Thoracic Spine Complaint Flashcards
acute pain in thoracics often from
compression fractures or muscle spasm
in younger pts with pain or deformity:
scoliosis and hyperkyphosis
in older pts with pain or deformity:
chronic postural problems or long term scoliosis
in seniors with pain or deformity
compression fractures
in older pts with weight loss, history of cancer, night pain or fever:
look for cancer or infection
if there is stiffness with normal ROM:
posturally strained muscles
if there is deformity possible:
compression fracture, Scheuermann’s, scoliosis, postural issue
if there is scapular winging:
scoliosis or muscle weakness (traps and serratus anterior)
if there is high scapula:
Sprengel’s deformity
if there is buffalo hump:
cushings or from corticosteroid use
if there is Dowagers hump or acute angle kyphosis:
compression fracture
if there is hyperkyphosis in adolescents:
Scheuermann’s and postural problems
if there is referred pain from lower costovertebral area:
from kidney
if there is referred pain from mid thoracic or scapular area:
from gallbladder
management for infections, tumor, fractures, progressive scoliosis, active Scheuermann’s:
orthopedic consultation
management for inactive Scheuermann’s, non progressive scoliosis, facet syndrome:
conservative care
fever with night pain and/or history of IV drug use
do thoracic spine xrays looking for infection
older pt with weight loss, history of cancer, night pain, unresponsive to conservative care
do thoracic spine xrays looking for metastasis or multiple myeloma
older pt with trauma and/or history of corticosteroid use, or postmenopausal pt, or pt with major trauma
do thoracic spine xrays to look for compression fracture
younger pt with no fever, pain at night relieved by aspirin
do thoracic spine xrays to look for osteoid osteoma
pt has associated chest pain
do thoracic spine xrays and/or electrocardiogram
traumatic onset of pain or pain with inspiration
do chest and rib xrays
insidious onset of constant pain and pt is hyperkyphotic
do prone extension test to differentiate structural from functional kyphosis
scoliosis is suspected
do adam’s test to differentiate structural from functional scoliosis
insidious onset of pain in a dermatomal, unilateral pattern
herpes zonser/shingles
pain that may radiate along rib, pain may increase with Valsalva, deficit in corresponding dermatome or myotome
neuritis or radiculitis
pain that may radiate along rib, pain increased with hyperextension, positive Kemps, end range restriction to the side of involvement
facet syndrome
active Scheuermann’s:
skeletal immaturity
inactive Scheuermann’s:
skeletal maturity
if kyphosis persists with prone extension test
structural
if kyphosis improves with prone extension test
functional
anterior step defect and zone of impaction on xray
compression fracture
decreased height of more than half of the anterior vertebral body may suggest
unstable fracture
management of new or unstable fracture
orthopedic consultation
decreased posterior vertebral body height
pathological fracture
diff di for pathological fracture in older pt
osteoporosis, lytic mets, multiple myeloma
diff di for pathological fracture in young pt
eosinophilic granuloma
tests to do for lytic mets
bone scan, MRI, biopsy
tests to do for multiple myeloma
PEP, skeletal survey, MRI, biopsy
localized mid back pain, in young males (10-25), pain worse at night relieved by salicylates
osteoid osteoma
diff di of missing pedicles
congenital, destructive, surgical
reasons for destructive changes with missing pedicles
bone tumor, soft tissue tumor, infection
diff di with decreased disc height/joint space
DDD, DJD, inflammatory, developmental, infection
Riser’s sign
growth plate along top of iliac crest
rotational component of scoliosis
Nash-Moe method
if a vertebral body is darker with T1 MRI and lighter with T2 MRI, is the injury new or old?
new
diff di for ivory vertebrae
blastic mets, lymphoma, pagets
