Tspine/Ribs Common Presentations Flashcards
What is a pancoast tumor?
Tumor at apex of lung which can impinge on lower portions of the brachial plexus
Which nerve structures involved in pancoast tumor?
C8 and T1
How would symptom distributions of pancoast tumor look like?
similar to radicular pain/ radiculopathy, thoracic outlet syndrome, peripheral nerve entrapment
What are the symptoms of pancoast tumor?
Chronic cough Bloody sputum Unexplained weight loss Malaise Dyspnea
What are you looking for during physical examination of pancoast tumor?
Fever
Wheezing
Cardiovascular/pulm focus
MI referred pain into what general areas?
Chest and upper back
Pericarditis referred pain into what general areas?
substernal, costal margins, neck/upper trap, down left arm
Pneumothorax referred pain into what general areas?
Upper/lateral thoracic wall
Ipsilateral shoulder
across chest
over abdomen
Pleuritis referred pain into what general areas?
Same side a pleuritic lesion: shoulder, lower chest wall, abdomen
Pleuropulmonary disorders referred pain into what general areas?
substernal/chest pain
Over involved lung fields
Neck/Upper trap
The vert is split into what 3 columns?
- Anterior (vert body)
- Middle (vert body)
- Posterior (posterior compenents)
T/F Osteoporosis is not painful, secondary complications likely painful
True
Vertebral fracture is a predictor for what?
subsequent vertebral fracture (4-5x) and hip fracture (3x)
T/F Vertebral fractures associated with increased mortality.
True, population so heightened risk for comorbidities, other predisposing factors
What are 3 morphological descriptors of thoracolumbar fractures?
- Compression
- Rotation/translation
- Distraction
Why are traditional vert compression fractures considered more stable?
anterior column affected
How will traditional vert compression fractures affect spinal canal?
Still intact
What is the common MOA of traditional compression fractures?
axial loading in flexed position
What are traumatic MOA of traditional compression fractures?
High energy
Osteoporotic
Burst compression fracture will affect what column/s of T vert?
Anterior and middle columns
Burst compression fracture account for what % of all major vertebral body fractures?
15-20%
Burst compression fracture most common at what junction?
T/L
Why might burst compression fractures have potential neural involvement?
fragments may be found in canal
What high force MOA can cause burst compression fractures?
MVC
Falls from heights
High-speed sport injury
Rotation/translation vert fractures are associated with what MOA?
Associated with fall from a height or heavy object falling on body with bent trunk
What direction is displacement of one T/L vert body on another in rotation/translation vert fracture?
Horizontal displacement of one T/L vertebral body on another
T/F In rotation/translation vert fracture facet joints are still intact but dislocated.
True
It’s important to do what type of testing with rotation/translation vert fracture?
Neuro
What are distraction vert fractures?
- Separation in the vertical axis
- Anterior & posterior ligaments, anterior & posterior bony structures, both
T/F Neuro testing for distraction vert fractures in not important.
False, important!
T/F High false positive rates with vertebral fractures, though important not to dismiss
True
4 Red flags for vert fractures?
Older age
Significant trauma
Corticosteroid use
Contusion/ abrasion
Recommendations for 4 clustered findings for vert fractures?
Age > 70 years
Significant trauma
Prolonged corticosteroid use
Sensory alterations from the trunk down
A cluster of findings to aid in identifying the presence of an osteoporotic vertebral compression fracture includes the following:
Age > 52 years No presence of leg pain (just anterior, no effect on neuro) Body mass index = 22 Does not exercise regularly Female gender