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Thoracic conditions Flashcards

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1
Q

Thoracic outlet syndrome

A

Group of disorders that occur when blood vessels or nerves in the space between your clavicle and first rib are compressed

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2
Q

Epidemiology of thoracic outlet syndrome

A

Vascular TOS- develop secondary to repetitive upper limb activities that lead to claudication (pain in legs/arms when walking/using)
Same condition can develop spontaneously, unrelated to trauma
Neurogenic TOS commonly develops following micro trauma to neck or shoulder girdle areas (e.g., car accident, work related repetitive stressful activities)

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3
Q

Age groups affected by TOS

A

Most cases diagnosed between 20 and 50 years
Can occur in teenagers
Women 3x more likely to develop neurogenic TOS

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4
Q

Risk factors of TOS

A

Car accident
Repetitive injury job or sport-related injuries
Pregnancy
Anatomical defects (e.g., having extra rib)

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5
Q

Clinical presentation of TOS

A

Diagnosing TOS can be challenging because symptoms vary between patients
Vascular TOS easier to diagnose, venous has no objective test to confirm
Diagnosis of exclusion
Symptoms range from mild pain and sensory changes to limb –> life-threatening complications
Uni or bilateral
Record position of Pt head, shoulders, scapulae, and arms in seating and standing
Shoulder/neck pain
Upper arms- oedema (venous compromise), atrophy in hand, hand palpated for temp changes and moistness to detect sympathetically mediated symptoms

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6
Q

Prognosis for TOS

A

Treatable, resolution of around 90%
Exercises to strengthen and stretch shoulder muscle to open thoracic outlet, improve posture and ROM

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7
Q

Intercostal neuralgia

A

Characterised by neuropathic pain in distribution of affected intercostal nerves (along chest, ribs and abdomen)

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8
Q

Epidemiology of intercostal neuralgia

A

Pregnancy
Compression of nerves
Inflammation in intercostal nerves

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9
Q

Groups affected by intercostal neuralgia

A

Tends to affect women 1.5 times more than men

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10
Q

Clinical presentation of intercostal neuralgia

A

Manifest as sharp, aching, radiating, burning or stabbing pain
May be associated with numbness and tingling
Follows dermatomal patterning
Involuntary contraction of muscles
Colour changes of skin above affected area and loss of sensitivity

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11
Q

Prognosis for intercostal neuralgia

A

Variable- some Pt achieve resolution of symptoms over time, while some develop chronic pain

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12
Q

Tietze syndrome

A

Rare, inflammatory disorder characterised by chest pain and swelling of one or more upper rib (costochondral junction)

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13
Q

Epidemiology go tietze syndrome

A

Exact cause unknown, suggested that multiple microtrauma to anterior chest way may develop into TS

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14
Q

Age groups affected by tietze syndrome

A

Older children or young adults

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15
Q

Tietze syndrome risk factors

A

Excessive coughing
Severe vomitting
Upper respiratory tract infections
Higher cases in winter/spring period

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16
Q

Clinical presentation of tietze syndrome

A

Unilateral chest pain
Tenderness upon palpation and swelling of upper costochondral joints

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17
Q

Tietze syndrome prognosis

A

Usually goes away after treatment
Treatment- rest, avoidance of strenuous activity, application of heat to affected are, pain meds

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18
Q

Precordial catch syndrome

A

Non-serious condition causing sharp stabbing pains in chest

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19
Q

Precordial catch syndrome epidemiology

A

No specific cause

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20
Q

Age groups affected by precordial catch syndrome

A

Children between 6 and 12
Males and females affected equally

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21
Q

Risk factors of precordial catch syndrome

A

Non-specific
Sudden onset may be caused by nerves getting pinched or irritated in inner lining of chest wall

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22
Q

Clinical presentation of precordial catch syndrome

A

Sharp pain in left side of chest near heart

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23
Q

Prognosis of precordial catch syndrome

A

Should outgrow by 20s
Painful episodes should become less frequent and less intense as time goes on

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24
Q

Herpes zoster

A

Aka shingles
Caused by varicella-zoster virus, same as chicken pox

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25
Herpes zoster epidemiology
When a child has chicken pox, body fights varicella-zoster virus and physical signs of chicken pox fade away, but virus remains in body In adulthood, the virus can become active again --> presented as shingles
26
Age groups affected by herpes zoster
Chances increase as you get older Half of cases occur in 50+
27
Clinical presentation of shingles
Outbreak of a painful rash or blisters on the skin Rash/blisters appear as a band on one area of body- aids diagnosis Fever, chills, headache, fatigues, stomach upset, sensitivity to light
28
Prognosis for herpes zoster
No cure, but vaccines Antiviral medication to ease discomfort
29
Costovertebral joint syndrome
Occurs when there is damage to the connective tissue that surrounds a joint
30
Epidemiology for costovertebral joint syndrome
Exaggerated and repetitive movements involving Tsp Rotation can overstretch the trunk and ribcage and surrounding costovertebral joints
31
Clinical presentation of costovertebral joint syndrome
Dull ache in upper back Made worse by deep breathing, coughing, and rotation movements of trunk
32
Prognosis for costovertebral syndrome
Massage, joint mobilisation, home exercise program, dry needing With assistance it should heal
33
Post herpetic neuralgia
Usually described as pain in a dermatomal distribution which persists for three months or more following healing from shingles
34
Epidemiology of post herpetic neuralgia
After effect of shingles
35
Age groups affected by post herpetic neuralgia
Risk increases with age
36
Risk factors of post herpetic neuralgia
Older than 50 Severity of shingles Prince of chronic disease Shingles location (face or torso) Delayed treatment with singles antiviral treatment more than 72 hours after rash appeared
37
Clinical presentation of post herpetic neuralgia
Constant or intermittent stabbing or burning pain Intense itching Intermittent or continuous nerve pain in an area of skin previously affected by shingles
38
Prognosis for post herpetic neuralgia
Symptoms can resolve after a few months, may persist for longer Intervention won't completely resolve pain but could reduce it
39
Acute pancreatitis
Lies in upper half of abdomen behind stomach infant of spine Sudden inflammation of pancreas gland that begins in cells of pancreas that produces digestive enzymes If enzymes become activated too early they cause damage to pancreas
40
Epidemiology of acute pancreatitis
Gallstones Drinking too much alcohol
41
Risk factors for acute pancreatitis
Following trauma (bike or road)] Side effects of medicine (e.g., azathioprine and steroids) Genetics
42
Clinical presentation of acute pancreatitis
Sudden onset abdominal, usually starting in upper abdomen Can be accompanied by vomiting
43
Prognosis of acute pancreatitis
No specific medicine that can stop inflammation Treatment in hospital is vital
44
Scoliosis
Apparent lateral curvature of the spine
45
Epidemiology of scoliosis
Spine not forming properly in womb (congenital scoliosis) Underlying nerve or muscle condition, such as cerebral palsy or muscular dystrophy (neuromuscular scoliosis)
46
Age groups affected by scoliosis
Develop in infancy or early childhood Primary onset is 10-15 years old
47
Risk factors of scoliosis
Family history
48
Clinical presentation of scoliosis
Deformity usually presenting symptom Spine deviated from midline, may become apparent when Pt bends forward Pain is a rare complaint- should alert physician, neural tumour need for MRI? Run fingers down SPs
49
Prognosis of scoliosis
Aim is to prevent severe deformity Management differs for different types Operative treatment for severe cases Milwaukee brace, reduces lumbar lordosis by stretching and strengthening thoracic spine
50
Idiopathic scoliosis
Constitutes for about 80% of cases
51
Epidemiology off idiopathic scoliosis
No cause
52
Spondylolisthesis
Vertebral displacement Normal laminae and facets constitute a locking mechanism which prevents each vertebra from moving forwards on the one below Forward shift (listhesis) occurs when mechanism fails
53
Age groups affected by spondylolisthesis
+50 Women x3
54
Clinical presentation of spondylolisthesis
Usually occurs between L4/5 Intermittent backache, common symptom of lytic spondylolisthesis, may be initiated or exacerbated by exercise of strain 'step' can usually be felt when fingers run down spine Normal ROM in younger Pt, limited in elderly
55
Spondylolisthesis prognosis
COnserative treatment, similar to other types of back pain Operative treatment available if symptoms are disabling or interfere with daily activities Osteos can reduce symptoms and advice exercises to help prevent further problems
56
Adult degenerative scoliosis
Complex problem created by combo of degeneration of discs, arthritis in facets and osteoporosis Asymmetric force causes vertebra to unevenly settle upon themselves, rotate, and create spinal curve Curvature creates increasing asymmetric forces on concave part of curve As curve increases, forces increase and accelerate the process Commonly associated with loss of lumbar lordosis, producing flat back syndrome
57
Epidemiology of adult degeneration scoliosis
Associated with ageing Predisposing factors including injury, herniated disc, prior back surgery, osteoporosis More common in women and may have familial, genetic basis
58
Age group associated with adult degenerative scoliosis
Pt over 65, process initiated well before that age
59
Clinical presentation of adult degenerative scoliosis
Increase structural change may cause nerve irritation, creating symptoms in leg and/or foot May include pain radiating into buttocks or legs with activity, numbness burning or weakness Radiating symptoms vary with nerve roots affected Most common segments= L4/5 Palpable curvature of SPs, loss of lumbar lordosis, diminishing height and lower ribs settling closer to iliac crest
60
Prognosis of adult degenerative scoliosis
Daily exercise with focus on core strengthening or increase in activity tolerance recommended Anti-inflammatory drugs also prescribed Ease symptoms but cannot be completely cured
61
Rib # Hx
Sharp local P following trauma or prolonged cough
62
Rib # physical exam
Palpable crepitus Possible edema and/or discolouration P with chest motion
63
Rib # diagnostic test
X-ray
64
Rib subluxation Hx
Sharp local P or near spine with inspiration
65
Rib subluxation SSx
Palpatory tenderness and local myospasm
66

Orthopaedic Conditions (11 decks)

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