Thoracic spine/rib/abdominal pain Flashcards
What are some red flags for thoracic pain?
- Angina
- AMI
- Dissection
- Lung / secondary metastases
- Osteomyelitis
- Pneumorthorax
- Osteoporosis
What are some red flags for acute abdominal pain?
- Fever
- Collapse on toilet whilst straining
- Ischaemic heart disease
- Pallor/sweating
- Progressive vomiting/pain/distension
- Menstrual abnormalities
- Atrial fibrillation (can cause blood clotting)
- Rebound tenderness and guarding
Probable diagnosis of thoracic pain?
- Musculoligamentous strains/sprains
- CT/CV dysfunctions
- Discogenic pain
- Rib/ Vertebral #
- Scheurrmans
How do you differentiate between a CV/CT/Facet, muscle strains and referred pain from the neck in the thorax?
CV/CT/Facet: Chronic postural, acute minor/major trauma, excessive coughing, pain on deep inspiration and tenderness of local structure
Muscle strains: Active movements into that direction + resistance from the muscle causes pain, pain on palpation, acute onset and usually clear mechanism
Referred neck pain: Radiation from neck, springing the Tx doesn’t reproduce pain, dysfunction seen on Cx ROM or palpation
What is Scheuermann’s Disease? How is it caused?
-Characterised by vertebral endplate irregularities of 3+ adjacent vertebral bodies - usually in the Tx but can also be present in the T/L junction
- Caused by abnormal endplate ossification causing anterior wedging and an increase kyphosis
- Genetic component?
Clinical features of Scheurmann’s disease?
- Aggravated by activity and relieved by rest
- Sometimes asymptomatic
- Cervical/Lumbar hyperlordosis
- +/- scoliosis
- Tight hamstrings
- Loss of disc space
- Commonly affecting 12-17 year old males
What is osteoporosis?
Osteoporosis is a loss of bone density making the bones brittle, weaker and easy to fracture
Reduction in bone density
Risk factors for osteoporosis?
- Elderly
- Females
- Long term corticosteroid/steroid/NSAID use
- Malnutrition/calcium deficient
- Coeliac/bowel/liver conditions
- Eating disorders
- Thyroid and parathyroid conditions
- Excessive alcohol consumption
- Smoking
What type of osteoporosis’s are there?
Primary: Menopausal (idiopathic) and Senile
Secondary: Iatrogenic (corticosteroids/ chemotherapy) and Pathological (Crohns disease)
What are the probable diagnoses for acute and chronic abdominal pain?
Acute: Appendicitis, gastroenteritis, painful ovulation, IBS, Musculoskeletal - myofascial, hernia, referred Tx pain, side strains
Chronic: peptic ulcer, IBS, painful ovulation
Serious disorders not to miss in the chest/abdomen?
- Angina
- AAA (hypertension, older age, pallor, high BMI, male, smoker)
- Secondary neoplasia (metastasis)
- Pneumothorax
- Osteoporosis
- Myocardial Infarction
- Bowel/stomach/ovarian cancer
- Hepatitis
- Pelvic inflammatory disease
- Menstral abnormalities
- Atrial Fibrillation
- Rebound tenderness
What is an abdominal hernia?
-The protrusion of abdominal contents (intestines, omentum) into the inguinal canal
Risk factors for an abdominal hernia?
- Male
- Advanced age
- Occupations involving lifting
- Connective tissue disorders
- Inguinal cryptochidism
- Smoking
- High BMI
What types of abdominal hernias are there?
Indirect: Hernia sac passes through the deep inguinal ring and runs in the canal
Direct: Bulges directly through the canal
What is a side strain?
Usually involves a tear of the I/O muscle at either the rib or costal cartilage attachment
Who is at greater risk of a side strain injury?
-Athletes involved in repetitive, unilateral and explosive trunk motions
Clinical features of a side strain?
- Acute pain and focal tenderness at costal margin
- Reproduced by movements consistent with mechanism
- Aggravated by deep breathing, coughing and rolling over in bed
What are some causes of CV/CT joint dysfunction:
- Mechanical joint sprains
- Degenerative change (OA)
- Inflammatory spondyloarthropathies
- Chronic postural issue
- Excessive coughing
Clinical features of CV/CT joint dysfunction?
- Localised tenderness 3-4cm lateral to midline on the rib
- Restricted motion or catching sensation
- Often evident on deep inspiration and Tx AROM
- Hypertonicity of paraspinal musculature
- Referral to other areas of the body
Clinical features of Thoracic muscle strains?
- Reproduction of pain when mm in activated
- Active resisted
- Pain on palpation
- Postural or acute mechanisms
Clinical features of Thoracic pain due to referred neck pain?
- Pain travels
- Are not able to reproduce pain on the Tx spine
- Restricted ROM of Cx spine
What ligaments make up the costovertebral joints?
- Radiate ligament
- Intrarticular ligament
What ligaments make up the costotransverse joints?
- superior costotransverse
- lateral costotransverse liagemnt
- costotranservse ligament
Where can C4-7 posterior disc bulges or tears refer to?
Interscapular region (according to Cloward 1959) Where as posterolateral injuries refer to upper limb
