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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
Q

Rotation/translation vert fractures are associated with what MOA?

A

Associated with fall from a height or heavy object falling on body with bent trunk

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26
Q

What direction is displacement of one T/L vert body on another in rotation/translation vert fracture?

A

Horizontal displacement of one T/L vertebral body on another

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27
Q

T/F In rotation/translation vert fracture facet joints are still intact but dislocated.

A

True

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28
Q

It’s important to do what type of testing with rotation/translation vert fracture?

A

Neuro

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29
Q

What are distraction vert fractures?

A
  • Separation in the vertical axis

- Anterior & posterior ligaments, anterior & posterior bony structures, both

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30
Q

T/F Neuro testing for distraction vert fractures in not important.

A

False, important!

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31
Q

T/F High false positive rates with vertebral fractures, though important not to dismiss

A

True

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32
Q

4 Red flags for vert fractures?

A

Older age
Significant trauma
Corticosteroid use
Contusion/ abrasion

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33
Q

Recommendations for 4 clustered findings for vert fractures?

A

Age > 70 years
Significant trauma
Prolonged corticosteroid use
Sensory alterations from the trunk down

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34
Q

A cluster of findings to aid in identifying the presence of an osteoporotic vertebral compression fracture includes the following:

A 
Age > 52 years
No presence of leg pain (just anterior, no effect on neuro)
Body mass index = 22
Does not exercise regularly
Female gender
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35
Q

If <2/5 for cluster for identifying osteoporotic vertebral compression fracture, is it a good -LR?

36
Q

If 4/5 for cluster for identifying osteoporotic vertebral compression fracture, is it a good +LR?

37
Q

What concerns with rib fractures?

A
  1. Brachial plexus/ vascular structures (3-15% of upper rib fractures associated with this)
  2. Laceration of pleura, lungs, abdominal organs
38
Q

Many simple rib fractures become stable in about how many weeks?

39
Q

Symptomology of rib fractures?

A
  • Focal pain, radiating pain
  • Pain with inspiration
  • Pain with coughing/ sneezing
40
Q

Physical examination of rib fractures?

A
  • Focal tenderness

- Possible palpable defect

41
Q

What is scheuermann’s disease?

A

Defective growth of vertebral endplate due to poor diffusion of nutrients to un-vascularized disc

42
Q

What is the proposed etiology of scheuermann’s disease?

A
  • Genetics

- Excessive stress on pre-disposed (weak) endplate

43
Q

Increase risk of scheuermann’s disease among what groups?

A
  • Manual workers who begin at early age
  • High intensity athletes?
  • High BMI?
  • “Short sternum”?
44
Q

Criteria for diagnosis of scheuermann’s disease includes what 3 things?

A
  1. Thoracic kyphosis > 45 deg
  2. Wedging x 3 adjacent vertebrae > 5 deg
  3. Thoracolumbar kyphosis > 30 deg
45
Q

Symptomology of scheuermann’s disease?

A

Thoracic pain, commonly apex of curvature (muscular tension, IV disc bulging/ spondylosis)

46
Q

Physical examination of scheuermann’s disease?

A
  • 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
Q

Costochondritis involves how many rib/s?

A

> /= 1 rib

48
Q

Proposed pathophys of Costochondritis?

A

Repetitive stress

49
Q

T/F Costochondritis usually resolves within a year.

50
Q

Symptomology of Costochondritis:

A
  • Pain and local tenderness at costochondral or chondrosternal articulations
    1. At rest
    2. Trunk movement
    3. Respiration
51
Q

Physical examination of Costochondritis:

A
  1. Local tenderness

2. Painful with Chondrosternal joint mobility testing

52
Q

Disc disease is more common in…

A

Lowe t-spine (75% T8-T12)

53
Q

Potential neurologic involvement can be what two types depending on where disc disease is?

A

Radicular

Myelopathy

54
Q

Disc disease symptomology:

A
  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
Q

Disc disease Physical examination:

A

If myelopathy, myelopathic examination

56
Q

Related health conditions with Tspine myelopathy?

A

Compression Frx

Stenosis

57
Q

Symptomatology of Tspine myelopathy:

A

(cauda equina symptoms)
Sexual dysfunction
Bowel and bladder dysfunction

58
Q

Physical examination of Tspine myelopathy:

A

Sensory/ motor impairments
UMN signs
Hyperreflexia

59
Q

What is intercostal neuralgia caused by?

A
  • Infection (ex: varicella zoster

- Mechanical Compression (disc protrusion, osteophyte complex, neuroma, Frx)

60
Q

Symptomology of intercostal neuralgia:

A

Burning pain/ Paresthesia along intercostal nerve path (from back to chest)

61
Q

Physical examination of intercostal neuralgia:

A

Focal tenderness of intercostal area

62
Q

T4 syndrome is seen women (>/=) men

A

women > men (4:1)

63
Q

T/F Etiology of T4 syndrome is unknown.

A

True, Theory: sympathetic reaction with hypomobile segment

64
Q

T4 syndrome can affect what segments?

65
Q

Primary pain generators in T4 syndrome?

A
  1. Thoracic IV disks

2. Thoracic zygapophyseal joints

66
Q

Symptomology of T4 syndrome:

A
  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
Q

Physical examination of T4 syndrome:

A
  1. Tender spinous process
    • Thoracic Slump Test
    • Upper Quarter Neurodynamic Tension Tests
  4. Hypomobile thoracic segment
68
Q

Etiology of scoliosis?

A

Congenital or acquired

  1. Adolescent idiopathic scoliosis (congenital or neuromuscular)
  2. Degenerative scoliosis (up to 68% of adults >70 y/o)
69
Q

How is scoliosis named?

A

For it’s convexity and segments

70
Q

T/F Zygapophyseal arthropathy can be degenerative or traumatic in nature.

71
Q

If there is unilateral Zygapophyseal arthropathy degeneration, where will the referred pain be?

A

Unilateral

72
Q

Symptomology of Zygapophyseal arthropathy:

A

Local and/or referred pain

73
Q

Physical examination of Zygapophyseal arthropathy:

A
  1. Painful movement with closing of z-joints (AROM/ PROM)
  2. Painful spring testing
  3. Hypomobility with joint mobility testing
74
Q

What is structural rib dysfunction?

A

subluxation of joint (anterior or posterior)

75
Q

What is torsional rib dysfunction?

A

Rib held in rotated position

76
Q

What is respiratory rib dysfunction?

A

related to posture, may affect respiration

77
Q

Symptomology of rib dysfunction:

A

Aggravated with deep inspiration, trunk rotation, sneezing/ coughing

78
Q

Physical examination of ryb dysfunction:

A
  1. Diminished rib mobility (structural)
  2. Pain/ hypomobility with joint mobility testing
  3. Limited/ painful thoracic spine motion
79
Q

What is thoracic outlet syndrome?

A

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
Q

Thoracic outlet syndrome can be compression of what 3 structures?

A
  1. Subclavian artery (ATOS)
  2. Subclavian vein (VTOS)
  3. Brachial plexus (NTOS): 90-95% of TOS
81
Q

Potential areas for compression in thoracic outlet syndrome:

A
  1. Scalenes
  2. Cervical rib
  3. Pec minor
  4. First rib
    - Hypertonic scalenes
  5. Clavicle
82
Q

Clinical presentation/hx of thoracic outlet syndrome:

A
  1. Hx neck trauma
  2. Cervical rib (incidence < 1% of population)
  3. Raynaud’s phenomenon (decrease blood flow to extremities)
83
Q

symptomology of thoracic outlet syndrome:

A
  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
Q

Physical examination of thoracic outlet syndrome:
Guarding -
Provocation - (2)

A
  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
Q

Physical examination of thoracic outlet syndrome:

Vascular -

A

edema, cyanosis, coldness of hand, and diminished pulses

86
Q

Physical examination of thoracic outlet syndrome:

Neurologic -

A

characteristic C8/T1 distribution LMN signs, possibly atrophy abductor pollicis brevis

87
Q

Physical examination of thoracic outlet syndrome:

Potentially positive special tests -

A
  • 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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