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pt momints ver 2.0 > MS1: Affectation of Spine and Thorax > Flashcards

MS1: Affectation of Spine and Thorax Flashcards

1
Q

how many vertebrae are there and what are the divisions

A

33
- cervical: 7
- thoracic: 12
- lumbar: 5
- sacral: 5 fused into 1
- coccyx: 3-4

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2
Q

what are the curves in the VC

A

primary
- kyphotic: thoracic and sacral

secondary
- lordotic: cervical and lumbar

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3
Q

what is the normal thoracic kyphotic angle

A

AROUND 35 DEGREES or 20-45 deg

> 45 deg is hyperkyphosis

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4
Q

what is the normal lumbar lordotic angle

A

AROUND 60 DEGREES or 40-80

dec w age

60-70% of lordosis is at L4-S1

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5
Q

what are the causes of kyphosis

A

faulty posture
degen of IV discs
atrophy
collapse of vertebral body < postmenopausal and senile osteoporosis

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6
Q

what are the pathologic causes of kyphosis

A

chronic arthritis
osteitis deformans
poliomyelitis
fracture
TB
tumor
myeloma
myelomeningocele; children > lumbar or lumbosacral

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7
Q

what are the clinical features of kyphosis

A

deformity w or w/o pain, weak back and fatigue
- pain and tiring below apex
- tenderness if there is compression fracture is senile osteoporosis
- pain if tumor or infection

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8
Q

what is the treatment for kyphosis

A

maintain to correct posture
brace or corset
excersise > strengthen back and abdominals
rest on straight na higaan
treat the cause kung infection or tumor

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9
Q

what is dowagers hump

A

rounded hump > multiple anterior wedge compression fractures in middle to upper thoracic

due to post menopausal osteoporosis or steroids abuse

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10
Q

what is hump back

A

more steep bc single vertebra lang > anterior wedging of 1-2

due to infection - TB, fracture or congenital anomaly

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11
Q

what is scheuermann’s kyphosis

A

structural sagittal plane deformity on thoracic or thoracolumbar

common in male; 7:1
12-16 yo.

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12
Q

what are the criterias for scheuermann’s kyphosis

A

thoracic kyphosis > 45 deg

wedging > 5 deg of 3 adjacent vertebrae

thoracolumbar kyphosis > 30 deg
- smaller kase pa lordosis na dapat

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13
Q

what is the clinical presentation of scheuermann’s kyphosis

A

fatigue and pain; many are asymptomatic
curve is only partly correctable
present compensatory lumbar lordosis
pain and discomfort more severe in lumbar type

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14
Q

what is the cause of scheuermann’s kyphosis

A

growth disturbance of vertebral epiphyses bc of vascular disturbance

end plate abnormality

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15
Q

what is the management for scheuermann’s kyphosis

A

PT and observation: < 50 deg and no evidence of progression; adolescent

bracing: 50-70 deg in skeletally immature; milwaukee for 1-2 yrs

surgery: >70 deg w pain or failure of brace
- harrington rods
- for severe > fusion

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16
Q

what is vertebra plana

A

calves or eosiniphilic granuloma

2-12 yo.

vertebral lesion in only one vertebra > pathologic fracture bc of eosiniphilic granuloma

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17
Q

SSx of vertebra plana

A

clinical
pain, fatigue, mild angular kyphosis
muscle spasm and tenderness
pwd spinal cord compression

radiological
eroded or fragmented body
flattened or wedged
may regain height as child grows

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18
Q

management of verterba plana

A

rest in recumbent pos
brace

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19
Q

what is the apex

A

area of greatest curvature

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20
Q

what are the types of curve in scolio

A

primary > structural
- large cobbs angle

secondary: nonstructural, compensatory
- lesser cobbs

if 2 angles are equal > 2 primary curves

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21
Q

what is the curve progression in scolio

A

affected by age and how early treatment started

40-50 should be observed for progression > 1 deg per yr.

thoracic curve of 60-90 > cardiopulmo compromise; RLD

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22
Q

compare structural and nonstructural scoliosis

A

structural > non functional
- morphologic abnormality
- PT most concerned
- fixed lateral curve w rotaton
- spine rotated to concave
- LOM side bending

non structural > functional
from temporary postural influence
no rotational or assymetric change
resolvable
nawawala upon side bending

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23
Q

what is the etiology for scolio

A

structural
- idiopathic
- congenital
- neuromuscular: polio, cerebral palsy, muscle imbalance
- disease of vertebrae: tumor, infection, arthritis, potts

nonstructural
- postural
- leg length discrepancy
- nerve root irritation
- hip contractures

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24
Q

what is idiopathic scolio

A

unknown cause; most common

25
Q

what is infantile idiopathic scolio

A

detected during 1-3 yo. but curves develop in first 6 mo.
more common in boys
left thoracic most common
85% regress if appeared before 12 mo.

treatment
- observe
- cast
- surgery if progresses

26
Q

what is adolescent idiopathic scolio

A

10-16 yo. > skeletal maturity
more common in females
inc incidence if mother has scolio
most common type 80%
right thoracic most common

risk of progression
- if < 12 yo.
- female
- larger curve
- risser 0-1

27
Q

what is juvenile idiopathic scolio

A

3-10
equal sex occurence
right thoracic most common
does not resolve on its own

treatment
- less than 20 - no brace
- 20-25 w 5 progression or >25 = brace
- rapid progression or failed brace - surgery

28
Q

what is congenital scolio

A

failure of formation, segmentation or abnormal spinal canal

29
Q

what are the grades of risser index

A

1 - lateral 25% ossified
2- 50%
3 - 75%
4 - 100%
5 - complete fusion

1 and 2 are high progression of curve
> 3o before maturity = surgery

30
Q

tanner whitehouse

A

measure of maturity using boob and penis

31
Q

what is the clinical presentation of scolio

A

shoulder not level
trunk tilt
flexibility test

structural
- post rib hum on convex side; adams
- shortening of intrinsic muscles on concave; lengthen on convex
- ribs closer on concave; farther on convex
- canal wider on convex and narrow on concave

32
Q

what is the management of scolio

A

bracing for minimum 12 hrs a day until skeletal maturity
- succes if > 5 deg progression

apex above T7 - milwaukee

apex at or below T7 - boston or charleston

surgical
- rods para ma straight
- fusion to maintain sagittal and coronal balance ehile preserving motion

33
Q

when is skeletal maturity

A

risser 4; <2cm change in height in 6 months apart

2 yrs post menarchal

34
Q

what is lordosis

A

hollow back; obese, weak back muscles

treat > back support

35
Q

what is pigeon breast

A

pectus carinatum; premature dev of emphysema or cor pulmonale

sternum projects forward > impairs cough and volume of ventilation; AP diameter is inc

mild: inc size of pecs
surgery: remove of sternum pero cosmetic lng

36
Q

what is funnel chest

A

pectus excavatum; marfans syndrome and arthrogryposis

sternum pushed pst > AP diameter is dec > heart on left site
- result in kyphosis, respi infection, wheezing, arrythmia and premature emphysema

mild: palakihin chest
SWIMMING

surgery: resection of CC and sternum

37
Q

what is costal chondritis

A

painful inflammatory lesion in manubriosternal and sternoclav > localized tenderness of CC junction

younf and middle aged adullt; no sex

good prognosis and consrvative
activity modification
NSAID
sterioid
local anesthesis
PT

38
Q

what is tietze’s syndrome

A

DD for costal chondritis; if may swelling > tietze’s

hereditary, visruses and trauma

redness, tenderness, warmth, swelling
- pain is sharp and DD for chest pain bc may swelling
- pain for hours to weeks

NSAIDS

39
Q

compare sacralization and lumbarization

A

scaralizaton - 4 lumbar bc 5th is naging sacral

lumbarizaation - 6 lumbar bc S1 becomes lumbar

40
Q

what is pars interarticularis

A

betw lamina and sup inf articular process; site of stress fracture bcs subjected to large bending force

41
Q

what are the innervated strucutres of spine

A

vertebrae
facet joints; zygopophyseal
external annulus

anterior and post longitudinal ligament, interspinous ligament

muscles and fascia

nerve root

42
Q

what are the non innervated strucutres of spine

A

ligamentum flavum
internal annulus
nucleus pulposus

43
Q

compare nucleus pulposus and annulus fibrosus

A

NP: water, proteoglycan and TYPE 2 collagen
- 90% water and dec w age

AF: concentric layers of fibers at oblique angles; TYPE 1
- resists tensile forces
- more collages and less proteoglycans and water

44
Q

what is lumbar spondylosis

A

common cause of back pain in elderly; degen of IV discs and zygap joints > slipping or spurring; degenerative disk disease

pain reffered to buttock and legs; L4-L5 AND L5-S1

moderate: no impingement/fracture > conservatice
severe: muscle weakness and bladder prob > surgery

45
Q

what us shcmorl node

A

nuclear materials protrude to VB bc of osteomalacia/prosis

46
Q

what is spondylolisthesis

A

forward slippage of one VB

most common with L5 slip or L4 slip

47
Q

what are the gradings for spndylolisthesis

A

conservative
1: 0-25
2: 25-50

nerve pulles > surgery
3: 50-75
4: 75-100

48
Q

what is isthmic spondylolisthesis

A

most common type; absence of bony continuity at isthmus; ununited fracture or hereditary

often bilat; L5-S1

severe, mod or no pain; localized on lumbosacral joint or radiate to legs

worse w exercise and strain

49
Q

what is degenerative spondylolisthesis

A

via arthritis; 50 yo. women
- long standing LB, buttocks and thigh relieved by sitting or reclining

LOM forward felxion; inc hip flexion

no neurologic findings

50
Q

what is spondylolysis

A

pa start pa lang yung shift; sclerosis of pars interarticularis; scottie dog

most common cause of back pain in children and adolescents; 4-6%

activity related from hyperextension and 47% in gymnasts, weightlifters and football linemen

51
Q

treatment for spondylolysis

A

non-op
- observe and no activity limit: asymptomatic and low grade
- PT and limit: symtomactic
- bracing for 6-12 wks: failed PT

surgery: fusion or laminectomy
- neuro deficits
- instability of spine
- pain after conservative
- severe progress of slip

52
Q

what is canal stenosis

A

narrowing of spinal canal > compression of cauda equina > LBP

cause
- local bone deform
- congenital or acquired
- achondroplasis; short pedicles; pagets
- degenerative spinal disease; MOST COMMON

clinical presentation
- > 40 yo.
- pain, paresthesia and numbness of legs during exercise relieved by rest
- LBP
- LE has weakness, wasting and ankle jerk

53
Q

what are the causes of SI disorder

A

inflammatory arthritis; seronegative spondyloarthropaties

preggy in latter weeks or after delivery; SI strain and hormonal relax of symphysis pubis

osteomyeletis, infectious arthritis

manlgaigne fractuer: disruption of SI joint due to severe pelvic fracure

54
Q

SSx of SI disorder

A

tenderness over one or both SI joints

assoc tendrness of symhpysis pubis

+ gaenslen’s: pt hugs knee and other knee is is extreme flexion > pain = +

NSAID PT HEAT

55
Q

what is coccygodynia

A

pain on coccyx and lower sacrum

cause
sprain in sacrocox lig from direct blow na naka upo
- prolonged sitting on hard surface

SSx
- aching, nagging pain w shooting pains in buttocks to legs
- pain when sitting sa matigas and pag tayo
- pain on defecation

treatment
- deformed > gentle manipulation of coccyz
- hot baths
- adhesive strapping across buttocks
- soft cushion
- surgical - not relieved by conservatiice > removal of coccyx

56
Q

what is dysplastic spondylolisthesis

A

congenital anomalis to lumbosacral junction

57
Q

what is traumatic spondylolisthesis

A

fracture causing displacement

58
Q

what is pathologic spondylolisthesis

A

deforming or destrciton of bone or facets via tumor or infection

pt momints ver 2.0 (14 decks)

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