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Clinic - Common Conditions Overview > Thoracic > Flashcards

Flashcards in Thoracic Deck (19)
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1
Q

What are the red flags for thoracic pain that could indicate a serious cardiovascular disorder?

A
  • palpitations
  • SOB / dyspnoea
  • pallor
  • sweating
  • mental state changes
  • nausea / vomiting
  • SSX agg. by activity and stress
2
Q

What are the red flags for thoracic pain that indicate a serious respiratory disorder?

A
  • SOB / dyspnoea
  • tachycardia
  • pallor / cyanosis
  • persistent or productive cough
  • SSX agg. by activity and deep inspiration
3
Q

What are the red flags for thoracic pain that indicate a potential neoplasia?

A
  • age over 50
  • Hx malignancy
  • pain at multiple sites
  • pain at rest, night pain
  • unexplained weight loss
  • failure to improve
  • vomiting
4
Q

What are the signs of a Pancoast tumour?

A

Tumour that compresses both the brachial plexus and sympathetic trunk

  • UL weakness, sensory deficit, paraesthesia
  • Horner’s syndrome
5
Q

Which substances are red flags with thoracic pain?

A

Cocaine
Amphetamines
Corticosteroids
Anticoagulants

6
Q

What are the 8 serious conditions that need to be considered in thoracic pain presentations?

A
Myocardial ischaemia
Aortic dissection
Pneumonia
Pneumothorax
Osteomyelitis
Tuberculosis
Neoplasia
Vertebral or rib fracture
7
Q

What are the 7 musculoskeletal / discogenic conditions that need to be considered in thoracic pain presentations?

A
Muscle strain
CV/CT sprain
Cx / Tx facet sprain
Osteoperosis
Scheurmann's disease
Costochondritis
Tx discogenic pathology
8
Q

Which viscera can refer pain to the thoracic region?

A
Heart (T1-6)
Lungs (T1-6)
GIT
Gallbladder (Rt)
Pancreas (Lt)
9
Q

What is the best way to differentiate between a Tx facet sprain and a CV/CT sprain?

A
  • similar presentations
  • site of tenderness to palpation different
  • tenderness of rib springing more indicative of CV/CT sprain, tenderness of PA springing of vertebrae more indicative of facet sprain
  • agg. by breathing more indicative of CV/CT sprain
10
Q

Describe the condition of a CV/CT facet sprain including presentation, pathology, risk factors, and prognosis

A

Mechanism:
- typically chronic overuse assoc. w/ sustained Tx kyphosis and/or repetitive or prolonged forces (ie: work with arms in front of body)

Pathology:

  • Grade 1-3 sprain of the CV and/or CT ligaments (usually concurrent)
  • may cause radiculopathy of spinal nerves

Presentation:

  • unilateral posterior Tx pain, maybe radiating along rib line to chest, GH, HA, neck pain
  • dull and aching constant pain, sharp on movement or palpation

Agg by:

  • deep breathing, coughing, sneezing
  • shoulder movement
  • TL movement (esp. ipsilateral sidebending)

Findings:

  • decreased Tx ROM & adj. rib ROM
  • tenderness on palpation of affected joint and springing over affected rib

Prognosis:

  • SSX reduction 1-3/52
  • resolution and recovery 4-6/52
11
Q

Describe the condition of a Tx facet sprain including mechanism, pathology, presentation, findings, and prognosis

A

Mechanism:
- typically chronic overuse assoc w/ sustained Tx kyphosis and/or repetitive overuse (ie: working with arms in front of body)

Pathology:

  • Grade 1-3 sprain of intervertebral ligs
  • may cause radiculopathy of spinal nerves

Presentation:

  • unilateral posterior Tx pain
  • may have radicular pain ina ffected dermatome
  • pain is dull, aching and constant; and sharp on movement / palpation

Agg by:
- movement (esp. etension, ipsilateral SB & rotation)

Findings:

  • decreased Tx ROM and pain with movement
  • tenderness on palpation and PA springing of affected joint

Prognosis:

  • SSX reduction 1-3/52
  • resolution 4-6/52
12
Q

What are risk factors and the typical mechanism of injury for Tx facet sprains and CV/CT sprains?

A

Mechanism: usually chronic overuse injury assoc w/ prolonged Tx kyphosis and/or overuse (ie: working with arms in front of body)

Risk factors:
- forward head posture, Tx kyphosis, obesity, heavy breasts, pregnancy, repetitive work with arms in front of body, degenerative conditions

13
Q

What are the typical healing timeframes for a facet or CV/CT sprain?

A

SSX reduction 1-3/52

Resolution 4-6/52

14
Q

Why are discogenic pathologies least common in the thoracic spine?

A
  • the presence of the Tx cage lends rigidity, stability and protection to the Tx spine and makes discs less vulnerable to excessive forces and anterior shearing
15
Q

What are the risk factors associated with discogenic herniations in the thoracic spine?

A

High risk of myelopathy in the thoracic spine (because of the narrow canal) - this is an emergency referral

SSX of thoracic myelopathy:

  • decreased bilateral LL motor strength
  • bilateral sensory disturbance LL
  • bladder changes
  • increased tone / spasticity
  • hyper-reflexia
  • clonus with reflex testing
  • ataxia
16
Q

Describe the condition of Scheuermann’s disease including pathology, presentation, and findings

A

Pathology: no clear mechanism (potentially genetic)

  • structural kyphosis of Tx spine caused by abnormal vertebral endplate ossification
  • creates disproportionate vertebral body growth during adolescence and causes an anterior wedged shape of vertebrae
  • most common at T7-9
  • 3 or more adjacent bodies affected for diagnosis

Presentation:

  • structural Tx kyphosis
  • decreased Tx joint play ROM
17
Q

Which cervical facets can refer pain to the thoracic spine?

A

C6-7 - referred pain to scapular region and up into top of shoulder

18
Q

Which nerves supply cutaneous innervation to the thoracic spine?

A

Dorsal rami of spinal nerves (medial and lateral cutaneous branches)

19
Q

Which organs are supplied by levels of the thoracic spine, and can cause referred pain via visceral afferents?

A

T1-6: heart and lungs
T5-9/10: stomach, liver, pancreas, spleen
T10-12: small and large intestines