Thoracic Spine and Rib Cage part 2

Question 1

Describe respiratory pain of costochondritis.

Answer 1

Pain is localized to costal cartilages - tender to palpation
Dull, aggravated by shoulder movement
Typical symmetry for 3, 4, 5 joints

Question 2

What are the symptom of costochondral pain?

Answer 2

Pain in anterior chest wall

Question 3

What are the physical findings of costochondral pain?

Answer 3

Tenderness at costochondral junction

Possible rib dysfunction

Question 4

What is the OMT treatment for costochondritis?

Answer 4

Anterior cartilages may be site of multiple counterstrain tender points
Could be attempted but won’t be fixed in true costocondritis
Treat rib dysfunctions

Question 5

What are the drug treatments for costochondritis?

Answer 5

Analgesics : lidocaine
NSAIDs
Oral and Inject cortiocosteriods

Question 6

Describe Tietze sydrome.

Answer 6

Palpable fusiform swelling of costal cartilage
Generally asymmetric involving cartilages 2 and 3
Maybe post-viral: parvo B19
Usually before age 40

Question 7

What is the OMT treatment for Tietze syndrome?

Answer 7

Correct accompanying costal and thoracic segmental dysfunctions
Use thoracic pump and splenic stimulation to boost immune response

Question 8

What is the drug treatment for Tietze syndrome?

Answer 8

Analgesic: lidocaine
NSAIDs
Oral and Inject corticosteriods

Question 9

What could cause respiratory pain due to infections (fever)?

Answer 9

Herpes Zosters, pleurisy, epidemic pleurodynia, osteomyelitis, epidural abcess, infectious chondritis, periodtitis

Question 10

How is herpes zoster diagnosed?

Answer 10

Classic dermatomal rash that does not cross the midline
Maybe proceeded by intercostal neuralgia for several days before rash appears
May develop post hepatic neuralgia

Question 11

What is intercostal neuralgia?

Answer 11

Tenderness occurs at the cutaneous branches of the intercostal nerve
Paraspinal, parasternal, mid-axillary

Question 12

When is the incidence for herpes zoster the highest?

Answer 12

6th through 8th decade of life

2% of pts will endure a second round

Question 13

What are some characteristics of herpes zoster?

Answer 13

Commonly effects T3-L3 dermatomes
Pain may precede onset on lesions by 48/72 hours
Vesicles for 7-10 days
Skin may take 2-4 weeks to become normal
People rarely have the pain without the rash

Question 14

What is the OMT treatment for herpes zoster?

Answer 14

Treat segmental and costal dysfunctions at rash levels
Painful- but prevents post-herpetic neuralgia
Thoracic pump and splenic stimulation to enhance immune response

Question 15

What us the drug treatment for herpes zoster?

Answer 15

Valacyclovir
Famcyclovir
Acyclovir

Question 16

What is the pain management for herpes zoster?

Answer 16

Analgesics: opiates and lidocaine
Tricyclic antidepressants: nortiptryline
Glucocorticoids: tapering dose

Question 17

What should be done is the person with herpes zoster gets post-herpatic neuralgia?

Answer 17

Antiseizure meds: gabapentin, topiramate, lamotrigine, etc.

Question 18

How is herpes zoster prevented?

Answer 18

Herpes zoster vaccine

Question 19

Describe respiratory pain from pleurisy.

Answer 19

Knife like- shooting pain
Fever, CBC-leukocytosis
Pleural friction rub
Pain sensed in thoracic wall

Question 20

Describe the pleura in terms of pain.

Answer 20

Parietal pleura is sensitive, visceral pleura is not

Pleura innervated by overlying intercostal nerves

Question 21

What is the OMT treatment for pleurisy?

Answer 21

Depends on underlying disease

Treat involved areas, improve costal motion (prevents formation of pleural adhesion)

Question 22

Describe diaphragm innervations

Answer 22

Periphery of diaphragm is innervated by T6 and T7 nerve roots
Central tendon region supplied by phrenic nerve (C3,4, 5)
Phrenic nerve inn both the thoracic side of diaphragm and abdominal side of diaphragm

Question 23

Describe diaphragmatic pain.

Answer 23

Pain is sensed at T6 lvl, pts with diaphragmatic pleuroisy or upper ab disease sense the pain in lateral neck and shoulder

Question 24

Describe respiratory pain from epidemic pleurodynia.

Answer 24

Bornholme disease, devil’s grip
Severe paroxysms of thoracic and ab pain
Fever, headache, pharyngitis, no leukocytosis

Question 25

What is the etiology of epidemic pleurodynia?

Answer 25

Coxsackie B. echo virus

Question 26

What are some complications of epidemic pleurodynia?

Answer 26

Pericarditis, orchitis

Question 27

How is epidemic pleurodynia diagnosed?

Answer 27

Rising viral titers Pt w/ ventilator due to hypoxia Pain severe end up in CCU w/ Dx of R/O myocardial infarction or R/O dissecting aneurysm

Question 28

What could cause intercostal neuralgia?

Answer 28

``` Tabes dosalis (neurosyphillis) Neoplasm Potts disease (TB of spine) Neurofibromatosis Fracture Callous ```

Question 29

What is notalgia paresthetica?

Answer 29

Sensory neuropathy involving one the doral cutaneous rami of the upper thoracic region

Question 30

What are the symptoms of notalgia paresthetica?

Answer 30

Pruritis Local dysesthesia Local hyperesthesia Local skin hyperpigmentation

Question 31

What is the treatment for notalgia paresthetica?

Answer 31

``` OMT Lidocaine patch Paravertebral nerve block Botulinum toxin injection Anticonvulsant meds Transcutaneous electrical nerve stimulation ```

Question 32

Describe referred pain doe to rib pain.

Answer 32

Pain is sensed in deep tissue, bot skin Not always reproducible Looks for somatic dysfunction at spinal lvl associated with various viscera Chapman's reflex presence

Question 33

What is xiphalgia?

Answer 33

``` Painful prominent xiphoid Xiphisternal arthritis (syncondrosis) ```

Question 34

What is Dercum disease?

Answer 34

Adiposa dolorosa Painful obesity Peripheral stretch neuropathy from weight of rolls of hanging fat

Question 35

What is mondor disease?

Answer 35

Thrombophebitis of the thoracoepigastic vein Run in anterial-lateral abdomen and thorax (from femoral vein to axillary vein) Tender palpable cord (maybe visible) Potential complication of mastitis breast and abdominal surgeries

Question 36

How does one obtain rachitic rosary and what occurs when healed?

Answer 36

Rickets | Healing obliterates the costochondral knobs

Question 37

Describe the etiology of pectus exavatum.

Answer 37

Funnel breast, Trichterbrust Can come from genetics, rickets, marfans, cobbler chest Depression of the chest inwards Associated w/ mitral vavle prolapse 27% of women w/ mycobactrium avium Very severe can cause cardiopulm compromise

Question 38

Describe pectus carinatum/

Answer 38

Pigeon breast | Genetic, rickets, marfans, congential heart disease, kyphoscoliosis

Question 39

Describe the etiology of harrison grooves.

Answer 39

Genetics, rickets, young pregnancy, prune belly syndrome

Question 40

Describe the etiology of barrel chest.

Answer 40

Genetics, kyphosis, pulmonary emphysema

Question 41

How would a person obtain lumps, bumps and depressions?

Answer 41

Malnutrition, cardiac enlargement (bulging precordium), rickets, aortic aneurysm, neoplasm, abscess