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MC > Thoracic Pain > Flashcards

Thoracic Pain Flashcards

1
Q

The commonest site of pain in the spine is
the costovertebral articulations especially the
______

A

costotransverse articulation

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2
Q

Pain of thoracic spinal origin may be referred
anywhere to the chest wall, but the commonest sites
are the

1
2
3`

A

scapular region,

the paravertebral region 2–5 cm from midline and, anteriorly, over the costochondral region

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3
Q

Thoracic (also known as dorsal) pain is more
common in patients with abnormalities such as
______ and _______

A

kyphosis and Scheuermann disease

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4
Q

T or F

Intervertebral disc prolapse is very uncommon in
the thoracic spine

A

T

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5
Q

T or F

The older patient presenting with chest pain should
be regarded as having a cardiac cause until
proved otherwise

A

T

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6
Q

The______ is the commonest site in the

vertebral column for metastatic disease.

A

thoracic spine

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7
Q

________ which affects the lower
thoracic spine in adolescents, is often associated with
kyphosis and recurrent thoracic back pain

A

Scheuermann disease,

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8
Q

The commonest cause of thoracic back pain is

musculoskeletal, due usually to ______

A

musculoligamentous strains caused by poor posture

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9
Q

Problems of the thoracic spine usually occur at the?

A

lower cervical and thoracic spinal joints, especially those of the midthoracic (interscapular) area.

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10
Q

The various systemic infectious diseases such
as _______ and _________can
certainly cause diffuse backache

A

influenza and Epstein–Barr mononucleosis

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11
Q

Acute infections should be suspected in the following conditions

young patients_______
farm workers_______ and

migrants from South-East Asia and third world countries _______

A

(osteomyelitis),

(brucellosis)

(tuberculosis).

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12
Q

The three common primary malignancies that
metastasise to the spine are those originating in the
1
2
3

A

lung, breast and the prostate (all paired structures

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13
Q

Less common primaries that mets to the spine

A

thyroid,

the kidney and adrenals and malignant melanoma

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14
Q

Primary malignancies that develop in the

vertebrae include ___ and_____

A

multiple myeloma and sarcoma.

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15
Q

An _____ and _____ of the thoracic spine
should be the initial screening test in the presence of
these red flags

A

ESR and a plain X-ray

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16
Q

A common trap for the thoracic spine is lung cancer,
such as _______ which can invade parietal pleura
or structures adjacent to the vertebral column

A

mesothelioma,

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17
Q

Two commonly misdiagnosed problems
are a________ presenting with
lower thoracic pain and ______, which
can cause thoracic back pain

A

penetrating duodenal ulcer

oesophageal spasm

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18
Q

Inflammatory rheumatological problems are not
common in the thoracic spine but occasionally a
spondyloarthropathy such as_______
manifests here

A

ankylosing spondylitis

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19
Q

the strongest evidence indicates that pain from the

thoracic spine originates mainly from the ____ and _____

A

apophyseal

joints and rib articulations

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20
Q

The costovertebral joints are synovial joints unique
to the thoracic spine and have two articulations—
_____ and ______

A

costotransverse and costocentral

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21
Q

A specific syndrome called the_______ has
been shown to cause vague pain and paraesthesia in
the upper limbs and diffuse, vague head and posterior
neck pain.

A

T4 syndrome

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22
Q

most of the pain, stiffness and
discomfort arise from dysfunction of the upper and
middle thoracic segments with patients presenting
with the complaint of ______

A

pain between ‘my shoulder

blades’.

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23
Q

The unique feature of the thoracic spine is the

_____

A

costovertebral joint

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24
Q

Dysfunction of the costo-vertebral joint
commonly causes localised pain approximately
______ from the midline where the rib articulates
with the transverse process and the vertebral

A

3–4 cm

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25
Q

Characteristics of pain which is thoracic in origin

1
2
3

A

Aggravation and relief of pain on trunk rotation

Aggravation of pain by coughing, sneezing or deep
inspiration.

Relief of pain by firm pressure

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26
Q

The younger person in particular should be
screened for _____ which becomes
more prominent on forward flexion

A

scoliosis

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27
Q

A useful sign of scoliosis is _____

A

unequal

shoulder levels and apparent ‘winging’ of scapula

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28
Q

Sequence of Palpation to reporduce patients’ pain:

1 central—over _______
2 unilateral—over_____
3 transverse—_______
4 unilateral—_____
5 unilateral—over ribs (spring over posterior rib
curve with ulnar border of hand, along axis of rib)

A

spinous processes

apophyseal joints (2–3 cm from midline)

on side of spinous processes

costotransverse junctions (4–5 cm from midline)

29
Q

There are four main movements of the thoracic
spine to assess, the most important of which is
__________as this is the movement that so frequently
reproduces the patient’s pain where it is facet joint or
costovertebral in origin.

A

rotation,

30
Q

Main investigation in thoracic pain?

A

The main investigation is an X-ray, which may
exclude the basic abnormalities and diseases, such as
osteoporosis and malignanc

31
Q

The most common cause of thoracic back pain in
children is ______ also known as ‘TV
backache’, which is usually found in adolescent
schoolgirls and is a diagnosis of exclusion

A

‘postural backache’,

32
Q

Inflammatory disorders to consider are_______ and _______ which may affect adolescent
males in the lower thoracic spine (around T9) and
thoracolumbar spine.

A

juvenile
ankylosing spondylitis and spinal osteochondritis
(Scheuermann disease),

33
Q

can be associated with back
pain, especially as the patient grows older. It is the
commonest cause of kyphosis

A

(Scheuermann disease

34
Q

______ is the normal curve of the thoracic spine
when viewed from the side. The normal range is
20–45 °

A

Kyphosis

35
Q

In children a congenital cause of Kyphosis is likely (present from infancy);

in adolescents it is usually due to ______
disease or is postural; in adults consider ______ and ______n the elderly

A

Scheuermann

ankylosing spondylitis—and osteoporosis i

36
Q

This is a structural saggital plane deformity of

unknown cause affecting the T7, 8, 9 or T11, 12 areas.

A

Scheuermann disease

37
Q

Xray findings of Scheuermann disease

A

Diagnosis confirmed by X-ray (lateral
standing)—shows Schmorl node and anterior
vertebral body wedging

38
Q

Exercises for Scheuermann disease

A

extension

39
Q

A degree of scoliosis is detectable in____ of the

adolescent population

A

5%

40
Q

_____ of significant

curves in adolescent scoliosis occur in girls.

A

Eighty-five per cent

41
Q

T or F

The routine physical screening check
of an adolescent should include dx of scoliosis

A

T

42
Q

Aims of Mx in Scoliosis

1
2
3

A

Aims
• To preserve good appearance—level shoulders
and no trunk shift
• Prevent increasing curve in adult life: less than 45 º
• Not to produce a straight spine on X-ray

43
Q

Rarely used brace for scolio

A

Milwaukee brace (rarely used)

44
Q

How is the brace used

A

high-density polyethylene underarm orthosis
— to be worn for 20–22 hours each day until
skeletal maturity is reached

45
Q

Guidelines for scoliosis surgery in patients who are still growing

A 
• Still growing:
<20 º observe (repeat examination + X-ray)
20–30 º observe, brace if progressive
30–45 º brace
≥ 45–50 º operate
46
Q

Guidelines for scoliosis surgery in patients whos growth are complete

A

Growth complete:
<45 º leave alone
>45 º operate
Referral to consultant: >20

47
Q

Dysfunction of the thoracic spine is also known as

A

thoracic

hypomobility syndrome

48
Q

Mx of thoracic hypomobility syndrome

______ is helpful but the more forceful
______ produces better and quicker
results

A

Spinal mobilisation

manipulative therapy

49
Q

Spinal mobilisation and manipulation

The ______ technique is widely used for upper thoracic segments and the ________ (patient prone) or posteroanterior indirect thrust

A

sternal thrust (Nelson hold)

crossed pisiform technique

50
Q

There is _______ evidence that spinal

manipulation is effective compared with placebo

A

level II

51
Q

Most disc
protrusions occur below_____, with the commonest site,
as expected, being ______

A

T9

T11–12.

52
Q

What condition?

The common presentation is back pain and
radicular pain that follows the appropriate dermatome
so disc protrusion should be considered in patients with
neurological signs at thoracic levels. This may include a
flaccid area of the lower abdominal musculature

A

Thoracic disc protrusion

53
Q

The disc is relatively
inaccessible to surgical intervention, but over the past
decade there has been a significant improvement in
the surgical treatment of thoracic disc protrusions,
due to the _______

A

transthoracic lateral approach

54
Q

It is a rare, fluid-filled neurological
cavity within the spinal cord. It is usually a congenital
anomaly, but a neoplasm needs to be excluded

A

Syrinx

55
Q

A syrinx

usually begins at the ____ level and extends down

A

cervical

56
Q

Muscle injury is due to_____, ______, _____

can cause pain.

A

injury of intercostal muscles, the serratus anterior and the

musculotendinous origins of the abdominal muscles

57
Q

Several muscles including the _____, ______, ____
help stabilise scapular movement and may be a source
of pain in the scapular region.

A

rhomboids, serratus anterior and levator scapulae

58
Q

The patient complains of a loud cracking or snapping
sound upon abduction of the scapula. There is often
associated crepitus. What condition?

A

Snapping scapula

59
Q

CAuse of snapping scapula

A

bony spur on the superior

border of the scapula or an osteoma

60
Q

This condition causes localised pain and tenderness,
often severe, along the upper part of the medial
scapular border, with radiation around the chest wall
and shoulder girdle to the neck

A

Scapulocostal syndrome

61
Q

Causes of Scapulocostal syndrome

A

friction between the scapula and
the thoracic wall, scoliosis, trauma and myofascial
strain due to poor posture

62
Q

Common cause of winging of the scapula

A

The
common cause is neurogenic paralysis of the serratus
anterior muscle

63
Q

_________ is relatively uncommon but when
encountered presents an enormous management
problem. It is not to be confused with so-called
fibrositis or tender trigger points.

A

Fibromyalgia

64
Q

Cause of fibrositis

A

It
is probably almost always secondary to upper thoracic
or lower cervical spinal dysfunction

65
Q 
Other features/association of fibromyalgia
1
2
3
4
A

• Poor sleep pattern
• Dermatographia
• Fatigue (similar to chronic fatigue syndrome)
• Psychological disorders (e.g. anxiety, depression,
tension headache, irritable digestive system

66
Q

Thoracic back pain is frequently associated with

_______lesions

A

cervical

67
Q

Upper thoracic pain and stiffness is common after

_____

A

‘whiplash

68
Q

Symptoms due to a fractured vertebra usually last

_______

A

3 months and to a fractured rib 6 weeks

69
Q

Consider multiple myeloma as a cause of an

________

A

osteoporotic collapsed vertebra

MC (90 decks)

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