Thoracolumbar Complaint

Question 1

What are the 4 components of describing a thoracolumbar complaint?

Answer 1

1) Inspection
2) Palpation
3) Percussion
4) Auscultation

Question 2

What are the 4 components of Inspection?

Answer 2

1) Gait
2) Posture
3) Curves (thorax : kyphosis and lumbar : lordosis)
4) Skin (lesions and trauma)

Question 3

Name the components of palpation

Answer 3

tissue texture changes, asymmetry, ROM, tenderness, spinal column, paraspinal muscles, muscles of back

Question 4

What does percussion accomplish?

Answer 4

ID of pain points, area of fracture

Question 5

Why is auscultation important?

Answer 5

useful in comprehensive exam is suspect additional findings

ie: thoracic pain = aspic. pleural effusion, pleurisy, pulmonary infiltrate

costovertebral angle tenderness = polynephritis, maybe nephrolithiasis

Question 6

What is Scoliosis?

Answer 6

abnormal lateral curvature of the spine

Question 7

Types of scoliosis?

Answer 7

1) congenital
2) early onset = < 10 yo
3) Adolescent idiopathic = MOST COMMON , BW AGES 10-18
4) Adult scoliosis

Question 8

What is the Cobb angle that determines scoliosis?

Answer 8

< 10 degrees is w/in normal limits

Question 9

Adolescent Idiopathic Scoliosis main points

Answer 9

1) only 10% require treatment
2) males and females equally affected
3) females 10 times more at risk for curve progression

Question 10

Adult Scoliosis

Answer 10

• is secondary to any other condition

- can be caused from preexisting scoliosis

Question 11

Define Adult Spinal Deformity

Answer 11

encompasses scoliosis, kyphosis, lordosis, and spondylolisthesis

Question 12

Describe how you would screen for Scoliosis

Answer 12

1) Differences in hight of shoulders or scapulae
2) asymmetry of waistline
3) asymmetry in distance arms hang from trunk
4) head shift to one side, not centered over sacrum (trunk shift)
5) plumb line dropped from spinous process of 7th cervical vertebrae should pass thru gluteal cleft

Question 13

Describe steps of Adams forward bending test

Answer 13

1) bend forward with knees extended
2) side bend to left and right while physician observes for improvement of spinal curves

** functional curves improve with side bending, structure curves do not

Question 14

Describe scoliosis and observed by a scoliometer

Answer 14

Run along patients spine caudal to cephalic while patient in forward bend

** a right thoracic provinces causes right side of scoliometer to deviate up and the ball to deviate to the left**

Question 15

Spondololysis

Answer 15

DEFECT OF STRESS FRACTURE IN PARS ARTICULARIS OF THE VERTEBRAL ARCH

usu: L5, can occur in cervical vertebrae

Question 16

Spondolyisthesis

Answer 16

one vertebral body slips forward over another

• usu have spondololysis first

can be degenerative, ischemic, dysplastic, traumatic, pathologic

*pars interarticularis

STEP OFF OCCURS

Question 17

Spondylitis

Answer 17

inflammation of the spinal joints

Question 18

Spondylosis

Answer 18

aka osteoarthritis

painful degenerative IV discs

related to osteophytes

can lead to radiculopathy or myelopathy

Question 19

Treatments for scoliosis

Answer 19

1) observation
2) bracing
- underarm (Boston) b brace
- under chin (Milwaukee brace)
3) surgery ( >39-50 degrees)

Question 20

Types of scoliosis surgery

Answer 20

• posterior spina fusion and instrumentation and bone grafting
• anterior spinal fusion and instrumentation
• growth modulation techniques

Question 21

Stages of intervention

Answer 21

1) early = <30 degree (100% success)
2) likely to progress = 30-49 degrees ( 92% success)
3) above surgical threshold = >50 degrees ( 50% success)

Question 22

TENDERNESS OVER SACROILIAC JOINT IS INDICATIVE OF ?

Answer 22

• sacroilitis

AND

-ankylosing spondylitis

Question 23

Straight leg raise test

Answer 23

+ test = pain b/w 30-60 degrees, worse with dorsiflexion

-indicates: lumbosacral radiuclopathy (usu herniated disc)

+ signs > 70 = mechanical low back pain or muscle strain

pain lateral at >15 = IT band contracture

low specificity /high sensitivity (use with contra leg raise)

Question 24

Contralateral Leg raise

Answer 24

+ = presence or worsening of radiating pain into contralateral leg b/w 30-60 degrees

indicates : lumbosacral radiculopathy usu due to IV disc or sciatica

HIGH SENSITIVITY/ LOW SPECIFICITY

Question 25

Cauda equina syndrome

Answer 25

• spinal nerve root compression due to massive disc protrusion, fracture/trauma, or tumor resulting in bowel/bladder dysfunction

Symptoms :

• low back pain
• bowel/bladder dysfunction
• seneory loss of perineum
• bilateral sciatica/leg weakness

EMERGENT MANAGEMENT AND SURGICAL DECOMPRESSION

Question 26

FERGUSION’S ANGLE

Answer 26

normally 30-40 -> eval stability of lumbosacral region

-> lumbosacral angle and lumbar gravity line

Question 27

Red flags for patients <20 but >55 yo

Answer 27

-pain unrelenting at night (unaltered time or acitivity)
-widespread euro symptoms
unexplained weight loss
fever, chills
-trauma
previous history of osteoporosis, cancer, HIV, etc

Question 28

Other red flags

Answer 28

Iv drug use, previous steroid use

• failure to improve after 4-6 weeks
• compression fracture > 50 yo = thigh specificity and sensitivity

Question 29

Ankylosing spondylitis

Answer 29

< 40 yo = high sensitivity, low specificity 
-pain not alleviated supine 
-mornign back stiffness
-pain duration > 3 moths 
4/5 positive responses

Question 30

Sciatia or postclaudication neuro involvement

Answer 30

1) pain radiating distally (below knee) compared to pain radiation to posterior thigh
2) history of numbness/weakness

Question 31

Sciatica

Answer 31

• pain or discomfort with sciatica nerve

- shapr burning pain that raiates from lower back/hip down to back pf leg/ foot