Thoracic Spine and Rib Cage part 2 Flashcards
Describe respiratory pain of costochondritis.
Pain is localized to costal cartilages - tender to palpation
Dull, aggravated by shoulder movement
Typical symmetry for 3, 4, 5 joints
What are the symptom of costochondral pain?
Pain in anterior chest wall
What are the physical findings of costochondral pain?
Tenderness at costochondral junction
Possible rib dysfunction
What is the OMT treatment for costochondritis?
Anterior cartilages may be site of multiple counterstrain tender points
Could be attempted but won’t be fixed in true costocondritis
Treat rib dysfunctions
What are the drug treatments for costochondritis?
Analgesics : lidocaine
NSAIDs
Oral and Inject cortiocosteriods
Describe Tietze sydrome.
Palpable fusiform swelling of costal cartilage
Generally asymmetric involving cartilages 2 and 3
Maybe post-viral: parvo B19
Usually before age 40
What is the OMT treatment for Tietze syndrome?
Correct accompanying costal and thoracic segmental dysfunctions
Use thoracic pump and splenic stimulation to boost immune response
What is the drug treatment for Tietze syndrome?
Analgesic: lidocaine
NSAIDs
Oral and Inject corticosteriods
What could cause respiratory pain due to infections (fever)?
Herpes Zosters, pleurisy, epidemic pleurodynia, osteomyelitis, epidural abcess, infectious chondritis, periodtitis
How is herpes zoster diagnosed?
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
What is intercostal neuralgia?
Tenderness occurs at the cutaneous branches of the intercostal nerve
Paraspinal, parasternal, mid-axillary
When is the incidence for herpes zoster the highest?
6th through 8th decade of life
2% of pts will endure a second round
What are some characteristics of herpes zoster?
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
What is the OMT treatment for herpes zoster?
Treat segmental and costal dysfunctions at rash levels
Painful- but prevents post-herpetic neuralgia
Thoracic pump and splenic stimulation to enhance immune response
What us the drug treatment for herpes zoster?
Valacyclovir
Famcyclovir
Acyclovir
What is the pain management for herpes zoster?
Analgesics: opiates and lidocaine
Tricyclic antidepressants: nortiptryline
Glucocorticoids: tapering dose
What should be done is the person with herpes zoster gets post-herpatic neuralgia?
Antiseizure meds: gabapentin, topiramate, lamotrigine, etc.
How is herpes zoster prevented?
Herpes zoster vaccine
Describe respiratory pain from pleurisy.
Knife like- shooting pain
Fever, CBC-leukocytosis
Pleural friction rub
Pain sensed in thoracic wall
Describe the pleura in terms of pain.
Parietal pleura is sensitive, visceral pleura is not
Pleura innervated by overlying intercostal nerves
What is the OMT treatment for pleurisy?
Depends on underlying disease
Treat involved areas, improve costal motion (prevents formation of pleural adhesion)
Describe diaphragm innervations
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
Describe diaphragmatic pain.
Pain is sensed at T6 lvl, pts with diaphragmatic pleuroisy or upper ab disease sense the pain in lateral neck and shoulder
Describe respiratory pain from epidemic pleurodynia.
Bornholme disease, devil’s grip
Severe paroxysms of thoracic and ab pain
Fever, headache, pharyngitis, no leukocytosis
What is the etiology of epidemic pleurodynia?
Coxsackie B. echo virus
What are some complications of epidemic pleurodynia?
Pericarditis, orchitis
How is epidemic pleurodynia diagnosed?
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
What could cause intercostal neuralgia?
Tabes dosalis (neurosyphillis) Neoplasm Potts disease (TB of spine) Neurofibromatosis Fracture Callous
What is notalgia paresthetica?
Sensory neuropathy involving one the doral cutaneous rami of the upper thoracic region
What are the symptoms of notalgia paresthetica?
Pruritis
Local dysesthesia
Local hyperesthesia
Local skin hyperpigmentation
What is the treatment for notalgia paresthetica?
OMT Lidocaine patch Paravertebral nerve block Botulinum toxin injection Anticonvulsant meds Transcutaneous electrical nerve stimulation
Describe referred pain doe to rib pain.
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
What is xiphalgia?
Painful prominent xiphoid Xiphisternal arthritis (syncondrosis)
What is Dercum disease?
Adiposa dolorosa
Painful obesity
Peripheral stretch neuropathy from weight of rolls of hanging fat
What is mondor disease?
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
How does one obtain rachitic rosary and what occurs when healed?
Rickets
Healing obliterates the costochondral knobs
Describe the etiology of pectus exavatum.
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
Describe pectus carinatum/
Pigeon breast
Genetic, rickets, marfans, congential heart disease, kyphoscoliosis
Describe the etiology of harrison grooves.
Genetics, rickets, young pregnancy, prune belly syndrome
Describe the etiology of barrel chest.
Genetics, kyphosis, pulmonary emphysema
How would a person obtain lumps, bumps and depressions?
Malnutrition, cardiac enlargement (bulging precordium), rickets, aortic aneurysm, neoplasm, abscess
