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ms 1 - 2nd shift > scolio and thorax > Flashcards

scolio and thorax Flashcards

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1
Q

an older term that refers to an abnormal bending of the spine but gives no reference to the coupled rotation that also occurs

A

scoliosis

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2
Q

describes the curve of the spine by detailing how each vertebra is rotated and side flexed in relation to vertebra below

A

rotoscoliosis

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3
Q

spine curves (convex) to the left; commonly affects lumbar region

A

levocoliosis

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4
Q

spine curves (convex) to the right; commonly affects thoracic region; more common

A

dextroscoliosis

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5
Q

it refers to the vertebra that is located at the farthest point out laterally from the midline of the body (convex side)

A

apex of curve

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6
Q

vertebra w the greatest distance from the midline with most rotation

A

apical vertebra

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7
Q

apex of curve in cervical scoliosis

A

c1-c6

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8
Q

apex of curve in cervicothoracic

A

c7-t1

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9
Q

apex of curve in thoracic scoliosis

A

t2-t11

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10
Q

apex of curve in thoracolumbar scoliosis

A

t12-l1

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11
Q

apex of curve in lumbar scoliosis

A

l2-l4

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12
Q

apex of curve in lumbosacral scoliosis

A

l5 or lower

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13
Q

discuss cobb angle and how to measure scoliosis

A

cobb angle - standard measurement used to quanitfy scoliosis

measured on PA (post-ant) or AP (ant-post)

  • draw a line above the vertebra w greatest lateral tilt and another line at the bottom vertebra w greatest lateral tilt
  • extend the lines to the margin of the image
  • draw perpendicular lines on the two lines u drew
  • cobb angle is where the 2 perpendicular lines intersect
  • measure the angle
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14
Q

type of curve considered as structural and has a larger cobb angle

A

primary curve

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15
Q

type of curve considered as compensatory curve; lesser in magnitude, more flexible and less rotated; allows head to be centered over the pelvis; may or may not be structure curves, depending on flexibility

A

secondary curve

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16
Q

discuss structural scoliosis (based on rigidity)

A
  • also called non-functional
  • definite morphologic abnormality
  • therapeutic effort is concerned
  • has a fixed lateral curvature w rotation

on radiographs
- spinous process rotated to concavity
- lack of normal flexibility on side bending or traction radiograph

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17
Q

discuss non structural scoliosis (based on rigidity)

A
  • also called as functional scoliosis
  • results from temporary postural influence
  • no rotational or asymmetric change in the individual structures of the spine
  • curve is not fixed
  • if problem is corrected, scoliosis resolves
  • corrects or overcorrects on spine side bending radiograph or traction films
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18
Q

discuss structural scoliosis based on etiology

A
  • idiopathic
  • congenital
  • neuromuscular (neuropathic, myopathic)
  • neurofibromatosis with scoliosis
  • scoliosis with disease of vertebrae (tumor, infection, metabolic, arthritis)
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19
Q

discuss non structural scoliosis based on etiology

A
  • postural
  • leg length inequality
  • nerve root irritation
  • contracture about the hip
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20
Q

this type of structural scoliosis has an unknown cause and is the most common type

A

idiopathic scoliosis

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21
Q

idiopathic scoliosis - infantile

A

under 3 years of age

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22
Q

idiopathic scoliosis - juvenile

A

3-10 years of age

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23
Q

idiopathic scoliosis - adolescent

A

above 10 years old to skeletal maturity

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24
Q

discuss infantile idiopathic scoliosis

A
  • detected during1-3 years old
  • common in boys
  • curves develop within the first 6 months
  • 85% of curves regress spontaneously (usual if curve appeared before 12 months)
  • left thoracic curve most common
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25
treatment of infantile idiopathic scoliosis
- observe - serial cast - surgery (if curve progresses); posterior growing rod until 10-11 yrs old; posterior spinal fusion after skeletal maturity
26
discuss juvenile scoliosis
- 3-10 yrs of age - of equal sex predilection - right thoracic curve most common - curves do not resolve spontaneously
27
treatment of juvenile scoliosis
- less than 20 deg, observe. follow up after 6-8 mos - braces: 20-25 deg with > 5 deg progression or > 25 deg curve - surgery: rapid progression or failure of braces; w/o fusion before puberty followed by fusion at puberty
28
discuss adolescent idiopathic scoliosis
- 10-16 years old (skeletal maturity) - common in females - increases incidence in children who are daughters of mothers with scoliosis (familial) - most common type (80%) - right thoracic curve most common
29
risk of progression in adolescent idiopathic scoliosis
- age < 12 yrs old - female gender - maturity- father from skeletal; maturity (risser 0-1) higher risk - larger curve at detection, higher risk -larger curve at detection, higher risk
30
discuss congenital scoliosis
- failure of vertebral formation (hemivertebrae) - failure of segmentation (partial or complete bar) - abnormal spinal canal or cord (myelodysplasia)
31
this is used to grade skeletal maturity based on the level of ossification and fusion of iliac crest apophyses
risser classification
32
stage 0 of risser
no ossification center at the level of iliac crest apophysis
33
stage 1 of risser
apophysis under 25% of iliac crest
34
stage 2 of risser
apophysis over 25-50% of the iliac crest
35
stage 3 of risser
apophysis over 50-75% of iliac crest
36
stage 4 of risser
apophysis over > 75% of the iliac crest
37
stage 5 of risser
complete ossification and fusion of iliac crest apophysis
38
physical examination of scoliosis
- shoulder not leveled - tilt of trunk - decompensation is measured by plumb bomb from c7 where it falls w respect to gluteal line - flexibility test
39
clinical presentation of scoliosis (structural or functional)
- produce a fixed deformity - rib hump occuring on convex side - persistent scoliosis during forward bending (adam's sign) - adaptive shortening of intrinsic trunk muscles on the concave side; lengthening of intrinsic muscles on convex side
40
characteristics present on convex side of scoliosis
-ribs pushed posteriorly forming post rib hump - vertebral body rotate towards convex side - ribs are farther apart - lamina thicker - vertebral canal wider - iv discs spaced wider
41
characteristics present on concave side of scoliosis
- ribs pushed anteriorly - spinous process rotates concavity - ribs are closer - lamina is thinner - vertebral canal is narrower - iv disc spaced narrower
42
duration of hours required in wearing a brace
-16-23 hours/day until skeletal maturity or surgical intervention deemed necessary (actual wear min of 12 hrs required to slow progression)
43
type of brace used of curves with apex above T7
milwaukee brace
44
type of brace used of curves w apex T7 or below
TLSO boston style brace (underarm) charleston bending brace
45
bracing success is defined if
<5 deg curve progression
46
bracing failure is defined if
- 6 deg or more curve progression at skeletal maturity - absolute progression to >45 deg either before or at skeletal maturity in favor of surgery
47
skeletal maturity is defined as
- risser 4 - < 1cm change in heigh over 2 visits 6 mos apart - 2 years postmenarcal
48
this recommends one level above and two levels below the end vertebrae if these levels fall within the stable zone
harrington technique
49
this recommends fusion to the neutral vertebrae
moe technique
50
this recommends including all major curves and minor curves that are not flexible or are kyphotic
lenke technique
51
known as hallow back; anteroposterior curvature of the spine in which the concavity is directed posteriorly; cervical and lumbar lordosis exhibits this
lordosis
52
sternum projects forward and down like a keel of a boat; increases AP diameter of thorax; impairs the effectiveness of cough and restricts volume of ventilation
pigeon breast (pectus carinatum)
53
cause of pigeon breast
premature development of emphysema or cor pulmonale
54
management of pigeon breast
mild deformities can be less noticeable w exercises that increase strength of pectorals surgery if severe deformity
55
treatment of funnel chest
- mild- exercises to improve posture and build up shoulder girdle and pectoral muscle - swimming - surgery for severe cases
56
sternum is pushed posteriorly be overgrowth of ribs; ap diameter of thorax is decreased; heart displaced to left side; shortening of central tendon, seen in marfan's syndrome
funnel chest (pectus excavatum)
57
tenderness of costochondral junction of ribs or chondrosternal joint of anterior chest (2nd to 5th)
costochondritis
58
cause of costochondritis
localized inflammation; may precede upper respiratory infection and excessive coughing, local trauma, arthritis (ra, as)
59
symptoms of costochondritis
chest pain - sharp, associated w deep breathing or coughing tenderness on the area no observed swelling
60
treatment of costochondritis
non surgical: - activity modification - nsaids -corticosteroid injection -local anesthesia patch - pt -good prognosis and responds to conservative management
61
painful inflammation of the costochondral cartilages of upper front of chest (usually 2nd-3rd)
tietze's syndrome
62
causes of tietze's syndrome
heredity (genetic predisposition); viruses; trauma
63
tietze's syndrome vs costochondritis
tietze's syndrome - rare, more common in females - < 40 yrs old - no of sites affected: one in 70% of cases; usually unilateral - 2nd-3rd costochondral junction - (+) local swelling - no associations w other conditions costochondritis - more common - > 40 yrs old - no of sites affected: more than once (90% of cases) - 2nd-5th costochondral junction - no swelling - associated w seronegative arthropathies, anginal pain

ms 1 - 2nd shift (13 decks)

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