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Spine MSK > Thoracic Spine & Ribs - working > Flashcards

Thoracic Spine & Ribs - working Flashcards

1
Q

Describe a pancoast tumor.

A

Tumor at apex of lung.

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2
Q

A pancost tumor may involve what neurological structures?

A

C8-T1

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3
Q

Pancoast tumors present similar to

A

MSK origin, especially TOS

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4
Q

Symptoms of a pancoast tumor include

A
  • Chronic cough + blood sputum (red flag)
  • Unexplained weight loss
  • Malaise
  • Dyspnea
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5
Q

Pancoast tumor physical exam findings

A
  • Fever
  • Wheezing
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6
Q

What non-MSK diagnoses should be included for the thoracic spine?

(Visceral Pain Patterns)

A
  • MI
  • Pericarditis
  • Pneumothorax
  • Abdominal Organs
  • Pleuropulmonary disorders
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7
Q

Vertebral body fractures can be divided based on what portion of the vetebrae they involve. What are those parts?

A
  • Anterior column
  • Middle column
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8
Q

Posterior component vertebral fractures involved what anatomic structures?

A

Posterior column

Transverse processes, spinous processes, etc.

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9
Q
A
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9
Q

Why are vertebral fractures dangerous?

A
  • Increase mortality
  • Predictor for subsequent vertebral fractrue (4-5x) and hip fracture (3x)
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10
Q

The three classification elements fo the TLICS include:

A
  • Morphology
  • Integrity of Posterior Ligamentous Complex (PLC)
  • Neurologic status
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11
Q

The posterior ligamentous complex includes

A
  • Supraspinous ligament
  • Intraspinous ligament
  • Ligamentum flavum
  • Z-joint capsule
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12
Q

3 Morphologies of Vertebral Fractures

A
  • Compression
  • Rotation/Translation
  • Distraction
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13
Q

Compression vertebral fractrure types

A
  • traditional compression
  • Burst
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14
Q

Traditional Compression Fractures
- Stable v unstable?
- What portion of vertebrae involved?

A

Stable, anterior column

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15
Q

A common mechanism resulting in traditional compression fractures includes:

A

Axial loading in a flexed position (trauma: high energy v osteoporotic)

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16
Q

Burst Fractures
- What portion of vertebrae is involved?
- Most common region of spine involved?

A
  • Anterior/Middle columns
  • T/L junctions (T12/L1)
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17
Q

Common MOI for burst fractures?

A

high force axial load (+/- flexion)

MVC, Fall from height, high-sport injury

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18
Q

Rotation/Translation vertebral fractures are associated with what MOI?

A
  • Fall from a height
  • Heavy object falling on body with bent trunk
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19
Q

What force is involved in a rotation/translation vertebral fracture?

A

shear + torsion

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20
Q

Which fracture type can result in dislocation of the facet joints?

A

Rotation/Translation

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21
Q

Distraction Vertebral fractures occur due to

A

a tensile load

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22
Q

What segments of the spinal column are invovled in distraction vertebral fractures?

A

Anterior and posterior column.

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23
Q

RED FLAGS associated with vertebral fractures

A
  • Bruising/Abrasions (trauma)
  • Older Age
  • Significant trauma
  • Corticosteroid use
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24
Q

Henschke recommends clustered findings to identify vertebral fractures. They include:

A
  • Age >70 Y
  • Significant trauma
  • Prolonged corticosteroid use
  • Sensory alterations from trunk down

Think trauma!!

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25
Q

Roman proposed clusters of findings that suggest a vertebral compression fracture in the osteoporotic individual, including:

A
  • Age >52 Y
  • No presence of leg pain
  • BMI </= 22
  • Does not exercise regularly
  • Female gender
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26
Q

Scheuermann’s Disease

A

defective growth of vertebral endplate (poor vascularized disc)

27
Q

Proposed etiology of Scheuermann’s disease includes:

A
  • genetics
  • Excessive stress on pre-disposed (weak) endplate
28
Q

Risk of Scheuermann’s disease increases amoung…

A
  • Manual workers who begin at early age
  • High intensity athletes?
  • High BMI
  • “Short sternum”
29
Q

What is the criteria for diagnosis of Scheuermann’s disease?

A
  • Thoracic kyphosis >45º
  • Wedging x3 adjacent vertebrae >5º
  • Thoracolumbar kyphosis >30º
30
Q

Symptoms of Scheuermann’s disease

A
  • Thoracic pain, commonly apex of curvature

Due to muscular tension, IV disc bulging/spondylosis.

Potentially lumbar pain

31
Q

Disc Disease is most common where in the T-spine?

A

Lower T-spine, T8-T12

31
Q

Physical examination findings of Scheuermann’s disease

A
  • Scoliosis
  • Excessive thoracic kyphosis/compensatory hyperlordosis
  • Rounded shoulders, forward head
  • Pelvic rotation
  • Vertebral wedging
  • Schmorl’s nodes
  • Disc space narrowing
  • Limited thoracic ROM
  • Neurological complications (less common)
32
Q

Herniation occuring with disc disease typically occurs where?

A
  • Central
  • Lateral
  • Posteriolateral
33
Q

How does disc disease typically occur?

A

Degeneratively

34
Q

Symptoms of disc disease include

A
  • Midline back/chest pain that is radicular, band-like in affected level’s dermatome
  • Paresthesia/anesthesia that is radicular, band-like in affected level’s dermatome
  • Leg pain
  • Progressive/insidious (months to years)
35
Q

Physical exam findings of disc disease

A

Commonly asymptomatic, but presents variably. Potential for myelopathy.

36
Q

Health conditions related to thoracic spine myelopathy include?

A
  • Compression Fracture
  • Stenosis
37
Q

Symptoms of thoracic spine myelopathy

A
  • Sexual dysfunction
  • Bowel and bladder dysfunction
38
Q

Physical exam findings for thoracic myelopathy include

A
  • Sensory/motor impairments
  • UMN signs LEs
39
Q

Intercostal Neuralgia etiologies

A
  • Traumatic injury
  • Infection
  • Mechanical compression (disc protrusion, osteophyte comples, neuroma, fracture)
40
Q

Symptoms of intercostal neuralgia includes

A
  • Burning pain
  • Paresthesia/anesthesia
    Occurs along intercostal nerve path
41
Q

Physical Examination of intercostal neuralgia

A
  • Focal tenderness of intercostal area
  • Dermatomal distribution of rash with grouped vesicles and pustules (herpes zoster/shingles)
42
Q

T4 Syndrome etiology?

A

Unknown, thought to be a sympathetic reaction with hypomobile segment

43
Q

What patient population is commonly affected with T4 syndrome?

A

Women

44
Q

T4 Syndrome most commonly affects

A

T2-T7

45
Q

Primary pain generators with T4 syndrome include

A
  • Thoracic IV disks
  • Thoracic Z-joints
46
Q

Symptoms of T4 syndrome include

A
  • glove-like paresthesias (unilateral or bilateral UEs)
  • Neck/scapular/bilateral UE pain (constant or intermittent)
  • Pain worsens in side-lying or supine
  • Generalizes HA
47
Q

Physcial Examination findings of T4 syndrome include:

A
  • Tender spinous process
  • +Thoracic Slump Test
  • +Upper quarter neurodynamic tension tests
  • Hypomobile thoracic segment
48
Q

Scoliosis is named for

A

the convexity and invovled region based on the patient’s left and right

49
Q

Scoliosis etiology

A
  • congenital: adolescent idiopathic
  • aquired: degenerative
50
Q

Zygopophysial Arthropathy
Symptoms + Physical Exam

A
  • Local +/- referred pain
  • Painful movement with closing Z-joints (AROM=PROM)
  • Painful spring testing/hypomobile with joint mobility testing
50
Q

Scoliosis

A

coronal and rotational (transverse) spinal deformities

51
Q

Why do rib fractures raise concern?

A

Potential for brachial plexus/vascular damage, laceration of pleura, lungs and abdominal organs

52
Q

What treatment is NOT supported to rib fractures?

A

Taping/strapping

53
Q

How long do rib fractures take to become stable?

A

~6 weeks

54
Q

Symptoms and physical exam findings of a rib fracture includes:

A
  • Focal pain, radiating pain
  • Pain with inspiration
  • Pain with coughing/sneezing
  • Focal tenderness
  • Possible palpable defect
55
Q

How many rib(s) does costochondritis involve?

A

1 or more rib

56
Q

Costochondritis is likely due to ____ and resolves within ______

A

repetitive stress, one year.

57
Q

Symptoms and physical exam of costocondritis

A
  • Pain and local tenderness at costochondral or chondrosternal articulations (at rest, trunk movement, respiration)
  • Local tenderness
  • Painful with chondrosternal joint mobility testing
58
Q

Rib dysfunction

A

inflammatory or degenerative health conditions

59
Q

3 types of rib dysfunction

A
  • Structural
  • Torsional
  • Respiratory
60
Q

Structural rib dysfunction

A

subluxation of joint (anterior or posterior)

61
Q

Torsional rib dysfunction

A
  • rib held in rotated position
62
Q

Respiratory rib dysfunction

A

related to posture, may affect respiration

63
Q

Rib Dysfunction symptoms and physical exam findings

A
  • Aggravated with deep inspiration, trunk rotation, sneezing/coughing
  • Diminished rib mobility (structural)
  • Pain/hypomobility with joint testing
  • Limited/painful thoracic spine motion

Spine MSK (6 decks)

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