Thoracic Spine Common Presentations Flashcards
What is a pancoast tumor? What structures are involved?
- tumor at the apex of the lung
- may involve C8 and 1st thoracic nerve structures
Symptoms of pancoast tumor
symptoms similar to radicular pain/radiculopathy, thoracic outlet, and/or peripheral nerve entrapment
- chronic cough
- bloody sputum
- unexplained weight loss
- malaise
- dyspnea
physical exam findings of pancoast tumor
- fever
- wheezing
MI referred pain
- center chest
- neck
- medial arm
pericarditis referred pain
substernal pain that may radiate to costal margins, neck, upper back/trap, and left medial arm
pneumothorax referred pain
upper and lateral thoracic wall with referral to ipsilateral shoulder, across the chest, or over the abdomen
pleuritis referred pain
chest pain with referred pain on ipsilateral shoulder, upper trap, neck, lower chest wall, or abdomen
compression fracture common MOI
axial loading in flexed position
- traumatic - high energy or osteoporotic
What part of the vertebrae is typically involved with a compression fracture?
anterior column affected
burst fractures involve which parts of the vertebrae
- What part of the spine does this most commonly occur at?
anterior and middle columns
-most common at T/L junction (T12, L1)
MOI of burst fractures
- MVC
- falls from heights
- high-speed sport injury
- potential neural involvement
What type of fracture usually involves all 3 columns? What is the MOI?
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
MOI of distraction fracture
forced flexion or forced extension
- anterior and posterior ligaments, anterior and posterior bony structures, both
red flags for vertebral fractures
- older age
- significant trauma
- corticosteroid use
- contusion/abrasion
Criteria used to ID presence of an osteoporotic vertebral compression fracture
- age > 52 years
- no presence of leg pain
- BMI = 22
- does not exercise regularly
- female
symptoms of rib fracture
- focal pain, radiating pain
- pain with inspiration
- pain with coughing/sneezing
physical examination of rib fracture
- focal tenderness
- possible palpable defect
What is scheuermann’s disease? What does it cause?
- congenital abnormality where endplate of vertebra hasn’t fully formed
- defective growth of vertebral endplate
- causes wedging of vertebral body
criteria for diagnosis of scheuermann’s disease
- thoracic kyphosis > 45 deg
- wedging x 3 adjacent vertebrae > 5 deg
- thoracolumbar kyphosis > 30 deg
What is a schmorl’s node?
- 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
physical exam findings of scheurmann’s disease
- scoliosis
- excessive thoracic kyphosis
- vertebral wedging, schmorl’s nodes, disc space narrowing
- limited thoracic ROM - multidirectional A/PROM limited
- neurologic complications
What causes costochondritis?
- repetitive stress (coughing)
- involves >/= 1 rib
symptoms of costochondritis
- pain and local tenderness at costochondral or chondrosternal articulations
- at rest, during trunk movements, and respiration
physical exam findings of costochondritis
- local tenderness
- painful with chondrosternal joint mobility testing
Why is disc disease less common in the thoracic spine?
- 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)
symptoms of disc disease
- 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
symptoms of thoracic spine myelopathy
- sexual dysfunction
- bowel and bladder dysfunction
- should see more bilateral distributions
physical exam findings of thoracic spine myelopathy
- sensory/motor impairments
- UMN signs (Babinski’s, gait dysfunction, ankle clonus, hyperreflexia in lumbosacral)
MOI of intercostal neuralgia
- infection (varicella zoster)
- mechanical compression (disc protrusion, osteophyte complex, neuroma, fracture)
- following thoracic surgery
symptoms and physical exam of intercostal neuralgia
symptoms
- burning pain/paresthesia along intercostal nerve path
physical exam
- focal tenderness of intercostal area
who is more likely to have T4 syndrome
women > men (4:1)
symptoms of T4 syndrome
- glove-like paresthesias unilateral/bilateral UEs
- neck/scapular/bilateral upper extremity pain - gets worse with side-lying or supine
- generalized headache (bilateral)
physical exam findings of T4 syndrome
- tender spinous process
- thoracic slump test
- upper quarter neurodynamic tension tests
- hypomobile thoracic segment
How is scoliosis named?
for the direction of convexity
symptoms and physical exam findings of zygapophysial arthropathy
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
symptoms and physical exam of rib dysfunction
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
what motion is the most provoking during rib dysfunction? A/PROM?
A/PROM rotation should both be painful with rib dysfunction
what structures can be compressed with thoracic outlet syndrome?
- subclavian artery
- subclavian vein
- brachial plexus
potential areas of compression in thoracic outlet syndrome
- scalenes
- cervical rib
- pec minor
- first rib
- clavicle
symptoms of thoracic outlet syndrome
- UE pain
- paresthesia, anesthesia/weakness (glove-like)
- chest/anterior shoulder pain
- typically progressive/insidious onset
physical exam findings of thoracic outlet syndrome
- cervicothroacic/scapulothoracic muscle guarding
- provocation w/ contralateral neck lateral flexion
- provocation w/ stretching
Vascular TOS physical exam findings. How can you determine this?
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
Neurologic TOS physical exam findings
C8/T1 distribution LMN signs, possibly atrphy abductor pollicic brevis
what special tests would potentially be positive with thoracic outlet syndrome
- 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
