Thoracic Spine and and Rib cage part 1 Flashcards
How many patients will present will chest wall pain who have a myocardial infarction?
15%
If there an absence of breath sounds on the right side what test should be done and what does that entail?
Coin test
Place flat coin on anterior of chest wall and strike it with a second coin
Places the chest piece of the stethoscope to the back of the same hemithorax
What will be heard in the coin test in pneumothorax?
Clear ringing sound called Bell Tympani
What is important x-ray to obtain in thoracic pain?
Chest (not ribs)
What is one of the first question to ask a pt with a new symptom of chest pain?
Did this arise spontaneously or as a result of an injury?
What are some etiologies of pneumothorax?
Asthma, esophageal perforation, exercise induced, manipulative treatment, rib fracture, spontaneous, thoracic or cervical surgery, tracheobronchial perforation, ventilator
What are some symptoms of a rib fracture?
Pain is well localized to site of fracture
Pain lancinating
What should be palpated in a rib fracture?
Careful palpation in indication of pain
Use layer by layer approach
Careful not to touch site of elicited tenderness
What should be auscultated in a rib fracture?
Heart (pericardial friction rub)
Lungs
Chest wall (listen at pain site, pleural friction rub, fracture crepitance)
What are the auscultation findings (pneumothorax) for a rib fracture?
Inaudible breath sounds
Inaudible spoken voice
Bell Tympani
Crepitance (at pain site)
What are the physical findings for palpation in a rib fracture?
Exquisite local tenderness
Palpable crepitance
What are the physical findings in motion induction for a rib fracture?
Pain at fracture site with remote pressure on rib cage
What are the appropriate test for a rib fracture?
Chest x-ray (looking for pneumothorax)
Rib x-ray (look for fracture)
What is the treatment for a rib fracture?
OMM done to the opposite side of the fracture and diaphragm to max remaining pulmonary function (C3-C5 dysfunction)
Bracing - rib belts not needed for fracture healing but can control pain
What is the medication treatment for a rib fracture?
Analgesic
May require an opiate (but can suppress a respiratory function)
Should an injection treatment be used for a rib fracture?
No
What are chest injuries due to trauma?
Rib fracture Fractured costal cartilage Seperated costal cartilage Subperiosteal hematoma Rib tip syndrome Cough fracture
What should you look for in a fractured costal cartilage history?
Common injury in MVAs and the seat belt
What are the symptoms of a fractured costal cartilage?
Pain is well localized to site of fracture
Pain is lancinating or stabbing
What are the physical findings like is a fractured costal cartilage?
All the same as rib fracture except in palpation there may be signs of hepatic or splenic enlargement or tenderness
(hepatic or splenic ruputre - tachycardia, hypotension, hypothermia)
What are the appropriate tests to do for a fractured costal cartilage?
Chest x-ray (pneumothorax)
Rib x-ray not indicated
Bone scan (inc radionuclide at fracture site)
Peritoneal lavage (only for hepatic or splenic injury - use MRI if possible)
What treatments should be used for a fractured costal cartilage?
The same as rib fracture
What should be seen a history of a cough fracture?
Bronchitis or pneumonia
What are the symptoms of a cough fracture?
Persistent pain at level of the lower ribs posterior (most commonly)
What would you find a vital signs and inspection of someone with a cough fracture?
Fever
Rapid respiratory rate
Dec diaphragmatic breathing
What would you find in the auscultation of pneumonia in a cough fracture?
Early - suppressed breathing sounds
Late - bronchial breathing and crepitant rales
What would you find in the auscultation of bronchitis in a cough fracture?
Sibilant (hissing)
Sonorous (ringing)
Moist rales
Would would be palpated and percussed in person with a cough fracture
Tender of involved rib(s)
Often R11/R12
Percussion of pneumonia (dullness) or bronchitis (no dull)
What occurs in motion induction in a cough fracture?
Loss of thoracic and rib motion
Pain with deep inhalation/cough
Restricted diaphragmatic breathing
What are the appropriate test for a cough fracture?
Chest x-ray (pneumonia)
Rib x-ray not indicated
Bone scan (demonstrates stress fracture)
MRI hard to get floating ribs
What is the OMM treatment for cough fracture?
Indirect myofascial release technique only
Counterstrain technique cannot be used here due to bone pain
How should the underlying condition of the cough fracture be treated?
Antibiotic
Mucolytic
Cough Suppressant
How would a cough fracture be evaluated?
Pulmonary - look for consolidation
Spinous process - pain elicited could be a red flag for fracture, tumor or infection
What does a compression fracture of the spine lead to?
Acute angulation of the kyphosis
What would be seen in the evaluation in motion induction of a cough fracture?
Active Regional Range of Motion
Passive Regional Range of Motion
Respiratory Motion (3 inches deeps with inhalation)
What are some conditions associated with loss of motion?
Cicatrix (scarring) Calcification of the Costal Cartilages Atrophy or Myopathy Connective Tissue Disease Osteoarthritis Spondyloarthropathies Scheuermann Disease Somatic Dysfunction
What are some causes of cicatrix?
Burns Surgical Scars Adhesions Lacerations For all of these, if problematic, area of scar will be less mobile than all tissues around it
Where would you see atrophy or myopathy?
Post-polio syndrome
(Insidious onset)
Onset of weakness, fatigue, muscle fasciculations, and pain with additional atrophy of the muscle group involved during the initial paralytic disease 20-30 years earlier
What would bee seen in the connective tissue disease scleroderma?
Raynaud’s Phenomenon Puffy Fingers Edema is often accompanied by erythema Skin becomes thickened, and bound to the underlying fascia Skin becomes tight and shiny
What are the musculoskeletal features of scleroderma?
Pain swelling and stiffness of fingers and knees
Symmetric polyarthritis
Thickening of tendon sheaths - carpal tunnel
Resorption of bone (ribs and clavicle)
What are the pulmonary features of scleroderma?
Exertional Dyspnea Dry, non-productive cough Pulmonary Fibrosis Bibasilar rales Restriction of Chest movement by skin involvement
What are the cardiac features of scleroderma?
Pericarditis
Congestive Heart Failure
Cardiomyopathy
What are the renal manifestations of scleroderma?
Malignant Hypertension Hematuria Proteinuria Oligouria Renal Failure
What can occur in the spine in osteoarthritis?
Degenerative Disc Disease
Zygapophyseal Joint Disease
What can occur in the ribs in osteoarthritis?
Costotransverse Joint
Chondrosternal Joint
Chondrochondral Joints
What are some spondyloarthropathies?
Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis Associated with Inflammatory Bowel Disease (Crohn Disease, Ulcerative Colitis)
What are some characteristics of scheuermann disease?
Increased Kyphosis
Rigid Thoracic Spine
Characteristic X-ray Findings (Irregular endplates, Vertebral Wedging)
What are the characteristics of chest wall syndrome (precordial catch)?
Intercostal muscle spasm Intercostal myositis Costochondral Pain Costal Somatic Dysfunction Shoulder Girdle Disorders
What are the physical findings for chest wall syndrome?
Diffuse pain with pressure over the sternum
Pain with shoulder motion
Pain with Cervical Spine motion and nerve root impingement tests
What occurs in intercostal muscle spasm?
Sharp pain lasting one to three minutes
Intercostal tenderness and firmness
May be associated rib dysfunction
Often tenderness at serratus anterior
What is the treatment for intercostal muscle spasm?
Osteopathic Manipulation
Intercostal nerve block
Trigger Point Injection
Medication (Analgesic, Muscle Relaxant)
What is the main symptom of intercostal myositis?
Pain with respiration
What should be palpated for in intercostal myositis?
Tender intercostal space
Induration (firm)
Fascial nodularity
What is the treatment for intercostal myositis?
OMT indirect
Anti-inflammatory medication (NSAIDs, corticosteroid)
Injection
Describe shoulder girdle disorders
Pain may be referred from any shoulder girdle muscle attachment sites; also trigger points within the shoulder muscles may refer pain to the rib cage
