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Thoracic Spine & Ribs - working Flashcards

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1
Q

Describe a pancoast tumor.

A

Tumor at apex of lung.

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2
Q

A pancost tumor may involve what neurological structures?

A

C8-T1

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3
Q

Pancoast tumors present similar to

A

MSK origin, especially TOS

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4
Q

Symptoms of a pancoast tumor include

A
  • Chronic cough + blood sputum (red flag)
  • Unexplained weight loss
  • Malaise
  • Dyspnea
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5
Q

Pancoast tumor physical exam findings

A
  • Fever
  • Wheezing
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6
Q

What non-MSK diagnoses should be included for the thoracic spine?

(Visceral Pain Patterns)

A
  • MI
  • Pericarditis
  • Pneumothorax
  • Abdominal Organs
  • Pleuropulmonary disorders
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7
Q

Vertebral body fractures can be divided based on what portion of the vetebrae they involve. What are those parts?

A
  • Anterior column
  • Middle column
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8
Q

Posterior component vertebral fractures involved what anatomic structures?

A

Posterior column

Transverse processes, spinous processes, etc.

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9
Q
A
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9
Q

Why are vertebral fractures dangerous?

A
  • Increase mortality
  • Predictor for subsequent vertebral fractrue (4-5x) and hip fracture (3x)
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10
Q

The three classification elements fo the TLICS include:

A
  • Morphology
  • Integrity of Posterior Ligamentous Complex (PLC)
  • Neurologic status
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11
Q

The posterior ligamentous complex includes

A
  • Supraspinous ligament
  • Intraspinous ligament
  • Ligamentum flavum
  • Z-joint capsule
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12
Q

3 Morphologies of Vertebral Fractures

A
  • Compression
  • Rotation/Translation
  • Distraction
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13
Q

Compression vertebral fractrure types

A
  • traditional compression
  • Burst
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14
Q

Traditional Compression Fractures
- Stable v unstable?
- What portion of vertebrae involved?

A

Stable, anterior column

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15
Q

A common mechanism resulting in traditional compression fractures includes:

A

Axial loading in a flexed position (trauma: high energy v osteoporotic)

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16
Q

Burst Fractures
- What portion of vertebrae is involved?
- Most common region of spine involved?

A
  • Anterior/Middle columns
  • T/L junctions (T12/L1)
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17
Q

Common MOI for burst fractures?

A

high force axial load (+/- flexion)

MVC, Fall from height, high-sport injury

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18
Q

Rotation/Translation vertebral fractures are associated with what MOI?

A
  • Fall from a height
  • Heavy object falling on body with bent trunk
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19
Q

What force is involved in a rotation/translation vertebral fracture?

A

shear + torsion

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20
Q

Which fracture type can result in dislocation of the facet joints?

A

Rotation/Translation

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21
Q

Distraction Vertebral fractures occur due to

A

a tensile load

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22
Q

What segments of the spinal column are invovled in distraction vertebral fractures?

A

Anterior and posterior column.

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23
Q

RED FLAGS associated with vertebral fractures

A
  • Bruising/Abrasions (trauma)
  • Older Age
  • Significant trauma
  • Corticosteroid use
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24
Henschke recommends clustered findings to identify vertebral fractures. They include:
- Age >70 Y - Significant trauma - Prolonged corticosteroid use - Sensory alterations from trunk down | Think trauma!!
25
Roman proposed clusters of findings that suggest a vertebral compression fracture in the osteoporotic individual, including:
- Age >52 Y - No presence of leg pain - BMI
26
Scheuermann's Disease
defective growth of vertebral endplate (poor vascularized disc)
27
Proposed etiology of Scheuermann's disease includes:
- genetics - Excessive stress on pre-disposed (weak) endplate
28
Risk of Scheuermann's disease increases amoung...
- Manual workers who begin at early age - High intensity athletes? - High BMI - "Short sternum"
29
What is the criteria for diagnosis of Scheuermann's disease?
- Thoracic kyphosis >45º - Wedging x3 adjacent vertebrae >5º - Thoracolumbar kyphosis >30º
30
Symptoms of Scheuermann's disease
- Thoracic pain, commonly apex of curvature | Due to muscular tension, IV disc bulging/spondylosis. ## Footnote Potentially lumbar pain
31
Disc Disease is most common where in the T-spine?
Lower T-spine, T8-T12
31
Physical examination findings of Scheuermann's disease
- Scoliosis - Excessive thoracic kyphosis/compensatory hyperlordosis - Rounded shoulders, forward head - Pelvic rotation - Vertebral wedging - Schmorl's nodes - Disc space narrowing - Limited thoracic ROM - Neurological complications (less common)
32
Herniation occuring with disc disease typically occurs where?
- Central - Lateral - Posteriolateral
33
How does disc disease typically occur?
Degeneratively
34
Symptoms of disc disease include
- Midline back/chest pain that is radicular, band-like in affected level's dermatome - Paresthesia/anesthesia that is radicular, band-like in affected level's dermatome - Leg pain - Progressive/insidious (months to years)
35
Physical exam findings of disc disease
Commonly asymptomatic, but presents variably. Potential for myelopathy.
36
Health conditions related to thoracic spine myelopathy include?
- Compression Fracture - Stenosis
37
Symptoms of thoracic spine myelopathy
- Sexual dysfunction - Bowel and bladder dysfunction
38
Physical exam findings for thoracic myelopathy include
- Sensory/motor impairments - UMN signs LEs
39
Intercostal Neuralgia etiologies
- Traumatic injury - Infection - Mechanical compression (disc protrusion, osteophyte comples, neuroma, fracture)
40
Symptoms of intercostal neuralgia includes
- Burning pain - Paresthesia/anesthesia Occurs along intercostal nerve path
41
Physical Examination of intercostal neuralgia
- Focal tenderness of intercostal area - Dermatomal distribution of rash with grouped vesicles and pustules (herpes zoster/shingles)
42
T4 Syndrome etiology?
Unknown, thought to be a sympathetic reaction with hypomobile segment
43
What patient population is commonly affected with T4 syndrome?
Women
44
T4 Syndrome most commonly affects
T2-T7
45
Primary pain generators with T4 syndrome include
- Thoracic IV disks - Thoracic Z-joints
46
Symptoms of T4 syndrome include
- **glove-like** paresthesias (unilateral or bilateral UEs) - Neck/scapular/bilateral UE pain (constant or intermittent) - Pain worsens in side-lying or supine - Generalizes HA
47
Physcial Examination findings of T4 syndrome include:
- Tender spinous process - +Thoracic Slump Test - +Upper quarter neurodynamic tension tests - Hypomobile thoracic segment
48
Scoliosis is named for
the convexity and invovled region based on the patient's left and right
49
Scoliosis etiology
- congenital: adolescent idiopathic - aquired: degenerative
50
Zygopophysial Arthropathy Symptoms + Physical Exam
- Local +/- referred pain - Painful movement with closing Z-joints (AROM=PROM) - Painful spring testing/hypomobile with joint mobility testing
50
Scoliosis
coronal and rotational (transverse) spinal deformities
51
Why do rib fractures raise concern?
Potential for brachial plexus/vascular damage, laceration of pleura, lungs and abdominal organs
52
What treatment is NOT supported to rib fractures?
Taping/strapping
53
How long do rib fractures take to become stable?
~6 weeks
54
Symptoms and physical exam findings of a rib fracture includes:
- Focal pain, radiating pain - Pain with inspiration - Pain with coughing/sneezing - Focal tenderness - Possible palpable defect
55
How many rib(s) does costochondritis involve?
1 or more rib
56
Costochondritis is likely due to ____ and resolves within ______
repetitive stress, one year.
57
Symptoms and physical exam of costocondritis
- Pain and local tenderness at costochondral or chondrosternal articulations (at rest, trunk movement, respiration) - Local tenderness - Painful with chondrosternal joint mobility testing
58
Rib dysfunction
inflammatory or degenerative health conditions
59
3 types of rib dysfunction
- Structural - Torsional - Respiratory
60
Structural rib dysfunction
subluxation of joint (anterior or posterior)
61
Torsional rib dysfunction
- rib held in rotated position
62
Respiratory rib dysfunction
related to posture, may affect respiration
63
Rib Dysfunction symptoms and physical exam findings
- Aggravated with deep inspiration, trunk rotation, sneezing/coughing - Diminished rib mobility (structural) - Pain/hypomobility with joint testing - Limited/painful thoracic spine motion

Spine MSK (6 decks)

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