
Precordial catch syndrome epidemiology
No specific cause
Age groups affected by precordial catch syndrome
Children between 6 and 12
Males and females affected equally
Risk factors of precordial catch syndrome
Non-specific
Sudden onset may be caused by nerves getting pinched or irritated in inner lining of chest wall
Clinical presentation of precordial catch syndrome
Sharp pain in left side of chest near heart
Prognosis of precordial catch syndrome
Should outgrow by 20s
Painful episodes should become less frequent and less intense as time goes on
Herpes zoster
Aka shingles
Caused by varicella-zoster virus, same as chicken pox
Herpes zoster epidemiology
When a child has chicken pox, body fights varicella-zoster virus and physical signs of chicken pox fade away, but virus remains in body
In adulthood, the virus can become active again –> presented as shingles
Age groups affected by herpes zoster
Chances increase as you get older
Half of cases occur in 50+
Clinical presentation of shingles
Outbreak of a painful rash or blisters on the skin
Rash/blisters appear as a band on one area of body- aids diagnosis
Fever, chills, headache, fatigues, stomach upset, sensitivity to light
Prognosis for herpes zoster
No cure, but vaccines
Antiviral medication to ease discomfort
Costovertebral joint syndrome
Occurs when there is damage to the connective tissue that surrounds a joint
Epidemiology for costovertebral joint syndrome
Exaggerated and repetitive movements involving Tsp
Rotation can overstretch the trunk and ribcage and surrounding costovertebral joints
Clinical presentation of costovertebral joint syndrome
Dull ache in upper back
Made worse by deep breathing, coughing, and rotation movements of trunk
Prognosis for costovertebral syndrome
Massage, joint mobilisation, home exercise program, dry needing
With assistance it should heal
Post herpetic neuralgia
Usually described as pain in a dermatomal distribution which persists for three months or more following healing from shingles
Epidemiology of post herpetic neuralgia
After effect of shingles
Age groups affected by post herpetic neuralgia
Risk increases with age
Risk factors of post herpetic neuralgia
Older than 50
Severity of shingles
Prince of chronic disease
Shingles location (face or torso)
Delayed treatment with singles antiviral treatment more than 72 hours after rash appeared
Clinical presentation of post herpetic neuralgia
Constant or intermittent stabbing or burning pain
Intense itching
Intermittent or continuous nerve pain in an area of skin previously affected by shingles
Prognosis for post herpetic neuralgia
Symptoms can resolve after a few months, may persist for longer
Intervention won’t completely resolve pain but could reduce it
Acute pancreatitis
Lies in upper half of abdomen behind stomach infant of spine
Sudden inflammation of pancreas gland that begins in cells of pancreas that produces digestive enzymes
If enzymes become activated too early they cause damage to pancreas
Epidemiology of acute pancreatitis
Gallstones
Drinking too much alcohol
Risk factors for acute pancreatitis
Following trauma (bike or road)]
Side effects of medicine (e.g., azathioprine and steroids)
Genetics
Clinical presentation of acute pancreatitis
Sudden onset abdominal, usually starting in upper abdomen
Can be accompanied by vomiting
Prognosis of acute pancreatitis
No specific medicine that can stop inflammation
Treatment in hospital is vital
Scoliosis
Apparent lateral curvature of the spine
Epidemiology of scoliosis
Spine not forming properly in womb (congenital scoliosis)
Underlying nerve or muscle condition, such as cerebral palsy or muscular dystrophy (neuromuscular scoliosis)
Age groups affected by scoliosis
Develop in infancy or early childhood
Primary onset is 10-15 years old
Risk factors of scoliosis
Family history
Clinical presentation of scoliosis
Deformity usually presenting symptom
Spine deviated from midline, may become apparent when Pt bends forward
Pain is a rare complaint- should alert physician, neural tumour need for MRI?
Run fingers down SPs
Prognosis of scoliosis
Aim is to prevent severe deformity
Management differs for different types
Operative treatment for severe cases
Milwaukee brace, reduces lumbar lordosis by stretching and strengthening thoracic spine
Idiopathic scoliosis
Constitutes for about 80% of cases
Epidemiology off idiopathic scoliosis
No cause
Spondylolisthesis
Vertebral displacement
Normal laminae and facets constitute a locking mechanism which prevents each vertebra from moving forwards on the one below
Forward shift (listhesis) occurs when mechanism fails
Age groups affected by spondylolisthesis
+50
Women x3
Clinical presentation of spondylolisthesis
Usually occurs between L4/5
Intermittent backache, common symptom of lytic spondylolisthesis, may be initiated or exacerbated by exercise of strain
‘step’ can usually be felt when fingers run down spine
Normal ROM in younger Pt, limited in elderly
Spondylolisthesis prognosis
COnserative treatment, similar to other types of back pain
Operative treatment available if symptoms are disabling or interfere with daily activities
Osteos can reduce symptoms and advice exercises to help prevent further problems
Adult degenerative scoliosis
Complex problem created by combo of degeneration of discs, arthritis in facets and osteoporosis
Asymmetric force causes vertebra to unevenly settle upon themselves, rotate, and create spinal curve
Curvature creates increasing asymmetric forces on concave part of curve
As curve increases, forces increase and accelerate the process
Commonly associated with loss of lumbar lordosis, producing flat back syndrome
Epidemiology of adult degeneration scoliosis
Associated with ageing
Predisposing factors including injury, herniated disc, prior back surgery, osteoporosis
More common in women and may have familial, genetic basis
Age group associated with adult degenerative scoliosis
Pt over 65, process initiated well before that age
Clinical presentation of adult degenerative scoliosis
Increase structural change may cause nerve irritation, creating symptoms in leg and/or foot
May include pain radiating into buttocks or legs with activity, numbness burning or weakness
Radiating symptoms vary with nerve roots affected
Most common segments= L4/5
Palpable curvature of SPs, loss of lumbar lordosis, diminishing height and lower ribs settling closer to iliac crest
Prognosis of adult degenerative scoliosis
Daily exercise with focus on core strengthening or increase in activity tolerance recommended
Anti-inflammatory drugs also prescribed
Ease symptoms but cannot be completely cured
Rib # Hx
Sharp local P following trauma or prolonged cough
Rib # physical exam
Palpable crepitus
Possible edema and/or discolouration
P with chest motion
Rib # diagnostic test
X-ray
Rib subluxation Hx
Sharp local P or near spine with inspiration
Rib subluxation SSx
Palpatory tenderness and local myospasm
