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AT 531: Pathology > Patho Test 1: Thoracic and Ribs > Flashcards

Patho Test 1: Thoracic and Ribs Flashcards

1
Q

Salter-Harris Classification: Type I

A

Seperation - complete separation of epiphysis in relation to metaphysics w/out fracture to bone (infants)

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2
Q

Salter-Harris Classification:

Type II

A

Fracture/Seperation - Seperation of the growth plate with a small wedge broken off

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3
Q

Salter-Harris Classification:

Type III

A

Fracture of Epiphysis - Transverse and Perpendicular fracture resulting in a completed disrupted piece of bone that will be compromised to have new growth

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4
Q

Salter-Harris Classification:

Type IV

A

Fracture of a portion of the epiphysis and metaphysics: Same as type 3 but has piece extending into the shaft of the bone; requires surgery.

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5
Q

Salter-Harris Classification:

Type V

A

Crushing of the epiphyseal plate, no displacement but can cause gross deformity (fixator if necessary)

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6
Q

Osteochondritis Dissecans(OCD)

A

a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of the bone (idiopathic)

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7
Q

Sever’s Disease

A

“osgood spatter’s of the heel” - weakening in the growth plate

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8
Q

Nerve Root Compression: Causes

A
  • Facet joint inflammation
  • disc herniation
  • disc degeneration
  • osteophytes pressing on nerve
  • decreased lateral foramen diameter
  • muscle spasm, swelling
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9
Q

Clinical Evaluation

A
  • Patient History
  • Posture screening
  • Neuro screen
  • AROM assess
  • PROM assess
  • Manual Muscle test
  • Palpation for irritability
  • Special Tests: Provocation tests
  • Functional Testing/questionnaires
  • GOALS: MD needed or not?
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10
Q

On Field Evaluation

A
  • Emergency Care #1 priority
  • Breathing
  • bleeding
  • broken bones
  • EMS? (subjective)
  • No:
  • Neuro
  • Palpate for deformity
  • AROM
  • joint stability tests
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11
Q

Patho-anatomic vs. Biomechanical Diagnosis

A

Found structure/injury vs. found biomechanism of the injury

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12
Q

Local MOI vs. Regional Interdependence

A

MOI: Mechanism of Injury
RI: some other body party overcompensating leading to injury

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13
Q

Orthopedic Assessment in Clinical Setting

A
  1. History
  2. Posture
  3. Neuro Screen
  4. Palpate
  5. AROM
  6. PROM
    • Osteokinematic motion
    • Arthrokinematic motion
    • Muscle Length
  7. Strength
  8. Girth(swelling/atrophy or leg length measure
  9. Special Tests
  10. Functional Tests
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14
Q

Red Flags for Ortho Exams

A
  • Severe unremitting pain
  • Pain unaffected by meds or change in position
  • Severe night pain
  • Severe pain with no history of injury
  • Saddle area numbness
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15
Q

Patient’s History Questions

A
  • Age, Gender, Occupation
  • Past surgeries/Any Med DX
  • Chief complaint/S&S
  • MOI
  • Date of onset
  • Pain intensity(1-10)
  • Pain description
  • What alleviates pain?
  • What aggravates pain?
  • Previous injuries?
  • Valsalva sign?
  • Saddle area numb?
  • Prev Medical tests?
  • Medications?
  • DONT FORGET TO OBSERVE PATIENT
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16
Q

Upper Motor Neuron Lesions vs. Lower Motor Neuron Lesions

A

Upper: Problem with brain or spinal cord

  • Hyper-reflexia DTR (increase in stretch reflex)
  • Spasticity DTR
  • Minimal muscle atrophy
  • Altered Consciousness
  • Altered Cognition
  • Impaired vision, speech

Lower: Outside of spinal cord; Dorsal or Ventral nerve root

  • Decreased sensation
  • Decreased strength
  • DTR will be diminished or absent
  • May see significant muscle atrophy
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17
Q

Dermatome Screening

A

*patients eyes closed
L1 - Over greater trochanter
L2 - front of thigh
L3 - across the knee
L4 - Medial shin, dorsum of foot
L5 - Lateral aspect of shin, lateral foot
S1 - posterior shin, plantar aspect of foot

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18
Q

Myotome Screening

A 
L1-L2 = hip flexors
L3 = Quadriceps (not in full Ext)
L4 = anterior tibialis
L5 = EHL or peroneals (big toe)
S1 = Gastroc (calf raises)
S2 = Hamstrings
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19
Q

DTR: Lower lesion vs. Upper lesion

A

Lower: PNS
- Decreased response
- ie. herniated lumbar disc on a nerve root
Upper: CNS
- Increased response
- Brain or spinal cord disease or injury interferes with inhibitory inter neurons
- ie. MS, central spinal stenosis

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20
Q

DTR Grading scale

A 
Knee jerk: L3, L4
Achilles: S1
0= absent
1= diminished
2= normal
3= hyper reflexic
4= clonus(MS)
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21
Q

Adverse neural tension test(SLR) vs. Well’s SLR

A

Adverse SLR: lift to at least 30 degrees to elicit response = would cause sciatic burning in leg that is lifted
Well’s SLR: lifting leg causes burning in opposite leg due to a possible injury to the disc(puts pressure on the nucleus on the other side

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22
Q

Cyriax’s end feel: Normal vs. Abnormal

A

Normal:
1. Bony
2. Soft tissue approximation
3. Tissue stretch
Abnormal:
1. Bony - shows up where it shouldn’t be (Ca+ deposit)
2. Empty - ROM is limited from pain (muscle guarding)
3. Hard - restriction from muscular tightness (not pain)
4. Springy - rare; likely from a cartilage tear
5. Capsular - inflammatory cells in capsule (frozen shldr)

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23
Q

Kendall’s testing scale for Manual Muscle testing

A 
5 = normal
4 = Good, breaks with mod resistance
3 = Fair, complete ROM against Gravity only
2+ = Poor plus = initiates motion against gravity only
2 = Poor: full ROM gravity eliminated
2- = Poor minus; initiates ROM gravity eliminated
1 = Trace evidence of a twitch under your palpating hand
0 = Nothing
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24
Q

Special Test: Specificity and Sensitivity

A

Specificity = Rules diagnosis in (SPIN)
Sensitivity = Rules diagnosis out (SNOUT)
-Fasle positives: test is positive even though the condition does not exist
-False Negatives: Test shows that the problem is not there, but in fact the person really does have the problem

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25
Q

Nagi Model of Disability

A
  1. Pathology: Interruption or interference with normal process
  2. Impairments: Anatomical, physiological, mental or emotional abnormality or loss
  3. Functional Limitations: Limitation in performance at the level of the person
  4. Disability: Limitation in performance of socially defined roles and tasks within the environment
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26
Q

Spondylosis

A

Osteoarthritis of the spine

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27
Q

Spondylolysis

A

Crack, stress fracture; also called a Pars Stress Reaction

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28
Q

Spondylolisthesis

A

Stress fracture worsens, the vertebral body slips forward off of the vertebrae below

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29
Q

Wiltse’s Classifcation: Dysplastic

A

Congenital abnormality of upper sacrum

30
Q

Wiltse’s Classifcation: Spondylolytic

A

a pars lesion

31
Q

Wiltse’s Classifcation: Degenerative

A

pars, facet instability

32
Q

Wiltse’s Classifcation: Traumatic

A

non-pars fracture; force pushes V forward

33
Q

Scotty Dog Fracture

A

Fracture of the Pars Interarticularis

-Caused by hyper extensive forces

34
Q

Meyerding’s Spondylolisthesis Classification

A 
Grade 0 = Break
Grade 1 = 1/4 off Vert
Grade 2 = 1/2 off vert
Grade 3 = 3/4 off vert
Grade 4 = completely off Vert
35
Q

Diagnosing Spondylolisthesis

A
  • History
  • Horizontal muscle banding standing
  • Painfree FB
  • Painful return from FB
  • Painful extension and rotation and SB
  • Step Deformity
  • Referred pain - pain in a different area than injury
  • Shortened stride
  • Neurological involvement in grade 2 or Greater
  • Imaging tests: Xray (Stress fx won’t show up first two weeks) and/or Bone Scan(will present fx immediately)
36
Q

Treatment of Pars Stress RXN

A
  • Restricted activity to pain free limit of motion
  • antilordotic bracing 8-12 weeks
  • min of 4-6 weeks conditiong post bracing: 1.) start with FLEXION ROM
    2. ) Local core training(TrA and Multifidi first, then obliques)
    3. ) Global core-gluteals, lats
    4. ) Work back into extension ROM
    5. ) Gradual return to ground reaction forces
37
Q

Spinal Stenosis: Central vs. Lateral

A

Central(CNS) - results in myelopathy(spinal cord compression) or caudal equina syndrome
Lateral(PNS) - results in radiculopathy(nerve root compression)

38
Q

Causes of Spinal Stenosis

A
  • Degenerative changes are most common
  • Facet hypertrophy, buckling of ligamentum flavum
  • Disc bulge, osteophytes
  • Bony metastases from cancer
39
Q

Lumbar Stenosis Diagnosis

A
  • History: most common among 65 years and older
  • Claudicant pain - sitting at rest(no pain), stands up (pain arises)
  • Relief in flexion, Pain in extension
  • Hyper or Hypo DTR
  • Lower extremity sensory loss
  • Lower extremity weakness
  • Possible bowel/bladder involvement
  • Saddle area numbness
  • Imaging
40
Q

Spinal stenosis treament

A

Work on activities that increase mobility and decrease spinal compression:

  • Stretching, massage
  • Increase FLEXION ROM
  • positional distraction to open lumbar facets
  • Traction possibly
  • Endurance exercises that don’t compress or extend the spine
41
Q

Lumbar Nerve Root Impingement: Radiculopathy

A
  • Irritation of one or more lumbar nerve roots due to compression
  • Most common = L5 and S1
  • Most frequent cause is a herniated/ruptured disc
  • Other causes: facet arthritis, local inflammation, and tumors
42
Q

Lumbar Radiculopathy: Symptoms

A
  • Low back pain
  • Radicular pain(shooting)
  • Loss of sensation in dermatomes
  • LE weakness(myotomes)
  • Pain worsens with cough
  • Intolerance to sitting
  • Flexion or Extension pain pattern
43
Q

Lumbar Radiculopathy Diagnosis

A
  • History
  • Neuro screen: Dermatomes, myotomes, diminished DTR, positive Well SLR test(contra leg, 95% specific)
  • Possible lateral shift
  • Positive Imaging tests
44
Q

Disc Herniation: Protrusion

A
  • slight outstretching of posterior aspect of annulus and also the neuromuscular capsule
  • S/S: instability, ligament pain behavior, occasional leg pain
45
Q

Disc Herniation: Protrusion treatment

A
  • Postural/Mechanics correction
  • Mckenzie approach may work with this type
  • Stabilization exs= Core exs and Dynamic stablization exs
  • Endurance exs
46
Q

Disc Herniation: Prolapse

A

S/S: similar to protrusion, only now, leg pain may be more frequent and neurological signs may be present(dermatome, myotome, DTR)
-BOTH FB or BB may increase symptoms

47
Q

Disc Herniation: Prolapse Treatment

A
  • Determine what makes leg pain better/worse: May indicate McKenzie extension exercises will be helpful
  • Work on decreasing the radicular S/S first, then back pain
  • Posture will need to be corrected
  • Stabilization exercises
  • Endurance exercises
  • Behavioral and occupation/sport changes
48
Q

Disc Herniation: Extrusion

A
  • Outer annulus torn, nucleus starting to escape
  • S/S: LBP, worse in sitting, FB or BB may increase leg pain; Neuro S/S present; possible lateral shift; Significant disability
49
Q

Disc Herniation: Extrusion treatment

A

Acute: Rest, Ice, Back brace or leukotape in neutral

  • Goal is for 2 weeks to allow outer annulus to heal
  • After 2 weeks: work on leg pain = Positional distraction, manual traction, mechanical traction, modalities for pain
50
Q

Disc Herniation: Sequestered Nucleus

A 
S/S: same as Extrusion but worse
Surgery preferred:
 - discectomy - disc removed
 - Laminectomy - Lamina removed
 - Fusion - can be best option for radiculopathy
51
Q

Facet Syndrome

A

Caused by:

  • Trauma causing synovitis; joint swells causing local muscle spasm
  • Trauma or awkward mvmt causing facet to be entrapped= Use Quadrant testing
52
Q

Facet Syndrome Diagnosis

A
  • History
  • Palpate for malalignment or local muscle spasm
  • Assess spinal segment mobility
  • Rule out other spine pathologies
  • Determine the level and side of the problem
53
Q

Facet Syndrome Treatment

A
  • Ice, e-stim first, IF for local muscle spasm
  • Joint Manipulation
  • Positional Distraction to open facet
  • Manual or mechanical traction to open facet
  • Corrective exercises once facet motion is restored
54
Q

Chronic Low Back Pain (CLBP)

A
  • 10-20% of patients with acute LBP develop chronic pain
  • Does not have a confirmed spinal pathology
  • Often has a physical and cognitive-behavioral component
  • Instability at one or more segments within the neutral zone within 10 degrees in either direction(Flex/Ext); i.e.. segment has wobble
  • Abberrant motor control(struggle to fire muscles) and segment instability?
55
Q

CLBP diagnosis

A
  • History: present > 3 months
  • Clincal testing: Other dx have been ruled out and a presence of a segmental instability
    • Manual spinal segment mobility test
    • EMG: needle place in multifidi
    • Videofluoroscopy: imagining test
56
Q

CLBP treatment

A
  • Medical intervention: NSAIDS
  • Cognitive-Emotional counseling
  • Improve aerobic fitness
  • Core stabilization grouping
57
Q

Treatment Classifcation Groups

A
  1. Specific exercise
    • Extension Syndrome (Postural preference for extension)
    • Flexion syndrome (Postural preference for flexion)
  2. Mobilization: Unilateral LBP with segmental HYPOmobility (manipulation)
  3. Traction: Radiculopathy w/ or w/out lateral shift
  4. Immobilization: segmental HYPERmobility (Core training exercises)
58
Q

5 Criteria for Prediction Rule

A
  1. Duration of current episode of LBP 1 lumbar hypo mobile segment 1 hip with > 35 degrees of internal oration ROM
59
Q

Form vs. Force Closure

A

Form closure - if all is healthy you should have a closing effect of the ligaments and muscles
Force closure - if injury is present then you are going to have to recruit more muscles to close the chain

60
Q

Costochondral seperation

A 
= Seperation of costocartilage where it attaches to the rib or sternum
S/S: "pop" at injury site, with sharp localized pain/deformity
MGMT:
- 3-4 weeks rest
- NSAIDS
- local steroid injections
- Bracing
- Submax aerobic exercise - low impact
61
Q

Rib Fractures

A

Flail Chest = 3-4 ribs fractured - one side does not move in inspiration/expiration
- 5-9 most common

62
Q

Rib Fractures: S&S

A
  • localized pain, discoration, swelling
  • Increased pain with inspiration
  • Shallow breathing
  • painful spring test
  • SB toward fx side
  • Increased pain with SB and Rot away
63
Q

Rib Fractures: MGMT

A

Bracing

  • Multiple fx ribs= out for season
  • 1-2 rib fx = out for 4-8 weeks depending on sport. Painfree full inhalation and spring tests; Return with flakjacket
64
Q

Costochondritis

A

=Idiopathic inflammation of the costochondral junction usually ribs 2-4
-S&S: inflammation, raised rib cage(no MOI though), coughing increases S&S
Tx: Rest, MHP, US; goes away on own

65
Q

Scoliosis

A

Iiopathic: 75-85% of cases
Neuropathic: Nuerofibramatosis = calcium deposits around SC
Osteopathic: Arthrogyrposis = muscles on one side of spine is fibrotic(bent joint disease)

66
Q

Scoliosis: Severity

A 
Mild = < 20 degrees
Moderate = 20 - 40 degrees
Severe = > 40 degrees
67
Q

Scoliosis: Treatment

A
  • Early detection vital
  • Bracing 12/hrs a day
  • Stretch convex muscles/ Strengthen concave muscles
  • Surgery: Harrington rods for severe curves
68
Q

Scheurmann’s Disease

A

-Epiphyseal plate region of the Thoracic Vertebral bodies: Necrosis of anterior aspect of Vertebral body
- Sagittal plane disorder(idiopathic)
-Complaints of achy back and excessive kyphosis at early age
TX: bracing and back extension exercises

69
Q

Spina Bifida

A
  • Congenital abnormality of the spine
  • 2 per 1,000 births
  • Incomplete closure of one or more neural arches embryologically
70
Q

Spina Bifida Occulta

A
  • Hidden, mild: small parts of vertebra don’t close
  • Fawn’s Beard
  • No contraindications for contact sports
71
Q

Spina Bifida with meningocele

A

-Meninges forced into gaps of the vertebra

72
Q

Spina Bifida Meningmyelocele

A

This type of spina bifida often results in the most severe complications.[12] In individuals with myelomeningocele, the unfused portion of the spinal column allows the spinal cord to protrude through an opening. The meningeal membranes that cover the spinal cord form a sac enclosing the spinal elements.

AT 531: Pathology (2 decks)

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