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Tspine/Ribs Common Presentations Flashcards

1
Q

What is a pancoast tumor?

A

Tumor at apex of lung which can impinge on lower portions of the brachial plexus

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2
Q

Which nerve structures involved in pancoast tumor?

A

C8 and T1

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3
Q

How would symptom distributions of pancoast tumor look like?

A

similar to radicular pain/ radiculopathy, thoracic outlet syndrome, peripheral nerve entrapment

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4
Q

What are the symptoms of pancoast tumor?

A 
Chronic cough
Bloody sputum
Unexplained weight loss
Malaise
Dyspnea
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5
Q

What are you looking for during physical examination of pancoast tumor?

A

Fever
Wheezing
Cardiovascular/pulm focus

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6
Q

MI referred pain into what general areas?

A

Chest and upper back

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7
Q

Pericarditis referred pain into what general areas?

A

substernal, costal margins, neck/upper trap, down left arm

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8
Q

Pneumothorax referred pain into what general areas?

A

Upper/lateral thoracic wall
Ipsilateral shoulder
across chest
over abdomen

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9
Q

Pleuritis referred pain into what general areas?

A

Same side a pleuritic lesion: shoulder, lower chest wall, abdomen

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10
Q

Pleuropulmonary disorders referred pain into what general areas?

A

substernal/chest pain
Over involved lung fields
Neck/Upper trap

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11
Q

The vert is split into what 3 columns?

A
  1. Anterior (vert body)
  2. Middle (vert body)
  3. Posterior (posterior compenents)
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12
Q

T/F Osteoporosis is not painful, secondary complications likely painful

A

True

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13
Q

Vertebral fracture is a predictor for what?

A

subsequent vertebral fracture (4-5x) and hip fracture (3x)

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14
Q

T/F Vertebral fractures associated with increased mortality.

A

True, population so heightened risk for comorbidities, other predisposing factors

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15
Q

What are 3 morphological descriptors of thoracolumbar fractures?

A
  1. Compression
  2. Rotation/translation
  3. Distraction
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16
Q

Why are traditional vert compression fractures considered more stable?

A

anterior column affected

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17
Q

How will traditional vert compression fractures affect spinal canal?

A

Still intact

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18
Q

What is the common MOA of traditional compression fractures?

A

axial loading in flexed position

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19
Q

What are traumatic MOA of traditional compression fractures?

A

High energy

Osteoporotic

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20
Q

Burst compression fracture will affect what column/s of T vert?

A

Anterior and middle columns

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21
Q

Burst compression fracture account for what % of all major vertebral body fractures?

A

15-20%

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22
Q

Burst compression fracture most common at what junction?

A

T/L

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23
Q

Why might burst compression fractures have potential neural involvement?

A

fragments may be found in canal

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24
Q

What high force MOA can cause burst compression fractures?

A

MVC
Falls from heights
High-speed sport injury

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25
Rotation/translation vert fractures are associated with what MOA?
Associated with fall from a height or heavy object falling on body with bent trunk
26
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
27
T/F In rotation/translation vert fracture facet joints are still intact but dislocated.
True
28
It's important to do what type of testing with rotation/translation vert fracture?
Neuro
29
What are distraction vert fractures?
- Separation in the vertical axis | - Anterior & posterior ligaments, anterior & posterior bony structures, both
30
T/F Neuro testing for distraction vert fractures in not important.
False, important!
31
T/F High false positive rates with vertebral fractures, though important not to dismiss
True
32
4 Red flags for vert fractures?
Older age Significant trauma Corticosteroid use Contusion/ abrasion
33
Recommendations for 4 clustered findings for vert fractures?
Age > 70 years Significant trauma Prolonged corticosteroid use Sensory alterations from the trunk down
34
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 ```
35
If <2/5 for cluster for identifying osteoporotic vertebral compression fracture, is it a good -LR?
Yes, 0.16
36
If 4/5 for cluster for identifying osteoporotic vertebral compression fracture, is it a good +LR?
Okay, 9.6
37
What concerns with rib fractures?
1. Brachial plexus/ vascular structures (3-15% of upper rib fractures associated with this) 2. Laceration of pleura, lungs, abdominal organs
38
Many simple rib fractures become stable in about how many weeks?
6
39
Symptomology of rib fractures?
- Focal pain, radiating pain - Pain with inspiration - Pain with coughing/ sneezing
40
Physical examination of rib fractures?
- Focal tenderness | - Possible palpable defect
41
What is scheuermann's disease?
Defective growth of vertebral endplate due to poor diffusion of nutrients to un-vascularized disc
42
What is the proposed etiology of scheuermann's disease?
- Genetics | - Excessive stress on pre-disposed (weak) endplate
43
Increase risk of scheuermann's disease among what groups?
- Manual workers who begin at early age - High intensity athletes? - High BMI? - “Short sternum”?
44
Criteria for diagnosis of scheuermann's disease includes what 3 things?
1. Thoracic kyphosis > 45 deg 2. Wedging x 3 adjacent vertebrae > 5 deg  3. Thoracolumbar kyphosis > 30 deg
45
Symptomology of scheuermann's disease?
Thoracic pain, commonly apex of curvature (muscular tension, IV disc bulging/ spondylosis)
46
Physical examination of scheuermann's disease?
- Scoliosis (15% and 20%) - Excessive thoracic kyphosis - Compensatory hyperlordosis, rounded shoulders/ forward head, pelvic rotation - Vertebral wedging, Schmorl’s nodes (16-48%), disc space narrowing - Limited thoracic ROM - Neurologic Complications (less common)
47
Costochondritis involves how many rib/s?
>/= 1 rib
48
Proposed pathophys of Costochondritis?
Repetitive stress
49
T/F Costochondritis usually resolves within a year.
True
50
Symptomology of Costochondritis:
- Pain and local tenderness at costochondral or chondrosternal articulations 1. At rest 2. Trunk movement 3. Respiration
51
Physical examination of Costochondritis:
1. Local tenderness | 2. Painful with Chondrosternal joint mobility testing
52
Disc disease is more common in...
Lowe t-spine (75% T8-T12)
53
Potential neurologic involvement can be what two types depending on where disc disease is?
Radicular | Myelopathy
54
Disc disease symptomology:
1. Back or chest pain - Radicular: band-like pain in affected level’s dermatome, paresthesia/ anesthesia, leg pain - Back pain at midline 2. Progressive/ insidious (months to years)
55
Disc disease Physical examination:
If myelopathy, myelopathic examination
56
Related health conditions with Tspine myelopathy?
Compression Frx | Stenosis
57
Symptomatology of Tspine myelopathy:
(cauda equina symptoms) Sexual dysfunction Bowel and bladder dysfunction
58
Physical examination of Tspine myelopathy:
Sensory/ motor impairments UMN signs Hyperreflexia
59
What is intercostal neuralgia caused by?
- Infection (ex: varicella zoster | - Mechanical Compression (disc protrusion, osteophyte complex, neuroma, Frx)
60
Symptomology of intercostal neuralgia:
Burning pain/ Paresthesia along intercostal nerve path (from back to chest)
61
Physical examination of intercostal neuralgia:
Focal tenderness of intercostal area
62
T4 syndrome is seen women (>/=) men
women > men (4:1)
63
T/F Etiology of T4 syndrome is unknown.
True, Theory: sympathetic reaction with hypomobile segment
64
T4 syndrome can affect what segments?
T2-T7
65
Primary pain generators in T4 syndrome?
1. Thoracic IV disks | 2. Thoracic zygapophyseal joints
66
Symptomology of T4 syndrome:
1. Glove-like paresthesias unilateral/ bilateral UEs 2. Neck/ scapular/ bilateral upper extremity pain (constant or intermittent) - Worsens with side-lying or supine positioning 3. Generalized headache
67
Physical examination of T4 syndrome:
1. Tender spinous process 2. + Thoracic Slump Test 3. + Upper Quarter Neurodynamic Tension Tests 4. Hypomobile thoracic segment
68
Etiology of scoliosis?
Congenital or acquired 1. Adolescent idiopathic scoliosis (congenital or neuromuscular) 2. Degenerative scoliosis (up to 68% of adults >70 y/o)
69
How is scoliosis named?
For it's convexity and segments
70
T/F Zygapophyseal arthropathy can be degenerative or traumatic in nature.
True
71
If there is unilateral Zygapophyseal arthropathy degeneration, where will the referred pain be?
Unilateral
72
Symptomology of Zygapophyseal arthropathy:
Local and/or referred pain
73
Physical examination of Zygapophyseal arthropathy:
1. Painful movement with closing of z-joints (AROM/ PROM) 2. Painful spring testing 3. Hypomobility with joint mobility testing
74
What is structural rib dysfunction?
subluxation of joint (anterior or posterior)
75
What is torsional rib dysfunction?
Rib held in rotated position
76
What is respiratory rib dysfunction?
related to posture, may affect respiration
77
Symptomology of rib dysfunction:
Aggravated with deep inspiration, trunk rotation, sneezing/ coughing
78
Physical examination of ryb dysfunction:
1. Diminished rib mobility (structural) 2. Pain/ hypomobility with joint mobility testing 3. Limited/ painful thoracic spine motion
79
What is thoracic outlet syndrome?
Upper extremity symptoms due to compression of the neurovascular bundle by various structures in the area just above the first rib and behind the clavicle
80
Thoracic outlet syndrome can be compression of what 3 structures?
1. Subclavian artery (ATOS) 2. Subclavian vein (VTOS) 3. Brachial plexus (NTOS): 90-95% of TOS
81
Potential areas for compression in thoracic outlet syndrome:
1. Scalenes 2. Cervical rib 3. Pec minor 4. First rib - Hypertonic scalenes 5. Clavicle
82
Clinical presentation/hx of thoracic outlet syndrome:
1. Hx neck trauma 2. Cervical rib (incidence < 1% of population) 3. Raynaud’s phenomenon (decrease blood flow to extremities)
83
symptomology of thoracic outlet syndrome:
1. UE pain, paresthesia, anesthesia/ weakness (Glove-like vs. particular distribution consistent with area of compression) 2. Chest/ anterior shoulder pain 3. Typically progressive/ insidious onset
84
Physical examination of thoracic outlet syndrome: Guarding - Provocation - (2)
1. Guarding of cervicothoracic/ scapulothoracic musculature 2. Provocation with contralateral cervical lateral flexion (and/ or combined rotation) 3. Provocation with stretching any compressive musculature (pec stretch)
85
Physical examination of thoracic outlet syndrome: | Vascular -
edema, cyanosis, coldness of hand, and diminished pulses
86
Physical examination of thoracic outlet syndrome: | Neurologic -
characteristic C8/T1 distribution LMN signs, possibly atrophy abductor pollicis brevis
87
Physical examination of thoracic outlet syndrome: | Potentially positive special tests -
- Roo’s Test - Hyperabduction Test - Adison’s Test - Cervical Rotation Lateral Flexion Test: Restricted 1st Rib - First Rib Spring Test: Restricted 1st Rib

MSK (18 decks)

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