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MSK 3 > Thoracic Spine Common Presentations > Flashcards

Thoracic Spine Common Presentations Flashcards

1
Q

What is a pancoast tumor? What structures are involved?

A
  • tumor at the apex of the lung
  • may involve C8 and 1st thoracic nerve structures
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2
Q

Symptoms of pancoast tumor

A

symptoms similar to radicular pain/radiculopathy, thoracic outlet, and/or peripheral nerve entrapment

  • chronic cough
  • bloody sputum
  • unexplained weight loss
  • malaise
  • dyspnea
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3
Q

physical exam findings of pancoast tumor

A
  • fever
  • wheezing
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4
Q

MI referred pain

A
  • center chest
  • neck
  • medial arm
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5
Q

pericarditis referred pain

A

substernal pain that may radiate to costal margins, neck, upper back/trap, and left medial arm

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6
Q

pneumothorax referred pain

A

upper and lateral thoracic wall with referral to ipsilateral shoulder, across the chest, or over the abdomen

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7
Q

pleuritis referred pain

A

chest pain with referred pain on ipsilateral shoulder, upper trap, neck, lower chest wall, or abdomen

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8
Q

compression fracture common MOI

A

axial loading in flexed position
- traumatic - high energy or osteoporotic

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9
Q

What part of the vertebrae is typically involved with a compression fracture?

A

anterior column affected

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10
Q

burst fractures involve which parts of the vertebrae
- What part of the spine does this most commonly occur at?

A

anterior and middle columns
-most common at T/L junction (T12, L1)

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11
Q

MOI of burst fractures

A
  • MVC
  • falls from heights
  • high-speed sport injury
  • potential neural involvement
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12
Q

What type of fracture usually involves all 3 columns? What is the MOI?

A

rotation/translation
- fall from a height or heavy object falling on body with bent trunk that causes horizontal displacement of one T/L vertebral body on another
- causes facet joint dislocation

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13
Q

MOI of distraction fracture

A

forced flexion or forced extension
- anterior and posterior ligaments, anterior and posterior bony structures, both

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14
Q

red flags for vertebral fractures

A
  • older age
  • significant trauma
  • corticosteroid use
  • contusion/abrasion
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15
Q

Criteria used to ID presence of an osteoporotic vertebral compression fracture

A
  • age > 52 years
  • no presence of leg pain
  • BMI = 22
  • does not exercise regularly
  • female
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16
Q

symptoms of rib fracture

A
  • focal pain, radiating pain
  • pain with inspiration
  • pain with coughing/sneezing
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17
Q

physical examination of rib fracture

A
  • focal tenderness
  • possible palpable defect
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18
Q

What is scheuermann’s disease? What does it cause?

A
  • congenital abnormality where endplate of vertebra hasn’t fully formed
  • defective growth of vertebral endplate
  • causes wedging of vertebral body
19
Q

criteria for diagnosis of scheuermann’s disease

A
  • thoracic kyphosis > 45 deg
  • wedging x 3 adjacent vertebrae > 5 deg
  • thoracolumbar kyphosis > 30 deg
20
Q

What is a schmorl’s node?

A
  • common spinal disc herniation in which the soft tissue of the intervertebral disc bulges out into the adjacent vertebrae through an endplate defect
  • Vertebra structure is compromised – strength may be affected
21
Q

physical exam findings of scheurmann’s disease

A
  • scoliosis
  • excessive thoracic kyphosis
  • vertebral wedging, schmorl’s nodes, disc space narrowing
  • limited thoracic ROM - multidirectional A/PROM limited
  • neurologic complications
22
Q

What causes costochondritis?

A
  • repetitive stress (coughing)
  • involves >/= 1 rib
23
Q

symptoms of costochondritis

A
  • pain and local tenderness at costochondral or chondrosternal articulations
  • at rest, during trunk movements, and respiration
24
Q

physical exam findings of costochondritis

A
  • local tenderness
  • painful with chondrosternal joint mobility testing
25
Q

Why is disc disease less common in the thoracic spine?

A
  • There is less motion and more skeletal stability in the thoracic column
  • Tend to see them in the lower T spine (transition zone and not as much articulation)
26
Q

symptoms of disc disease

A
  • back or chest pain at the same level
  • radicular band like pain in affected level’s dermatome
  • progressive/insidious
  • may see multidirectional ROM deficit and pain with spring testing, coughing, wrapping around pain
27
Q

symptoms of thoracic spine myelopathy

A
  • sexual dysfunction
  • bowel and bladder dysfunction
  • should see more bilateral distributions
28
Q

physical exam findings of thoracic spine myelopathy

A
  • sensory/motor impairments
  • UMN signs (Babinski’s, gait dysfunction, ankle clonus, hyperreflexia in lumbosacral)
29
Q

MOI of intercostal neuralgia

A
  • infection (varicella zoster)
  • mechanical compression (disc protrusion, osteophyte complex, neuroma, fracture)
  • following thoracic surgery
30
Q

symptoms and physical exam of intercostal neuralgia

A

symptoms
- burning pain/paresthesia along intercostal nerve path

physical exam
- focal tenderness of intercostal area

31
Q

who is more likely to have T4 syndrome

A

women > men (4:1)

32
Q

symptoms of T4 syndrome

A
  • glove-like paresthesias unilateral/bilateral UEs
  • neck/scapular/bilateral upper extremity pain - gets worse with side-lying or supine
  • generalized headache (bilateral)
33
Q

physical exam findings of T4 syndrome

A
  • tender spinous process
    • thoracic slump test
    • upper quarter neurodynamic tension tests
  • hypomobile thoracic segment
34
Q

How is scoliosis named?

A

for the direction of convexity

35
Q

symptoms and physical exam findings of zygapophysial arthropathy

A

symptoms
- local and/or referred pain

physical exam
- painful movement with closing of z-joints (A/PROM)
- painful spring testing/hypomobility w/ joint mobility testing
- ipsilateral referred pain

36
Q

symptoms and physical exam of rib dysfunction

A

symptoms
- aggravated w/ deep inspiration, trunk rotation, sneezing/coughing

physical exam
- diminished rib mobility
- pain/hypomobility w/ joint mobility testing
- limited/painful thoracic spine motion

37
Q

what motion is the most provoking during rib dysfunction? A/PROM?

A

A/PROM rotation should both be painful with rib dysfunction

38
Q

what structures can be compressed with thoracic outlet syndrome?

A
  • subclavian artery
  • subclavian vein
  • brachial plexus
39
Q

potential areas of compression in thoracic outlet syndrome

A
  • scalenes
  • cervical rib
  • pec minor
  • first rib
  • clavicle
40
Q

symptoms of thoracic outlet syndrome

A
  • UE pain
  • paresthesia, anesthesia/weakness (glove-like)
  • chest/anterior shoulder pain
  • typically progressive/insidious onset
41
Q

physical exam findings of thoracic outlet syndrome

A
  • cervicothroacic/scapulothoracic muscle guarding
  • provocation w/ contralateral neck lateral flexion
  • provocation w/ stretching
42
Q

Vascular TOS physical exam findings. How can you determine this?

A

edema, cyanosis, coldness of hand, diminished pulses

Take BP on both arms and if there is a 20 mmHg difference
- involved side will be diminshed

43
Q

Neurologic TOS physical exam findings

A

C8/T1 distribution LMN signs, possibly atrphy abductor pollicic brevis

44
Q

what special tests would potentially be positive with thoracic outlet syndrome

A
  • Roo’s test
  • hyperabduction test
  • adison’s test
  • wright’s test
  • cervical rotation lateral flexion test: restricted 1st rib
  • 1st rib spring test: restricted 1st rib

MSK 3 (13 decks)

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