Thoracic Spine Complaint

Question 1

acute pain in thoracics often from

Answer 1

compression fractures or muscle spasm

Question 2

in younger pts with pain or deformity:

Answer 2

scoliosis and hyperkyphosis

Question 3

in older pts with pain or deformity:

Answer 3

chronic postural problems or long term scoliosis

Question 4

in seniors with pain or deformity

Answer 4

compression fractures

Question 5

in older pts with weight loss, history of cancer, night pain or fever:

Answer 5

look for cancer or infection

Question 6

if there is stiffness with normal ROM:

Answer 6

posturally strained muscles

Question 7

if there is deformity possible:

Answer 7

compression fracture, Scheuermann’s, scoliosis, postural issue

Question 8

if there is scapular winging:

Answer 8

scoliosis or muscle weakness (traps and serratus anterior)

Question 9

if there is high scapula:

Answer 9

Sprengel’s deformity

Question 10

if there is buffalo hump:

Answer 10

cushings or from corticosteroid use

Question 11

if there is Dowagers hump or acute angle kyphosis:

Answer 11

compression fracture

Question 12

if there is hyperkyphosis in adolescents:

Answer 12

Scheuermann’s and postural problems

Question 13

if there is referred pain from lower costovertebral area:

Answer 13

from kidney

Question 14

if there is referred pain from mid thoracic or scapular area:

Answer 14

from gallbladder

Question 15

management for infections, tumor, fractures, progressive scoliosis, active Scheuermann’s:

Answer 15

orthopedic consultation

Question 16

management for inactive Scheuermann’s, non progressive scoliosis, facet syndrome:

Answer 16

conservative care

Question 17

fever with night pain and/or history of IV drug use

Answer 17

do thoracic spine xrays looking for infection

Question 18

older pt with weight loss, history of cancer, night pain, unresponsive to conservative care

Answer 18

do thoracic spine xrays looking for metastasis or multiple myeloma

Question 19

older pt with trauma and/or history of corticosteroid use, or postmenopausal pt, or pt with major trauma

Answer 19

do thoracic spine xrays to look for compression fracture

Question 20

younger pt with no fever, pain at night relieved by aspirin

Answer 20

do thoracic spine xrays to look for osteoid osteoma

Question 21

pt has associated chest pain

Answer 21

do thoracic spine xrays and/or electrocardiogram

Question 22

traumatic onset of pain or pain with inspiration

Answer 22

do chest and rib xrays

Question 23

insidious onset of constant pain and pt is hyperkyphotic

Answer 23

do prone extension test to differentiate structural from functional kyphosis

Question 24

scoliosis is suspected

Answer 24

do adam’s test to differentiate structural from functional scoliosis

Question 25

insidious onset of pain in a dermatomal, unilateral pattern

Answer 25

herpes zonser/shingles

Question 26

pain that may radiate along rib, pain may increase with Valsalva, deficit in corresponding dermatome or myotome

Answer 26

neuritis or radiculitis

Question 27

pain that may radiate along rib, pain increased with hyperextension, positive Kemps, end range restriction to the side of involvement

Answer 27

facet syndrome

Question 28

active Scheuermann's:

Answer 28

skeletal immaturity

Question 29

inactive Scheuermann's:

Answer 29

skeletal maturity

Question 30

if kyphosis persists with prone extension test

Answer 30

structural

Question 31

if kyphosis improves with prone extension test

Answer 31

functional

Question 32

anterior step defect and zone of impaction on xray

Answer 32

compression fracture

Question 33

decreased height of more than half of the anterior vertebral body may suggest

Answer 33

unstable fracture

Question 34

management of new or unstable fracture

Answer 34

orthopedic consultation

Question 35

decreased posterior vertebral body height

Answer 35

pathological fracture

Question 36

diff di for pathological fracture in older pt

Answer 36

osteoporosis, lytic mets, multiple myeloma

Question 37

diff di for pathological fracture in young pt

Answer 37

eosinophilic granuloma

Question 38

tests to do for lytic mets

Answer 38

bone scan, MRI, biopsy

Question 39

tests to do for multiple myeloma

Answer 39

PEP, skeletal survey, MRI, biopsy

Question 40

localized mid back pain, in young males (10-25), pain worse at night relieved by salicylates

Answer 40

osteoid osteoma

Question 41

diff di of missing pedicles

Answer 41

congenital, destructive, surgical

Question 42

reasons for destructive changes with missing pedicles

Answer 42

bone tumor, soft tissue tumor, infection

Question 43

diff di with decreased disc height/joint space

Answer 43

DDD, DJD, inflammatory, developmental, infection

Question 44

Riser's sign

Answer 44

growth plate along top of iliac crest

Question 45

rotational component of scoliosis

Answer 45

Nash-Moe method

Question 46

if a vertebral body is darker with T1 MRI and lighter with T2 MRI, is the injury new or old?

Answer 46

new

Question 47

diff di for ivory vertebrae

Answer 47

blastic mets, lymphoma, pagets