Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Thoracic Spine, Ribs, & Scoliosis Information > Flashcards

Thoracic Spine, Ribs, & Scoliosis Information Flashcards

1
Q

Important anatomy considerations of Thoracic vertebra

A
  • Oblique spinous processes (limits extension)
  • Overlapping lamina
  • Demifacets (costal facets)
  • Transverse costal facets (T1-10)
  • Transverse process posterior and superior
  • Articular facets
    • 1-6 frontal ( more rotation)
    • 6-12 sagittal (more flexion & rotation)
  • T2-9 heart shaped, superior facet
  • T1 facet more cervical resembling
  • T10-12 only one costal facet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Rib anatomy

A
  • Named for vertebra inferior
  • Costovertebral joint
    • 2-10 articulate with vertebral body & disc
  • Costotransverse joint
    • 1-10 articulate with transverse process
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Rib classifications

A

1-7 True ribs
8-10 False ribs
11-12 Floating ribs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Thoracic arthrology

A

Stronger annulus
- limits sagittal motion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Important thoracic musculature

A

Anterior
- Pectoralis major and minor
- Scalenes, SCM
Posterior
- Trapezius
- Levator scapula
- Rhomboids
- Serratus anterior
- Latissimus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Thoracic nervous system considerations

A

Canal is narrower which leads to dural adhesions
T4-9 is the critical zone due to canal narrowness
- T6 is tension point
Sympathetic chain is anterior to rib heads
Viscera & thoracic spine have shared innervation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Thoracic fun facts

A

Majority of rotation occurs here
Stable region
Nerve dysfunction is a ring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Thoracic RoM

A

Flexion: 20-45 (B facet opening)
Extension: 20-45 (B facet closing)
Side bending: 20-40 (ipsi closing)
Rotation: 35-50 (ipsi foramen opening)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Rotation’s effects on the ribs

A

R rotation
- L posterior rib goes up, front down
- R posterior rib goes down, front up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Spondylosis clinical findings

A
  • Pain with PA testing
  • Pain with A/PROM (closing)
  • Pain posterior, lateral; UL
  • May present as chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Rib Sprain

A

History:
- Illness, cough
Reported findings:
- pain in rib cage region
- pain with breathing, coughing, sneezing, laughing, rotation
Examination findings:
- intercostal tissue stretch is painful
- Pain with palpation of sternocostal, costochondral, costotransverse
- Pain with palpation of rib angles
- Pain with palpation of intercostal myofascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rib dysfunction

A
  • Asymmetry of motion
  • First rib elevation
  • Subluxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rib subluxations

A

Anterior
- sublux of costovertebral joint/anterior sheer
- Palpation of rib more anterior, depression on posterior
- MOI: blows to back, falls, MVA, muscle strain
Posterior
- Rib angle more prominent posteriorly
- Costochondritis pain
- MOI: MVA, surgery, muscle strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Muscle strain

A

Reported Findings
- Aching or sharp pain in muscle region
Examination findings
- Pain with limitation in muscle length tests
- Pain with limitation in muscle strength tests
- Tenderness upon palpation, potential divot, guarding, or spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Disc pathology

A

Occurs on convex side, lower thoracic due to increased mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nerve root pathology

A

Mechanical or chemical irritation
Symptom patterns:
- anterior > posterior
Dural entrapment/adhesion
- vague symptoms up/down spine
- tension point + small container = critical zone
- + slump, SLR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ankylosing Spondylitis (bamboo spine)

A

Prevalence 0.2%
Late adolescent to early adulthood
Spondyloarthritis of spine and pelvis of unknown etiology
HLA-B27 & other inflammatory diseases
Leads to structural & functional impairments
Affects synovial and cartilaginous joints, tendon, & ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ankylosis Spondylitis clinical presentation

A

Insidious, progressive
AM stiffness > 30min
Waking up second half of night
Sx inc with rest & dec with activity/exercise
Decreased chest expansion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Ankylosing Spondylitis Diagnosis

A

Increased erythrocyte sedimentation rate
Increased levels of C-reactive protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Scheurman’s Disease

A

Forward head posture
Rounded shoulders
Flexion contractures
Short hamstrings & protuberant abdomen
Address impairments
Bracing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dowagers Hump

A

Post menupausal osteoporosis
Trunk weakness
Somatosensory function
Impaired spinal mobility
Multiple compression fractures
Consequences:
- Decreased LE performance
- Decreased balance
- Decreased gait speed
- Increased fall & fracture risk
Treatment:
- Extensor strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Thoracic fractures

A

Kyphoplasty
- baloon & cement
Vertebroplasty
- cement into fracture
Conservative
- Brace, rest, medication
- 10 weeks of manual therapy, strengthening, & flexibility + tape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Rib fractures

A

Severe pain
Presentation
- breathing pain
- TTP
- +/- Hematoma
- Tap test
- Tuning fork
Treatment
- Rest, NSAIDs
- Splinting & education

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Costochondritis

A

Painful chronic inflammation of costochondral junction
Treat hypomobility posterior & lateral
If there is swelling & reddening of skin = Tietzes syndrome
MT + exercise + medical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

T4 syndrome “glove syndrome”

A

New job/hoby
Thoracic dysfunction & SNS influence
Diffuse in neck, head, mid back, & UE
Dull hand pain
+/- neuro signs
UL or BL
Medical management
Mobilizations, TrP, flexibility, postural exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Thoracic outlet syndrome

A

UE, chest, neck, shoulder
Symptoms are positional, intermittent
Compression of brachial plexus, and/or subclavian A & V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Where does thoracic pain refer to?

A

T4-7 = pseudo anginal pain
Lower thoracic -> abdomen & iliac crest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is pain here coming from?

A

Facet pathology
Adhesion of dura
Neck spondylosis
Rib sprain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Where is pain here coming from?

A

Facet pathology
Adhesion of dura
Neck spondylosis
Scoliosis
Cervical radiculopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Where is pain here coming from?

A

Facet pathology
Adhesion of dura
Neck spondylosis
Scoliosis
Cervical radiculopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Visceral referral pattern to thorax

A

Heart: T1-5
Lung: T2-4
Stomach: T6-10
Liver & gallbladder: R T7-9
Kidney: T10-L1
Bladder: T10-L2
Male genitalia: TL

Appendix: R mid/lower thoracic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Acute, pleuritic, red flag considerations in thoracic spine

A

*PE
*Pericarditis
*Pleurisy
*Tracheo-bronchial pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Acute, non-pleuritic, red flag considerations in thoracic spine

A

*MI
*Aortic dissection
*Cholecystitis
*Esophageal
*Renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Non-acute red flag considerations in thoracic spine

A

Cardiac
- Angina
GI
- Esophageal
- Peptic ulcer
- Cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Cardiac pain reports

A

Squeezing sub-sternal sensation, tightness, pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Cardiac pain conditions and what to do

A

Angina pectoris
- increased pain with exertion, relieved with rest
*eval by physician ASAP
Acute MI
- intolerable gripping/crushing substernal, diaphoresis and SOB
*Send to ER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Aortic dissection reports

A

Sudden/rapid, severe pain not changed by position

38
Q

Aortic dissection objective findings

A

Distress
Pale, or cyanotic
BP normal
Distal pulses decreased or absent
Strong throbbing pulse

39
Q

What to do for aortic dissection

A

Immediate medical evaluation

40
Q

Pericarditis reports

A

Mild to severe chest pain, epigastrium and L parasternal
Agg: respiration, cough, thoracic ROM
Ease: sitting, flexion

41
Q

Pericarditis objective findings

A

Fever
Chills
Weakness
Tachycardia
Cough
Pain in trapezius

42
Q

What to do for pericarditis?

A

Send to ER

43
Q

Esophageal disorder reports & course of action

A

Reports:
- Heart burn
Course of action:
- Referral to PCP

44
Q

Tracheobronchial pain reports & course of action

A

Reports:
- Dyspnea, dysphonia
Course of action:
- Referral to PCP
- Referral to ED

45
Q

Pulmonary embolism reports

A

UL swelling and chest pain
Dyspnea 80%
Hemoptysis 20-30%
Tachypnea

46
Q

Pulmonary embolism course of action

A

Medical emergency, must be treated immediately

47
Q

Cholecystitis Reports

A

Pain
- Paroxysmal (sudden) or gradual, severe
- 1-2hr after heavy meal, resolves in 10 hours
- RUQ of abdomen, R subscapular
Other
- Moderate fever
- Chills
- Distress
- Murphy’s sign (R upper quadrant tenderness worsens with deep inspiration)

48
Q

Cholecystitis course of action

A

ED or PCP

49
Q

Peptic Ulcer reports

A

Burning in epigastrium or LUQ
Boring sensation through back
Perforation -> pain in shoulder
1-2hr after meal

50
Q

Peptic ulcer course of action

A

PCP

51
Q

Renal disease reports

A

Genitourinary: costovertebral angle
Acute inflammation will have signs of UTI then flank pain
No relief with change in position
Fever, chills, sweats
Pain with percussing CV angle

52
Q

Renal disease course of action

A

Send immediately to physician

53
Q

Red flags of thorax sources, fracturs

A

Compression fractures
Acute pain from trivial strain in >60

  • can treat but good idea to send to team
54
Q

Red flags of thorac sources, inflammatory disorders

A

Ankylosing spondylitis
Morning pain & stiffness
Peripheral joint involvement

  • can treat but good idea to send to team
55
Q

Red flags of thorax sources, inflammatory or systemic disorders

A

Osteomyelitis
Discitis
Epidural infection
Pericarditis

56
Q

Red flags of thorax sources, neoplastic conditions

A

> 50
History
Unexplained weight loss
Constant pain without relief
Night pain

57
Q

Thoracic spine and ribs considerations

A

15% of all spine complaints
- lifetime prevalence of 77%
Limited evidence means we rely on anatomy, biomechanics, SINSS, and the ICF
Differential diagnosis is important

58
Q

Evaluation steps for a patient with thoracic spine pain

A
  1. Rule out red flags
  2. ID regional pain source: (upper t/s vs lower c/s)
    - Avoid over analysis of pathoanatomy
  3. ID impairments and classify
    - Mobility restrictions
    *mechanical thoracic
    *mechanical rib
    *muscle length
    - Movement impairments
    *balance of strength
    *form & quality of movement
59
Q

Subjective questions for thoracic pain

A

History: MOI
Medical history
Area of symptoms
- Behavior, nature, severity
Aggravating factors
- Beware of constant pain
Red flag screen
- Night pain, chest pain, abdominal pain, neurologic symptoms
Diagnosis

60
Q

Screening questions for thoracic spine

A

Pain pattern with:
- Movement or posture (MSK)
- Respiration (rib, pleuritic)
- Eating/drinking (gastric)
- Exertion (rib, cardiac)
Bowel & bladder

61
Q

Regional interdependence cervical spine CPR

A

Symptoms <30d
No symptoms distal to shoulder
Looking up is not an agg
FABQ PA <12
Diminished upper thoracic kyphosis
Cervical extension ROM <30

62
Q

Regional interdependence shoulder management CPR

A

Pain free shoulder flexion <120
Shoulder IR <53
Negative neers test
Not taking medication
Symptoms <90 days

63
Q

What is scoliosis?

A

3 dimensional deformity
Deformity in the coronal plane of the spine >10
May alter sagittal plane
Spinal rotation causes posterior prominence

64
Q

How is the anatomy changed with scoliosis?

A

All bony elements are altered
- vertebra are wedge shaped
- rib vertebral angle altered
- pedicles rotated
Discs are wedged was well

65
Q

Types of scoliosis

A

Congenital
Neurological
- CP
Syndrome related
- Marfan’s syndrome
Idiopathic
- 80%

66
Q

Where can adult scoliosis come from?

A

ASA (adolescent scoliosis in adults)
- pre-existing scoliosis carried over from childhood
Neuomuscular:
- PD
- MS
DDS (degenerative De-Novo Scoliosis)

67
Q

Scoliosis classification based on age

A

Infantile: 0-3 (0.5%)
Juvenile: 4-11 (10.5%)
Adolescent: 10-17 (89%)
Adult: >18

68
Q

Scoliosis classification based on curves

A

Mild: 10-25
Moderate: 25-50
Severe: >50

69
Q

How is the scoliosis curve pattern defined?

A

By the direction of convexity and location in the spine

70
Q

Scoliosis terminology

A

Named by apex
- cervical: C2-6
- cervicothoracic: C7-T1
- thoracic: T2-T11
- thoracolumbar: T12-L1
- lumbar L2 down
Primary vs secondary
Structural (scoliotic) vs nonstructural (unwinds with AROM)

71
Q

How do we diagnose scoliosis?

A

Uneven shoulder or hip height
Rib hump in flexion AROM

72
Q

Rotation of scoliosis

A

0: no rotation
+1: pedicle toward misline
+2: pedicle 2/3 to midline
+3: pedicle in midline
+4: pedicle beyond midline

Spinous process rotates into concavity

73
Q

Skeletal maturity by risser sign

A

0: no ossification at the level of the iliac crest
1: 25% apophysis of iliac crest
2: 25-50%
3: 50-75
4: 75%
5: complete ossification & fusion of the iliac crest apophysis

74
Q

What is the natural history of scoliosis?

A

If curve <30 at maturity
- no adult consequences, unlikely to progress
Curves >45
- may progress a degree/yr
Curves >90
- right heart failure
- decreased pulmonary function

75
Q

When do we treat a patient with scoliosis with an 11-25 degree curve that is at skeletal maturity?

A

Follow up as needed

76
Q

When do we treat a patient with scoliosis with an 11-25 degree curve that is NOT at skeletal maturity?

A

Follow up until skeletal maturity every 6 months

77
Q

When do we treat a patient with scoliosis with a 25-45 degree curve that is at skeletal maturity?

A

Follow up every 5 years to assess progression

78
Q

When do we treat a patient with scoliosis with a 25-45 degree curve that is NOT at skeletal maturity?

A

Follow up every 4-6 months
Consider bracing

79
Q

What do we do for a patient with scoliosis with a >40-50 degree curve?

A

Consider surgical intervention

80
Q

How long do we brace for scoliosis?

A

23 hours a day
Until skeletally mature

81
Q

What types of braces are there for scoliosis?

A

Milwaukee
Underarm orthosis
Charleston nighttime bending brace
Rigo cheneau brace (Schroth)

82
Q

Who is scoliosis bracing best for?

A

Girls
More flexible curves
Younger patients

83
Q

When is surgery indicated for scoliosis?

A

Failed bracing
Curves >45
Unbalanced curves >40

84
Q

What is the surgery for scoliosis?

A

Fusion with instrumentation

85
Q

What is the physical exam for scoliosis?

A

Iliac crest height
- leg length discrepancy
Shoulder height
Arm trunk space
Scapular position
Trunk shift
Inspection os skin
- Cafe au lait spots

86
Q

Tell me about Adam’s test

A

It shows rib deformity on the concave side
You can use a scoliometer with it
It is meant to identify people with scoliosis
It is sensitive

87
Q

Whats in the neurologic exam for scoliosis?

A

Gait
Heel and toe walking
Myotomes
Reflexes
Sensation

88
Q

In posture and movement analysis of scoliosis what are you looking for?

A

If the curve is flexible or rigid
If the curve unwinds with motion

89
Q

What are you doing in the palpation and manual assessment of scoliosis?

A

Assessing bony landmarks
Assessing leg length
Assessing muscle length
Assessing muscle strength
Assessing spine mobility
- accessory motion testing
- cervical/thoracic/lumbar
- rib mobility & respiration

90
Q

Physical therapy intervention for scoliosis

A

Patient education
Posture awareness & breathing
Strength/flexibility
Maintrain/restore joint mobility in adjacent areas
Retrain movement

MSK (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions