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518 Spine > L18 Thoracic Disorders > Flashcards

L18 Thoracic Disorders Flashcards

(54 cards)

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1
Q

where do most thoracic spine fractures occur?

A

lower thoracic spine
70% at TL junction

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2
Q

anterior wedge compression fracture moi

A

hyperflexion
axial load
fall or MVA, can be minor in pt w bone compromise like older pt

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3
Q

burst fracture moi

A

axial load from fall landing on bottom or LE

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4
Q

thrust/manip in pt with OP?

A

contraindication to T/S and ribcage in prone or supine
precaution in seated, consider degree of OP

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5
Q

diagnosing OP

A

need two area of altered bone mineral density w a DEXA scan
commonly hip, back, arm

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6
Q

T scores of osteoporosis

A

normal - within 1 SD of normal
osteopenia - 1-2.5 SD below normal adult
osteoporosis - 2.5 SD+ below normal adult
severe - 2.5 or more below normal adult

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7
Q

OP risk factors

A

alcohol
smoking
weight - low BMI
coexisting disease
drug treatment

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8
Q

How can PT intervention help OP?

A

exercise to build bone or decrease loss
proper posture
improve balance to reduce fall risk
provide weight bearing and resistance at appropriate level for pt
30 min daily weight bearing exercise
strength 2-3x week
balance/posture: daily

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9
Q

prevent wedge/compression fracture

A

promote spinal extension
discourage sleeping w multiple pillows in flexion
sustain erect posture
log roll to minimize flexor moment
walking
weight bearing
spinal brace pain

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10
Q

resistance training: important muscle groups

A

hip abduction
hip extension
quads
back extensors
shoulder musculature

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11
Q

activities to avoid in OP pts

A

avoid twisting, forward bending, sit ups, posterior pelvic tilt
heavy lifting, poor posture, sedentary

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12
Q

expected benefit of PT on OP

A

small if any effect on gaining bone mass (1-2%), prevent bone loss
reducing muscle mass loss
may reduce fall risk by improving strength/balance
decrease hip fx risk

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13
Q

scoliosis definition

A

3d deformity in sagittal, coronal, and transverse planes
>10 degrees lateral deformity
multiple planes due to coupled motion

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14
Q

types of idiopathic scoliosis

A

infantile, juvenile, adolescent, or adult
causes include familial, hormonal changes, change in cell structure

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15
Q

known etiologies of scoliosis

A

congenital: asymmetrical vertebral growth
geneitc: marfan’s, connective tissue disorder
neuromuscular: CNS like syrinx, chiari, spina bifida
neuropathic
tumor
trauma

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16
Q

how to name a scoliosis curve

A

name by convexity - whichever side it curves towards
part of spine - t/s, l/s, TL
name apex of curve - segment level
dextro = right, levo = left

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17
Q

shapes of scoliosis curves

A

C curve
S curve

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18
Q

angle of scoliosis is called

A

cobb measurement

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19
Q

scoliosis prevalence - population

A

2-3% have >10 degree curve
right curve more common
C curve more common
males more commonly get infantile/juvenile
females get adolescent

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20
Q

what structures are affected in scoliosis

A

vertebrae are wedge shaped
poorly developed concave side
rotated pedicles
wedge shaped disc
spinous process deviates
rib pushed postioer and narrower on convex side

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21
Q

structural vs non structural scoliosis

A

structural: spine has lateral curvature and rotation
non structural: spine has lateral curve but not due to structural abnormality, but habit or disease process

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22
Q

correcting non structural scoliosis

Study These Flashcards
A

forward or side bending
disappears in supine/prone
muscle contraction
positional changes to spinal or pelvic alignment
correction of leg length discrepancy

23
Q

causes of non structural scoliosis

Study These Flashcards
A

postural
compensatory - leg length
sciatic
inflammatory
hysterical

24
Q

king’s classification

Study These Flashcards
A

double curve crossing midline
l/s or t/s could be larger
t/s crossing midline, lumbar curve not crossing midline
long thoracic curve w L5 centered over sacrum and L4 tilting
t/s with T1 tilting to upper curve

25
s/s of scoliosis
back pain leg length discrepancy abnormal gait uneven hips clothes not fitting correctly one shoulder higher than other
26
findings on physical exam of scoliosis
uneven shoulder height 1 prominent shoulder bladder increased space between arm and body uneven hips one breast larger than other chest/rib prominence one leg longer than other appearance of leaning
27
adam's test
bend forward and assess for spinal alignment and rib hump pt puts their hands together with feet together can measure angle here
28
pathophys based on cobb angle
10: normal curve 25+ echo evidence of pulm artery pressure 40+ surgical intervention 65+ restrictive lung disease 100+ dyspnea on exertion 120+ alveolar hypoventilation
29
treatment: observation, is appropriate for what angles?
<20 degrees with monitoring every 6 mo
30
bracing is appropriate treatment for what degrees?
25-40 control progression but don't reverse must be used in children who are growing
31
types of scoliosis bracing
milwaukee brace - up to c spine, sits on pelvix boston brace - most common charleston brace - bending brace
32
success rate of correctly worn braces
74%
33
boston brace
worn 16-23 hours a day prevent curve progression to avoid surgery
34
milwaukee brace
indicated for scoliosis or schuermann disease to stop curve progression worn 23 hours a day in growing children
35
charleston brace
over corrects a curve by bending to the other side for small lumbar or small TL curve worn only while sleeping 8-10 hours single curve
36
providence brace
best for single curves less effective worn 8-10 hours at night
37
surgery is best option for what scoliosis
best option for severe curves fuse vertebrae and address risk to lung and heart function
38
indications for surgery scoliosis
spinal curves >45 trunk deformity pain deteriorating cardiopulm function family history of severe scoliosis cosmetic appearance
39
goals of surgery for scoliosis
correct curve prevent progression relief of back pain maintain posture prevent cardiopulm dysfunction
40
surgical options for scoliosis
spinal fusion: posterior, anterior, thoracoscopic spinal intrumentation without fusion
41
crank shaft phenomenon
progression and rotation of curve due to growth of anterior part of spine and fused posterior part
42
ther ex for scoliosis
symmetrical exercises - strengthen back and abs breathing asymmetrical exercise - lengthen shortened muscles, strengthen lengthened muscles static body weight hanging/traction to release spinal tension
43
PT intervention for scoliosis can include
derotation exercise QP exercise breathing balance aerobic education on posture
44
schuermann kyphosis
hyperkyphosis/hyperflexion of t/s due to shape of vertebrae being wedged forward anterior wedging with possible end plate cracking
45
schuermann disease population
pubescent athletes male and female
46
schuermann disease presentation
pain w extension and rotation or movements correcting curve pain w PA
47
schuermann disease treatment
postural reed mod aggravating activity regain motion bracing stretching pecs strengthening t/s extensors and scap retractors
48
T4 syndrome
upper thoracic syndrome pattern of upper extremity paresthesia can be caused by hypomobility or sympathetic origin
49
s/s of T4 syndrome
upper extremity paresthesia pain with/without head/neck symptoms glove like distribution without neurovascular symptons rule out thoracic outlet, nerve root compression + ULTT limited T/s mobility improves with mobilization early morning symptoms headache temp, swelling, clumsiness
50
T4 syndrome treatment includes
RICE HVLAT/mobs to t/s trigger point release postural reed stretching and strengthening
51
tietze syndrome
local inflammation to costosternal junction, cartilaginous attachment self limiting worse w breathing, cough, sneeze 2nd/3rd costochondral
52
tietze syndrome treatment
local injections joint mobs
53
slipping rib syndrome
hypermobility of rib cage most commonly 11/12th ribs
54
slipping rib syndrome treatment
pt edu pain management HVLAT MWM mobs taping

518 Spine (19 decks)

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