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OMM M1T3 test 1 > Thoracic Spine and and Rib cage part 1 > Flashcards

Thoracic Spine and and Rib cage part 1 Flashcards

1
Q

How many patients will present will chest wall pain who have a myocardial infarction?

A

15%

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2
Q

If there an absence of breath sounds on the right side what test should be done and what does that entail?

A

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

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3
Q

What will be heard in the coin test in pneumothorax?

A

Clear ringing sound called Bell Tympani

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4
Q

What is important x-ray to obtain in thoracic pain?

A

Chest (not ribs)

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5
Q

What is one of the first question to ask a pt with a new symptom of chest pain?

A

Did this arise spontaneously or as a result of an injury?

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6
Q

What are some etiologies of pneumothorax?

A

Asthma, esophageal perforation, exercise induced, manipulative treatment, rib fracture, spontaneous, thoracic or cervical surgery, tracheobronchial perforation, ventilator

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7
Q

What are some symptoms of a rib fracture?

A

Pain is well localized to site of fracture

Pain lancinating

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8
Q

What should be palpated in a rib fracture?

A

Careful palpation in indication of pain
Use layer by layer approach
Careful not to touch site of elicited tenderness

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9
Q

What should be auscultated in a rib fracture?

A

Heart (pericardial friction rub)
Lungs
Chest wall (listen at pain site, pleural friction rub, fracture crepitance)

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10
Q

What are the auscultation findings (pneumothorax) for a rib fracture?

A

Inaudible breath sounds
Inaudible spoken voice
Bell Tympani
Crepitance (at pain site)

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11
Q

What are the physical findings for palpation in a rib fracture?

A

Exquisite local tenderness

Palpable crepitance

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12
Q

What are the physical findings in motion induction for a rib fracture?

A

Pain at fracture site with remote pressure on rib cage

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13
Q

What are the appropriate test for a rib fracture?

A

Chest x-ray (looking for pneumothorax)

Rib x-ray (look for fracture)

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14
Q

What is the treatment for a rib fracture?

A

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

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15
Q

What is the medication treatment for a rib fracture?

A

Analgesic

May require an opiate (but can suppress a respiratory function)

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16
Q

Should an injection treatment be used for a rib fracture?

A

No

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17
Q

What are chest injuries due to trauma?

A 
Rib fracture
Fractured costal cartilage
Seperated costal cartilage
Subperiosteal hematoma 
Rib tip syndrome
Cough fracture
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18
Q

What should you look for in a fractured costal cartilage history?

A

Common injury in MVAs and the seat belt

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19
Q

What are the symptoms of a fractured costal cartilage?

A

Pain is well localized to site of fracture

Pain is lancinating or stabbing

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20
Q

What are the physical findings like is a fractured costal cartilage?

A

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)

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21
Q

What are the appropriate tests to do for a fractured costal cartilage?

A

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)

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22
Q

What treatments should be used for a fractured costal cartilage?

A

The same as rib fracture

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23
Q

What should be seen a history of a cough fracture?

A

Bronchitis or pneumonia

24
Q

What are the symptoms of a cough fracture?

A

Persistent pain at level of the lower ribs posterior (most commonly)

25
Q

What would you find a vital signs and inspection of someone with a cough fracture?

A

Fever
Rapid respiratory rate
Dec diaphragmatic breathing

26
Q

What would you find in the auscultation of pneumonia in a cough fracture?

A

Early - suppressed breathing sounds

Late - bronchial breathing and crepitant rales

27
Q

What would you find in the auscultation of bronchitis in a cough fracture?

A

Sibilant (hissing)
Sonorous (ringing)
Moist rales

28
Q

Would would be palpated and percussed in person with a cough fracture

A

Tender of involved rib(s)
Often R11/R12
Percussion of pneumonia (dullness) or bronchitis (no dull)

29
Q

What occurs in motion induction in a cough fracture?

A

Loss of thoracic and rib motion
Pain with deep inhalation/cough
Restricted diaphragmatic breathing

30
Q

What are the appropriate test for a cough fracture?

A

Chest x-ray (pneumonia)
Rib x-ray not indicated
Bone scan (demonstrates stress fracture)
MRI hard to get floating ribs

31
Q

What is the OMM treatment for cough fracture?

A

Indirect myofascial release technique only

Counterstrain technique cannot be used here due to bone pain

32
Q

How should the underlying condition of the cough fracture be treated?

A

Antibiotic
Mucolytic
Cough Suppressant

33
Q

How would a cough fracture be evaluated?

A

Pulmonary - look for consolidation

Spinous process - pain elicited could be a red flag for fracture, tumor or infection

34
Q

What does a compression fracture of the spine lead to?

A

Acute angulation of the kyphosis

35
Q

What would be seen in the evaluation in motion induction of a cough fracture?

A

Active Regional Range of Motion
Passive Regional Range of Motion
Respiratory Motion (3 inches deeps with inhalation)

36
Q

What are some conditions associated with loss of motion?

A 
Cicatrix (scarring)
Calcification of the Costal Cartilages
Atrophy or Myopathy
Connective Tissue Disease
Osteoarthritis
Spondyloarthropathies
Scheuermann Disease
Somatic Dysfunction
37
Q

What are some causes of cicatrix?

A 
Burns
Surgical Scars
Adhesions
Lacerations
For all of these, if problematic, area of scar will be less mobile than all tissues around it
38
Q

Where would you see atrophy or myopathy?

A

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

39
Q

What would bee seen in the connective tissue disease scleroderma?

A 
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
40
Q

What are the musculoskeletal features of scleroderma?

A

Pain swelling and stiffness of fingers and knees
Symmetric polyarthritis
Thickening of tendon sheaths - carpal tunnel
Resorption of bone (ribs and clavicle)

41
Q

What are the pulmonary features of scleroderma?

A 
Exertional Dyspnea
Dry, non-productive cough
Pulmonary Fibrosis
Bibasilar rales
Restriction of Chest movement by skin involvement
42
Q

What are the cardiac features of scleroderma?

A

Pericarditis
Congestive Heart Failure
Cardiomyopathy

43
Q

What are the renal manifestations of scleroderma?

A 
Malignant Hypertension
Hematuria
Proteinuria
Oligouria
Renal Failure
44
Q

What can occur in the spine in osteoarthritis?

A

Degenerative Disc Disease

Zygapophyseal Joint Disease

45
Q

What can occur in the ribs in osteoarthritis?

A

Costotransverse Joint
Chondrosternal Joint
Chondrochondral Joints

46
Q

What are some spondyloarthropathies?

A

Ankylosing Spondylitis
Psoriatic Arthritis
Reactive Arthritis Associated with Inflammatory Bowel Disease (Crohn Disease, Ulcerative Colitis)

47
Q

What are some characteristics of scheuermann disease?

A

Increased Kyphosis
Rigid Thoracic Spine
Characteristic X-ray Findings (Irregular endplates, Vertebral Wedging)

48
Q

What are the characteristics of chest wall syndrome (precordial catch)?

A 
Intercostal muscle spasm
Intercostal myositis
Costochondral Pain
Costal Somatic Dysfunction
Shoulder Girdle Disorders
49
Q

What are the physical findings for chest wall syndrome?

A

Diffuse pain with pressure over the sternum
Pain with shoulder motion
Pain with Cervical Spine motion and nerve root impingement tests

50
Q

What occurs in intercostal muscle spasm?

A

Sharp pain lasting one to three minutes
Intercostal tenderness and firmness
May be associated rib dysfunction
Often tenderness at serratus anterior

51
Q

What is the treatment for intercostal muscle spasm?

A

Osteopathic Manipulation
Intercostal nerve block
Trigger Point Injection
Medication (Analgesic, Muscle Relaxant)

52
Q

What is the main symptom of intercostal myositis?

A

Pain with respiration

53
Q

What should be palpated for in intercostal myositis?

A

Tender intercostal space
Induration (firm)
Fascial nodularity

54
Q

What is the treatment for intercostal myositis?

A

OMT indirect
Anti-inflammatory medication (NSAIDs, corticosteroid)
Injection

55
Q

Describe shoulder girdle disorders

A

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

OMM M1T3 test 1 (7 decks)

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