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OMM M1T3 test 1 > Thoracic Spine and Rib Cage part 2 > Flashcards

Thoracic Spine and Rib Cage part 2 Flashcards

1
Q

Describe respiratory pain of costochondritis.

A

Pain is localized to costal cartilages - tender to palpation
Dull, aggravated by shoulder movement
Typical symmetry for 3, 4, 5 joints

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2
Q

What are the symptom of costochondral pain?

A

Pain in anterior chest wall

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3
Q

What are the physical findings of costochondral pain?

A

Tenderness at costochondral junction

Possible rib dysfunction

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4
Q

What is the OMT treatment for costochondritis?

A

Anterior cartilages may be site of multiple counterstrain tender points
Could be attempted but won’t be fixed in true costocondritis
Treat rib dysfunctions

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5
Q

What are the drug treatments for costochondritis?

A

Analgesics : lidocaine
NSAIDs
Oral and Inject cortiocosteriods

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6
Q

Describe Tietze sydrome.

A

Palpable fusiform swelling of costal cartilage
Generally asymmetric involving cartilages 2 and 3
Maybe post-viral: parvo B19
Usually before age 40

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7
Q

What is the OMT treatment for Tietze syndrome?

A

Correct accompanying costal and thoracic segmental dysfunctions
Use thoracic pump and splenic stimulation to boost immune response

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8
Q

What is the drug treatment for Tietze syndrome?

A

Analgesic: lidocaine
NSAIDs
Oral and Inject corticosteriods

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9
Q

What could cause respiratory pain due to infections (fever)?

A

Herpes Zosters, pleurisy, epidemic pleurodynia, osteomyelitis, epidural abcess, infectious chondritis, periodtitis

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10
Q

How is herpes zoster diagnosed?

A

Classic dermatomal rash that does not cross the midline
Maybe proceeded by intercostal neuralgia for several days before rash appears
May develop post hepatic neuralgia

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11
Q

What is intercostal neuralgia?

A

Tenderness occurs at the cutaneous branches of the intercostal nerve
Paraspinal, parasternal, mid-axillary

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12
Q

When is the incidence for herpes zoster the highest?

A

6th through 8th decade of life

2% of pts will endure a second round

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13
Q

What are some characteristics of herpes zoster?

A

Commonly effects T3-L3 dermatomes
Pain may precede onset on lesions by 48/72 hours
Vesicles for 7-10 days
Skin may take 2-4 weeks to become normal
People rarely have the pain without the rash

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14
Q

What is the OMT treatment for herpes zoster?

A

Treat segmental and costal dysfunctions at rash levels
Painful- but prevents post-herpetic neuralgia
Thoracic pump and splenic stimulation to enhance immune response

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15
Q

What us the drug treatment for herpes zoster?

A

Valacyclovir
Famcyclovir
Acyclovir

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16
Q

What is the pain management for herpes zoster?

A

Analgesics: opiates and lidocaine
Tricyclic antidepressants: nortiptryline
Glucocorticoids: tapering dose

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17
Q

What should be done is the person with herpes zoster gets post-herpatic neuralgia?

A

Antiseizure meds: gabapentin, topiramate, lamotrigine, etc.

18
Q

How is herpes zoster prevented?

A

Herpes zoster vaccine

19
Q

Describe respiratory pain from pleurisy.

A

Knife like- shooting pain
Fever, CBC-leukocytosis
Pleural friction rub
Pain sensed in thoracic wall

20
Q

Describe the pleura in terms of pain.

A

Parietal pleura is sensitive, visceral pleura is not

Pleura innervated by overlying intercostal nerves

21
Q

What is the OMT treatment for pleurisy?

A

Depends on underlying disease

Treat involved areas, improve costal motion (prevents formation of pleural adhesion)

22
Q

Describe diaphragm innervations

A

Periphery of diaphragm is innervated by T6 and T7 nerve roots
Central tendon region supplied by phrenic nerve (C3,4, 5)
Phrenic nerve inn both the thoracic side of diaphragm and abdominal side of diaphragm

23
Q

Describe diaphragmatic pain.

A

Pain is sensed at T6 lvl, pts with diaphragmatic pleuroisy or upper ab disease sense the pain in lateral neck and shoulder

24
Q

Describe respiratory pain from epidemic pleurodynia.

A

Bornholme disease, devil’s grip
Severe paroxysms of thoracic and ab pain
Fever, headache, pharyngitis, no leukocytosis

25
Q

What is the etiology of epidemic pleurodynia?

A

Coxsackie B. echo virus

26
Q

What are some complications of epidemic pleurodynia?

A

Pericarditis, orchitis

27
Q

How is epidemic pleurodynia diagnosed?

A

Rising viral titers
Pt w/ ventilator due to hypoxia
Pain severe end up in CCU w/ Dx of R/O myocardial infarction or R/O dissecting aneurysm

28
Q

What could cause intercostal neuralgia?

A 
Tabes dosalis (neurosyphillis)
Neoplasm
Potts disease (TB of spine)
Neurofibromatosis
Fracture Callous
29
Q

What is notalgia paresthetica?

A

Sensory neuropathy involving one the doral cutaneous rami of the upper thoracic region

30
Q

What are the symptoms of notalgia paresthetica?

A

Pruritis
Local dysesthesia
Local hyperesthesia
Local skin hyperpigmentation

31
Q

What is the treatment for notalgia paresthetica?

A 
OMT
Lidocaine patch
Paravertebral nerve block
Botulinum toxin injection
Anticonvulsant meds
Transcutaneous electrical nerve stimulation
32
Q

Describe referred pain doe to rib pain.

A

Pain is sensed in deep tissue, bot skin
Not always reproducible
Looks for somatic dysfunction at spinal lvl associated with various viscera
Chapman’s reflex presence

33
Q

What is xiphalgia?

A 
Painful prominent xiphoid
Xiphisternal arthritis (syncondrosis)
34
Q

What is Dercum disease?

A

Adiposa dolorosa
Painful obesity
Peripheral stretch neuropathy from weight of rolls of hanging fat

35
Q

What is mondor disease?

A

Thrombophebitis of the thoracoepigastic vein
Run in anterial-lateral abdomen and thorax (from femoral vein to axillary vein)
Tender palpable cord (maybe visible)
Potential complication of mastitis breast and abdominal surgeries

36
Q

How does one obtain rachitic rosary and what occurs when healed?

A

Rickets

Healing obliterates the costochondral knobs

37
Q

Describe the etiology of pectus exavatum.

A

Funnel breast, Trichterbrust
Can come from genetics, rickets, marfans, cobbler chest
Depression of the chest inwards
Associated w/ mitral vavle prolapse
27% of women w/ mycobactrium avium
Very severe can cause cardiopulm compromise

38
Q

Describe pectus carinatum/

A

Pigeon breast

Genetic, rickets, marfans, congential heart disease, kyphoscoliosis

39
Q

Describe the etiology of harrison grooves.

A

Genetics, rickets, young pregnancy, prune belly syndrome

40
Q

Describe the etiology of barrel chest.

A

Genetics, kyphosis, pulmonary emphysema

41
Q

How would a person obtain lumps, bumps and depressions?

A

Malnutrition, cardiac enlargement (bulging precordium), rickets, aortic aneurysm, neoplasm, abscess

OMM M1T3 test 1 (7 decks)

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