Thorax & Abdomen Flashcards
What are the dermatomes for the back and abdomen
Cebra position starting at T2 under clavicle
T5 nipples
T8 inferior angle scapula
T9 umbilicus
T12 ASIS
What is the cutaneous nerve supply to the Abdomen?
- Supraclavicular N. - above clavicle
- Anterior cutaneous Intercostal N - anterior chest & abs
- Lateral cutaneous Intercostal N - lateral chest to hip
- Illiohypogastric
- Lateral cutaneus - above illiac crest
- Anterior cutaneus - top bikini line
What are the musculoskeletal common conditions affecting the trunk?
- •Muscle strains
- •Referred neck pain
- •Scheuermann’s Disease
- •Rib #
- •Vertebral #
- •Thoracic discogenic pain
What is the pain referral pattern from a CT/ CV sprain?
What is the Cx disc pain referral pattern to the Tx
Medial border of the scapula and upper traps
What is Scheuermann’s disease?
- •Characterised by vertebral endplate irregularities of 3+ adjacent vertebral bodies
- Usually in the Tx spine, but can also affect T/L junction
- Aetiology:
- Poorly understood - Hereditary component?
- Abnormal vertebral endplate ossification
- Disproportionate vertebral body growth resulting in anterior wedging
What is the clinical presentation of Scheuerman’s disease?
- •Most commonly diagnosed age 12-17
- •M:F ratio - 2:1
- •Subacute thoracic pain, no inciting event
- •Agg. by activity, rel. with rest
- •Some cases asymptomatic
- •Increasing thoracic kyphosis
- •Cervical &/or Lumbar hyperlordosis; +/- Scoliosis
- •Tight hamstrings
What is the management for Scheuermann’s?
lifestyle modification
bracing
surgery
Serious Trunk disorders not to be missed
- Cardiovascular
- •Angina
- •Myocardial infarction
- •Aortic dissection
- Neoplasia
- •Most common malignancies that metastasise to the spine?
- •Primary tumours that develop in the spine?
- Severe infections
- •Osteomyelitis, tuberculosis
- Pneumothorax
- traumatic (iatrogenic) pneumothorax
- primary (no underlying condition)
- secondary (lung disease)
- Osteoporosis
- Primary (age and menopause)
- Secondary (disease or condition)
What is the pharmacological management for osteoporosis?
hormone replacement therapies
antiresorptive drugs (target osteoblast to prevent calcium breakdown)
Monoclonal antibody therapy (inhibits sclerostin to increase bone formation)
What are the red flags for thoracic pain?
-
FRACTURE POINTER
- •Major trauma
- •Minor trauma:
- •Osteoporosis
- •Female >50 years
- •Male > 60 years
-
MALIGNANCY POINTER
- •Age >50
- •Past history of malignancy
- •Unexplained weight loss, fever, malaise
- •Pain at rest, Constant pain, Night pain
- •Unresponsive to treatment
-
OTHER SERIOUS CONDITIONS
- •Chest pain/heaviness
- •Shortness of breath, cough
-
INFECTION POINTER
- •Fever
- •Night sweats
- •Risk factors for infection
Other thoracic conditions often missed
Gastrointestinal
- Gord
- gastritis
- reflux
- oesophageal pain
- gastric ulcers
Costochondritis
Rheumatological
- •Spondyloarthropathies
- •Fibromyalgia
- Polymyalgia rheumatica
What are the red flags for abdominal pain ?
- •Fever
- •Collapse at toilet
- •Ischaemic heat disease
- •Pallor and sweating
- •Progressive vomiting, pain, distension•
- •Menstrual abnormalities
- •Atrial fibrillation
- •Rebound tenderness & guarding
What are the common acute abdominal pain conditions?
ACUTE ABDOMINAL PAIN
- •Acute gastroenteritis
- •Acute appendicitis
- •Painful ovulation/dysmenorrhoea
- •Irritable bowel syndrome
What are the common chronic abdominal pain conditions?
CHRONIC ABDOMINAL PAIN
- •Irritable bowel syndrome
- •Painful ovulation/dysmenorrhea
- •Peptic ulcer/gastritis
What causes acute gastritis?
Salmonela
e.coli
H.pilori
How to manage gastritis?
Hydrolites
allow for diarrhea to take its course
24-72h before going back to work
prevent transmission of gastro
hand sanitation
What causes appendicitis
Fecalite - poo stone
foreign object
what is the clinical presentation of appendicitis
rebound tendernes RLQ
hop
Mc. Burney’s point
fever chills
nausea
What is the management of appendicitis
surgical removal
what are the causes of peptic ulcer?
h.pylori
alcohol
Nsaid
smoking
What is the clinical presentation of peptic ulcer?
Pain aggravated/ relieved by eating
dyspepsia (discomfort, distention, belching)
what is the management of peptic ulcer?
antibiotic for H. pylori - if confirmed by gastroscopy
quadruple therapy
Urea breath test
What are the causes of IBS?
autoimmune
diet (cholesterol, sugar)
Microbiome
dysfunction of autonomic system (stress)
How to diagnose IBS?
diagnosis of exclusion
rule out
- tumour
- peptic ulcer
What is the management for IBS?
Walking - activity
Increase water and fibre intake
Probiotics
Drugs- stop
Manual treatment: walking the stool, raise legs for poop
What are the causes of Painful ovulation?
polycystic ovaries
endometriosis
fibroids
pelvic inflammatory disease
What are the serious disorders of the abdomen?
- Cardiovascular
- •Angina, myocardial infarction
- •AAA
- •Mesenteric artery ischemia
- Neoplasia
- •Bowel/Stomach cancer
- •Ovarian tumors & cysts
- Severe infections
- •Hepatitis
- •Pelvic inflammatory disease
- Ectopic pregnancy
Other disorders that affect the abdomen?
Acute appendicitis
Myofascial tear
Herpes zoster
Constipation
Psychogenic
Adhesions
Food allergies
Endometriosis
Diverticulitis
Inflammatory bowel disease
Myofascial tear
Abdominal hernia
Referred pain from thoracic spine
What is a side strain?
- Commonly reported in athletes requiring repetitive, unilateral and explosive trunk motion
- Usually a tear of IO, esp. at rib or costal cartilage attachment
- •Acute inflammation +/- haemorrhage
- •Acute pain and focal tenderness at costal margin
- •Reproduced by movements consistent with mechanism of injury:
- •Trunk lateral flexion, shoulder adduction
- •Agg. with deep breathing, coughing, rolling over in bed
What are the locations for hernias?
Inguinal hernia
Umbilical
Esophageal Hiatus
Clinical presentation of Myocardial Ischaemia?
Age>35
Pain: retro/parasternal, jaw, neck, inner arm, epigastrium, inner scapular
Quality of pain: Constricting, burning (clenched fist)
Aggravated: activity, food, stress, cold
Relieved: rest, glycerin
Hx: HBP, Obesity, smoking, dyspnea, nausea, sweating, pallor, fatigue
Clinical presentation of Referred Thoracic pain
Age 20-40
Pain: spinal, paraspinal, chest, substernal, illiac crest
Quality of pain: Dull, aching, sharp,
Aggravated: deep inspiration, poor posture, sleeping
Relief: Lying supine, erect spine
Hx: trauma, poor posture (office workers)
There are three views for thoracic X-ray
- AP: SHows scoliosis
- Lateral: vertebral fracture, shaumans, alligment of PLL ALL ligs
- Rib:
What is the management of a crush fracture
- • Most VCF are managed conservatively with medication for pain relief and rest.
- Manual therapy and exercise
- Falls prevention, strength based training.
- Bracing
- If complications – surgery – stabilisation.
What is the management for scoliosis?
Non- surgical intervention
- Specific evidence based physical therapy
- SEAS - Scientific Exercises Approach to Scoliosis
- Schroth method
- Bracing – in a curve greater than 250 used with excercises
- Surgery
- Growing rods
Management for Scheuermann’s?
M>F – usually with a family history
Ages 10-15
Presents with stiffness and deformity
Management
- Schroth method
- Physical therapy – including Osteo!!
- Extension sports – gymnastics, swimming
- Bracing
- Surgery – only in very
- severe – curve >800
WHat is the clinical presentation of herpes zoster?
stabbing and burning sensation in the spine
rash to one side or at the face
What is the treatment for herpes zoster?
Antiviral drugs.
