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MSK 2 > TS Classification/Diagnoses > Flashcards

TS Classification/Diagnoses Flashcards

1
Q

Arm Pit Pain (Body Chart)

A

T2

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2
Q

Whole Head Pain (Body Chart)

A

T4 Lower Lumbar

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3
Q

Low Back Pain (Body Chart)

A

T9-L2 Facet

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4
Q

Right UQ Pain (Body Chart)

A

T9

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5
Q

Lower Abdominal Pain (Body Chart)

A

T10/12 (Or L4/5)

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6
Q

Groin Pain (Body Chart)

A

T12 (L1)

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7
Q

Non-Radicular Referral

A

CS Facets

Green: C2-3

Purple: C3-4

Blue C4-5

Red: C5-6

Yellow: C6-C7

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8
Q

Non-Radicular Referral

A

Disc

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9
Q

Non-Radicular Referral

A

Generalized Hypomobility
Flattened TS

T4 Syndrome

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10
Q

Non-Radicular Referral

A

Nerve Root

(T2 and T8)

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11
Q

Non-Radicular Referral

A

Left Body:

L Yellow: T4-5

L Orange: T6-7

L Green: T8-9

L Blue: T10-11

R Purple: T3-4

R Green: T5-6

R Orange: T7-8

Plum: T9-10

Right Body:

Orange: T2-3

Blue: T9-10

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12
Q

Non-Radicular Referral

A

T2

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13
Q

Non-Radicular Referral

A

T4

Lower Lumbar

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14
Q

Non-Radicular Referral

A

T9

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15
Q

Non-Radicular Referral

A

T9-L2 Facet Lesions

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16
Q

Non-Radicular Referral

A

T10/12

(or L4/5)

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17
Q

Non-Radicular Referral

A

T12

(or L1)

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18
Q

Body Chart

A

1st Rib

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19
Q
A

Upper Rib/TOS

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20
Q
A

CTJ Pain

(From top to bottom, left then right)

Left T3

Left T5

Left T7

Right T2

Right T4

Right T6

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21
Q

Common pain generators of TS

A

Facet, Nerve, Disc, Rib, Mm

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22
Q

S/Sx Referred Radicular pain

A

Neurologic Tissues:: Sharp, stabbing, severe, burning band along intercostal space

Tumor compressing structures:: signs of cord compression, hyperreflexia, spasticity/clonus, Babinski, altered gait, symptoms of cancer

(Mediastinal tumors; TS common site for metastases)

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23
Q

Viscerogenic Referral

A

GI, Heart, Lungs, Kidneys, Pancreas, Metabolic Disorders

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24
Q

Vasculogenic Referral

A

TOS

(venous congestion/arterial deprivation)

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25
Q

GI Disorders

A
  • Ask if pain is relted to food/eating
  • Colorectal cancer, peptic ulcer dissease, acute cholecystitis, biliary colic, sever esophagitis
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26
Q

Peptic Ulcer Disease

A
  • 5-10 thoracic vertebra
  • periodic symptoms
  • relief with antacids
  • pain/food/meal time relationship
  • Symptoms consistent with anemia (fatigue, SOB on exertino, tachycardia, orthostatic hypotension) if occult bleeding present
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27
Q

Biliary Colic

A

(initial gallstone disease)

  • pn upper right back
  • midback between scapula
  • right interscapular or subscapular areas
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28
Q

Acute Cholecystitis

A
  • (obstruction due to gall stones)
  • right subscapular area
  • increase with movement or respiration
  • low grade fever may be present
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29
Q

Severe Esophagitis

A
  • Burning pain
  • associated with foul taste
  • morning pain, worse after meal
  • epigastric tenderness
  • or subscapular areas
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30
Q

Cardiac Conditions

A
  • pn radiating over left pectoral region, shoulder, medial left arm, right UE, epigastrium, jaw (MI)
  • pts with cardiac Hx and associated S/Sx (weak pulse, extremely high/low BP, unexplained perspiration/pallor, pulsating sensation in abdomen (AAA)
  • Palp abdominal aorta
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31
Q

Pleuropulmonary Conditions

A
  • breathlessness
  • Sx in right upper back (basilar pneumonia)
  • Sx in scapula (emphysema, pleurisy)
  • Sx in ipsilateral scapula (spontaneous pneumothorax)
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32
Q

Kidney Disorders

A
  • pn in posterior lateral thorasic cage and upper lumbar
  • recent or coexisting UTI, enlarged prostate, kidney stone or past kidney stone (pyelonephritis)
  • sudden, severe back/flank pain, chills, fever, N/V, renal colic, Sx of UTI (kidney stones)
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33
Q

Pancreatic Carcinoma

A
  • middle thoracic/lumbar pain
  • pain unrelated to digestive activities
  • S/Sx: jaundice, anorexia, severe weight loss, GI difficulties unrelated to meals
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34
Q

Metabolic Disorders

A
  • decreased calcification of bone
  • Osteoporosis, Diabetes, RA, Herpes Zoster
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35
Q

Osteoporosis

A
  • long term asthmatic have increased risk
  • 50% of all vertebral Fx in TS
  • Cushing’s Disease
  • Paget’s Disease
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36
Q

Diabetes

A
  • Diabetic Thoracic Olyradiculopathy
  • Abdominal pain due to intercostals neuralgia
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37
Q

RA

A
  • can induce discitis
  • source: CVJ
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38
Q

Herpes Zoster

A
  • >70 years old
  • no change with motion
  • intercostal pn
  • dermatomal pattern
  • (shingles)
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39
Q

Handprint pn:

Thumbprint pn:

A

Hand: TS facet/CS facet

Thumbprint: CTJ/IDD/LS Facet

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40
Q

What’s different about T4

A
  • spinal canal smaller than other vertebrae
  • smaller canal to cord ratio
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41
Q

Facet Joint Dysfunction

Location of Sx

A
  • Local (rare) or referred, nonradicular pn
  • unilateral pain (handprint pain)
  • rarely midline
  • Levels overlap
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42
Q

Flattened Upper TS

Location of Sx

A
  • Referred, nonradicular
  • general thoracic ache, several segments
  • bilateral (symmetrical more common)
  • associated with intractable head, neck, shoulder girdle, arm and rib joint pn
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43
Q

T4 Syndrome

Location of Sx

A
  • referred nonradicular
  • glove-like
  • nocturnal symptoms in sidelying or supine
  • pn in axilla
  • paresthesia in T1, T2 dermatomes
  • headache when sympathetic system increased
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44
Q

General Hypomobility

Location of Sx

A
  • Referred, nonradicular
  • general thoracic ache, several segments
  • bilateral (symmetrical more common)
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45
Q

Disc

Location of Sx

A
  • Referred, nonradicular
  • IDD/ProT, ProL (posterolateral): band-form pain, unilateral, nonradicular
  • Prot/ProL: (Central): severe central and radicular pn
  • more common in lower levels (T6-10)
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46
Q

Nerve Root

Location of Sx

A
  • Radicular: sharp, stabbing, severe, burning
  • referred band along intercostal space
  • T1 & T2: may have N/T, weakness in hand, pn in medial arm, forearm
  • T2 & T3: rare

T3-T8: unilateral/posterior pn, or front of trunk

-T9-T11: pn radiating to buttock

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47
Q

Facet Joint Dysfunction

Agg Factors

A

Pain with 3D movements

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48
Q

Flattened upper TS

Agg Factors

A
  • Pn with loaded extension postures
  • may have difficulty with flexion postures (unable to reverse curve)
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49
Q

General Hypomobility

Agg Factors

A
  • Pulling/pushing activities
  • sustained position
  • sustained flex/ext, twisting or deep breathing
  • CVJ: localized pn by coughing, sneezing or deep inspiration
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50
Q

T4 Syndrome

Agg Factors

A

Pulling and reaching activities

51
Q

Disc

Agg Factors

A
  • pn worse with prolonged sitting and physical labor
  • pn with rotation>flexion/extension
  • not worse with 3D movements
  • not worse at night
52
Q

Facet Joint Dysfunction

History

A

-gradual vs sudden

53
Q

Flattened Upper TS

History

A
  • Gradual vs sudden
  • long history of mid-back pain
54
Q

General Hypomobility

History

A
  • work Hx of prolonged positions (typing, computer, surgeon)
  • Upper: thoracic region stiffness, hardened and forward curved. Upper rib joints typically fixed. Limited UE movment. Mm imbalances present
55
Q

T4 Syndrome

History

A
  • unknown etiology
  • possibly due to sympathetic reaction to hypomobile segment
  • more in women than men (3:1)
56
Q

Disc

History

A
  • gradual onset/degenerative changes in disc
  • high velocity macrotrauma
  • Axial load: disc lesion/compression fracture
  • Rotatory: disc vs rib fracture
57
Q

Facet Joint Dysfunction

Observation

A
  • flatt vs increased kyphosis
  • increased curve in CTJ
58
Q

Flattened Upper TS

Observation

A
  • reduced TS kyphosis
  • resistant to treatment, hard to change contour of spine
59
Q

General Hypomobility

Observation

A

Increased TS kyphosis

60
Q

T4 Syndrome

Observation

A

-forward head, accentuated TS kyphosis, protracted shoulder girdle

61
Q

Disc

Observation

A

increased TS kyphosis

62
Q

Facet Joint Dysfunction

Neurodynamic Testing

&

Neuro Exam

A

Negative

Negative

63
Q

Flattened Upper TS

Neurodynamic Testing

&

Neuro Exam

A

-Negative

negative

64
Q

General Hypomobility

Neurodynamic Testing

&

Neuro Exam

A

+/- thoracic slump test

negative

65
Q

T4 Syndrome

Neurodynamic Testing

&

Neuro Exam

A

+thoracic slump test and ULNT1

negative

66
Q

Disc

Neurodynamic Testing

&

Neuro Exam

A

+ thoracic slump test

nerve root involvement rare (horizontal path of nerve), if nerve involved=large disc protrusion

67
Q

Nerve Root

Neurodynamic Testing

&

Neuro Exam

A

+Thoracic slump test

Sensation findings

Beevor’s Sign

68
Q

Beevor’s Sign

A
  • characteristic sign of SCI betweent T10 and T12
  • umbilicus is pulled upward with trunk flexion
  • upper abdominals intact but lower not so contraction pulls umbilicus upward
  • also seen in ALS
69
Q

Facet Joint Dysfunction

ROM

A

pn/restriction in 3D movements

70
Q

Flattened Upper TS

ROM

A
  • Depends on pn generator (disc, facet, rib)
  • Typically flexion restriction
  • 3D restriction if facet
  • 1D restriction if disc
71
Q

General Hypomobility

ROM

A
  • depends on pain generator (disc, facet, rib)
  • Limited UE movements
72
Q

T4 Syndrome

ROM

A
  • Gross cervical and thoracic motions usually normal
  • depends on pain generator (disc, facet, rib)
73
Q

Disc

ROM

A
  • TS Rotation most comparable sign followed by flexion and extension
  • Flexion: flexion + Expiration: increases pn
  • Extension: ext + inspiration increases pn
74
Q

Facet Joint dysfunction

Special Tests

A

Loss of motion and pn with 3d movements

75
Q

Flattened Upper TS

Special Tests

A

loss of motion with 2D/3d movement tests

76
Q

General Hypomobility

Special Tests

A

loss of motion and pn with 2d/3d movements tests

77
Q

T4 Syndrome

Special Tests

A
  • hypermobility (most common at C6-7)
  • stiffness in adjacent segments (T1-4)
78
Q

Disc

Special Tests

A

ProT/ProL (central): positive breathing, can have positive cord signs

79
Q

Flattened Upper TS

Palpation

A

C7-T1 segments stiff with variable mobility in flattened section of spine

80
Q

General Hypomobility

Palpation

A

Stiff TS segments

Ribs stiff

81
Q

T4 Syndrome

Palpation

A
  • Local tenderness
  • local thickening and stiffness of one segment
82
Q

Muscle Length/Strength

A

positional length/strength of lower trap, serratus, middle trap

-flexibiity of pec minor/major, lats, rhomboids, upper traps, levator

83
Q

Physical Outcome Measures

A
  • Oswestry Low Back Disability Questionnaire
  • Neck Disability Index
  • McGill Pain Questionnaire
84
Q

Upper Rib Dysfunction

Location of Sx

A

UE Sx of N/T, pn or vascular Sx

85
Q

Upper Rib Dysfunction

A

1st & 2nd Rib

Includes: Costal joint derangement (CTJ vs CVJ), Synovitis (costochondral/costosternal), costal arch syndrome (slipped rib tip)

86
Q

Muscular Condition

Location of Sx

A

Local pn/tenderness

87
Q

Scoliosis

Location of Sx

A

asymptomatic unless injury

88
Q

Upper Rib Dysf

Agg Factors

A
  • pn with deep breathing/cough, arm elevation
  • Synovitis: pn with deep breathing, trunk rotation, sneezing coughing
89
Q

Scoliosis

Agg Factors

A

-depends on structure at fault within the context of all health conditions of the TS

90
Q

Upper Rib Dysf

History

A
  • Gradual or sudden onset
  • 1st Rib: typically a mouth breather
91
Q

Scoliosis

History

A

Static (structural): caused by hemivertebrae, osteoporosis, osteomalacia or compression fractures/genetic, congenital/idiopathic

Sciatic: caused by sciatic pain by a lumbar disc herniation

Idiopathic: present since childhood

92
Q

Upper Rib Dysf

Observation

A

-elevated upper trap due to elevated 1st rib, vs upper trap tightness

93
Q

Muscular condition

Observation

A

-spasm, Mm guarding, tightness, atrophy

94
Q

Scoliosis

Observation

A

-adaptive shortening of intrinsic trunk Mm on concave side and lengthining on convex side

95
Q

Upper Rib Dysf

Neurodynamic

Neuro Exam

A

+/- T Slump test/ULNT1

negative

96
Q

Muscular Condition

Neurodynamic

Neuro Exam

A

Negative

negative

97
Q

Scoliosis

Neurodynamic

Neuro Exam

A

+/- T Slump test/ULNT1

Negative

98
Q

Upper Rib Syndrome

ROM

A

TS SB most comparable

+Breathing:

TS flexion, increase pn with inspiration

SB toward pn, increase pn with inspiration

99
Q

Muscular Condition

ROM

A

Pn with passive stretch

100
Q

Scoliosis

ROM

A

depends on structures involved

101
Q

Upper Rib Dysf

Special Tests

A

Upper Rib: positive TOS special tests

pn with positional testing and spring testing

102
Q

Muscular Condition

Special tests

A

pn with resisted motion

103
Q

Upper Rib Dysf

Palpation

A

1st rib: stiff, elevated (or 2nd rib)

Tietze’s Syndrome: localized swelling of costochondral cartilage

-stiffness with rib mobility testing. Pn/stiff with palpation (unilateral PA pressure) of CTJ joint

104
Q

Scoliosis

Palpation

A
  • depends on direction of curve
  • vert bodies rotate toward convex side with SP toward concave side
  • ris on convex side more post rotated (creates rib hump)
  • ribs on concave side rotated ant
105
Q

Pain generators for general hypomobility

Upper TS:

Mid TS:

Lower TS:

A

Upper TS: rib>zaj>disc

Mid TS: disc>zaj>rib

Lower TS: disc>rib>zaj

106
Q

Schmorl’s Nodes

A
  • herniation of disc substance through endplate of adjacent vertebra
  • Acute: axial load (motorcyclists, falling off ladder, jumping from height; common T8-T12)
  • Chronic: associated with jumping sports (gymnasts, wrestling); can give rise to early disc degeneration
107
Q

Scheuermann’s disease

A
  • typically in pubescent athletes (12-18 yo)
  • flexion overload of ant vert body
  • >30* flexion
  • defect to the ring apophysis of vert body and anterior wedging
  • end plate can crack leading to Schmorl’s node
  • thoracic kyphosis with pn in extension/rotation
108
Q

Scheuermann Disease Intervention

A
  • bracing
  • postural training
  • strengthening trunk extensors, shoulder ER, neck extensors
  • surgery fro curves >75*
109
Q

Spondylodiscitis

A
  • Inflammation of disc
  • 4-5 yo (due to sepsis)/14-19 yo and >50yo
  • central thoracic pain with capsular pattern
  • pn radiation into LE and or laterally
  • positive percussion and or heel drop
  • positive MRI or CT
  • Management: bedrest/antibiotic
110
Q

TOS

A
  • Compression syndrome involving subclavian artery/vein and/or brachial plexus from neck to axilla
  • vascular (rare) vs neurogenic
111
Q

Scheuermann’s Disease

Profile

A

-12-18 yo

112
Q

CVJ/CTJ Derangement

Profile

A

>55 yo

113
Q

CVJ vs CTJ

(Costal Joint derangement)

A
  • >55yo
  • initial Dx: renal colic, PE, spinal tumor, GI, pleurisy bc of Sx location (chest, abdomen, flank, paravertebral thoracic)
  • improvement after local injection
  • ankylosing spondylitis: CVJ synovitis
114
Q

Tietze’s Syndrome

Profile

A

20-45 yo

115
Q

Tietze’s Syndrome

A
  • Costochondritis
  • inflam of costochondral cartilage (2nd/3rd costochondral junctions)
  • gradual/sudden
  • increased pn with deep inspiration, cough, sneeze
  • local swelling of costosternal cartilage
  • linked to excessive UE movement pulling on rigid upper ribs
  • intervention: injection, transverse friction to costochondral junction, rib/upper TS mobs
116
Q

Costal Arch Syndrome

A
  • “slipped rib tip”
  • subluxation of interchondral joints between lower costal cartilatges may trap intercostal nerves (causing referred abdominal pain)
  • intervention: injection, postural management
117
Q

Dysfunction at manubriosternal Junction

profile

A

15-20 yo

118
Q

Dysfunction at manubriosternal junction

A

due to AS, Rieters (bladder dysf), psoriasis

119
Q

TS Vertebral Fractures

A
  • hyperflexion or axial loading
  • common: ant wedge Fx or burst Fx
  • most: 9th and 11th vert bodies
  • Tx: bed rest, return to activity
120
Q

Compression Fx

A
  • High velocity macrotrauma
  • due to osteoporosis
  • extension limitation
121
Q

End Plate Fx

A

Non-capsular pattern

younger population

Sx resolve spontaneously

122
Q

Costal Joint Derangement

Location of Sx

A

-localized pn 3-5cm from midline where rib articulates with TP and vertebral body

123
Q

Costochondral/Costosternal Dysfunction

Location of Sx

A

local unilateral/anterior pn

124
Q

Costal Arch Syndrome

Location of Sx

A

vague epigastric pn

increased pn after eating

sitting

cannot lean against lower rib cage

MSK 2 (16 decks)

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