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Diff Dx > Thoracic spine pain > Flashcards

Thoracic spine pain Flashcards

1
Q

acute pain is often from?

A

compression fractures or muscle spasm

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2
Q

what are the reasons for pain or deformity in young patients?

A

scoliosis and hyperkyphosis (scheueremann’s)

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3
Q

what are the reasons for pain or deformity in adults?

A

chronic postural problems, long term scoliosis problems

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4
Q

what are the reasons for pain or deformity in seniors?

A

compression fractures

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5
Q

how do you tell between a T1 and a T2 weighted image?

A

T1: dark CSF
T2: white CSF

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6
Q

red flags for thoracics

A

trauma, history of cancer, corticosteroid use, history of infection, drug or alcohol abuse
older: weight loss, history of cancer, night pain or fever

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7
Q

when examining the thoracic spine, what should you look for?

A 
deformity
skin lesions
AROM, PROM, Resisted ROM
prone extension test
Adam's test
palpate and percuss area of complaint
radiography if needed
specialized imaging if needed
labratory investigation if needed
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8
Q

how do you tell the difference between osteoporosis, lytic mets or multiple myeloma?

A

old films, if not helpful, go to labs (CBC, ESR, C-RP, BCP, UA)

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9
Q

if the labs look like they have lytic mets, what is going to happen next?

A

bone scan

if there are hot spots, do MRI, then biopsy

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10
Q

if the labs look like they have multple myeloma, what is going to happen next?

A

PEP (protein electrophoresis), if there is an M spike, then they get a skeletal survey, then they get an MRI, then biopsy

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11
Q

what is the most likely reason for pathological fracture in a child?

A

eosinophilic granuloma

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12
Q

what cells are involved with eosinophilic granuloma?

A

langerhans cell histiocytosis (LCH)

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13
Q

describe EG

A

proliferation of langerhans cells with an abundance of eosinophils, lymphocytes and neutrophils (produce prostaglandins, cause medullary bone resorption)
lesions may be ansymptomatic

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14
Q

what are symptoms of EG if there are symptoms?

A

pain, swelling, tenderness around lesion

malaise, occasionally fever with leukocytosis

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15
Q

describe osteoid osteoma demographic, pain and general location.

A

young male (10-25)
localized mid back pain
pain worse at night relievedby salicylates
metaphyseal region of long bones

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16
Q

what are the signs and symptoms that can be in the thoracic spine?

A 
postural problems
stiffness
deformity
scapular winging
Sprengel's deformity
buffalo hump 
dowager's hump
acute angle kyphosis
hyperkyphosis
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17
Q

lower costovertebral pain can be referred pain from?

A

kidney

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18
Q

mid thoracic/scapular pain can be referred pain from?

A

gallbladder

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19
Q 
thoracic sprain/strain
ortho
neuro
AROM 
PROM
radiography
recommendations
A

ortho: none
neuro: none
AROM: pain that contracts involved muscle
PROM: pain at end range of involved muscle or ligament
radiography: not required unless significan trauma
recommendations; myofascial therapy, limited orthotic support, ergonomic advice, preventative exercises and stretches

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20
Q

neuritis or radiculitis signs and symptoms, ortho, neuro, aROM, PROM, recommendations

A

radiation along rib
pain radiate with valsalva
ortho: valsalva may increase pain
neuro: deficit in corresponding dermatome or myotome
AROM: variable weakness
PROM: variable
recommendations: MRI if no progression, limited orthotic support, myofascial therapy

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21
Q

facet syndrome signs and symptoms, ortho, neuro, AROM, PROM, recommendations

A

signs and symptoms: may radiate along rib, but not usually, hyperextension increases local or radiating pain
ortho: Kemp’s or hyperextension
neuro: none
AROM: variable
PROM: variable
recommendations: myofascial therapy, limited orthotic support, ergonomic advice, preventative exercises and stretches, avoid hyperextension

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22
Q

describe Scheuermann’s disease

A

13-17 years, slight male predominance
mid back pain and fatigue
increased kyphosis
vertebral growth plate trauma
anterior wedging greater than 5 degrees in 3 consecutive vertebra
decreased disc height and end plate irregularity

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23
Q

what is the most likely place for scheuremann’s? second most common?

A 
mid thoracic region (75%)
thoracolumbar region (25%)
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24
Q

prone extension test

A

pt prone, place hands behind back, bring head up as far as you can

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25
Q

prone extension test findings

A

persistence of kyphosis indicates structural kyphosis

if it improves, it is a functional kyphosis

26
Q

describe what to do with someone with scheuermann’s

A

<60 degree curve- conservative, stretching, postural changes, hamstring stretching
60-80 degrees- brace
>80 degrees- surgery

27
Q

when is an orthopedic consultation needed for scheuermann’s?

A

when the patient is skeletally immature

28
Q

when can older patients get a compression fracture? Young patients?

A

older- could be a minor event (sneezing, stepping off curb, etc.)
younger- fall on butt or hyperflexion injury)

29
Q

what are signs/symptoms of compression fracture?

A

sharp kyphotic angle
pain on percussion and deep pressure
anterior step defect and zone of impaction

30
Q

when is a fracture unstable?

A

when more than 1 column has decreased in height or iif the middle segment has flattened.

31
Q

radiographic features of osteoid osteoma

A

acute angle scoliosis
lesion usually on concave side
small density that surrounds a central radiolucent nidus
bone scans or CT may be needed

32
Q

what needs to happen after an osteoid osteoma is confirmed?

A 
complete surgical excision of the nidus
little chance of recurrence
vertebral body lesions may be irradiated
percutaneous radiofrequency ablation is the preferred treatment option
resolve spontaneously in ~33months
33
Q

what are the different possibilities of a missing pedicle?

A

congenital
destructive
surgical

34
Q

what are the different possibilities if the missing pedicle is destructive?

A

bone tumor (lytic mets, primary (ABC, osteoblastoma))
soft tissue tumor (neurofibroma)
infection

35
Q

possible radiographic changes with infection

A 
osteopenia
soft tissue swelling
decreased joint space
lytic destructive changes
periosteal reaction
involucrum
cloaca with potential draining sinus
sequestrum
sclerosis
debris
ankylosis
36
Q

herpes zoster

A

shingles
acute, painful dermatomal dermatitis (blistering skin eruption)
presence of immunosupression

37
Q

describe how herpes zoster occurs

A

virus travels from skin and mucosal surfaces to the sensory ganglia, lies dormant
only reactivates with immunosupression, emotional stress, trauma, irradiation, surgical manipulation of spine

38
Q

signs and symptoms of herpes zoster

A

pain, blistering skin eruption with a dermatomal distribution
nerve pain
rash typically resolves in 2-4 weeks, nerve pain may continue for months to eyars after lesions have healed

39
Q

definition of a scoliosis

A

lateral deviation of >15 degrees and rotation of the spine, often associated with thoracic hypokyphosis
severe disease distorts chest wall enough to restrict pulmonary and cardiovascular function
cosmetic deformity may also be serious

40
Q

functional scoliosis

A

postural, compensatory reversible curve due to another condition (limb length, painful muscle spasm)

41
Q

structural scoliosis

A

nost postural, characterized by structural skeletal changes such as vertebral rotation and wedging and rib deformation

42
Q

idiopathic scoliosis

A

70-80% AKA familial scoliosis

not associated with dysmorphic features, skin lesions, bone fragility or neuromuscular disease

43
Q

congenital scoliosis

A

10%, errors of formation (hemivertebra) or errors of segmentation(unilateral bar, worsens gradually), commonly associated with genitourinary anomalies, curves present at birth, up to 75% require treatment

44
Q

neuromuscular scoliosis

A

15%
associated with any disease that causes weakness of spastic imbalance of paraspinal muscles in growth child, including cerbral palsy, muscular dystrophy, spinal muscular atrophy, spinal cord injury; may develop at any age in growing child but doesn’t occur after skeletal maturity

45
Q

dysmorphic syndrome (scoliosis)

A

neurofibromatosis, Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta, homocystinuria

46
Q

infantile scoliosis

A

by age 3, more common in boys and Europeans, usually resolves spontaneously

47
Q

juvenile scoliosis

A

4-10 years

48
Q

adolescent scoliosis

A

age 10 years until skeletal maturity, most significant and prevalent form, can become worse during growth spurt

49
Q

when do you send someone with a scoliosis to an orthopedist

A

if they have changed 5 degrees or more in a 3 month time period

50
Q

nash moe method

A

determines the rotational component of the vertebrae

51
Q

risser sign

A 
risser 1- 1/4 of bone
risser 2- 1/2 of bone
risser 3- 3/4 of bone
risser 4- all bone, not fused
risser 5- all bone, fused
52
Q

when is someone considered a good surgical candidtate for scoliosis?

A

> 50 degrees

53
Q

when do you send someone with scheuermann’s to an orthopedist?

A

if they are still growing

54
Q

how do you determine osteoporosis from lytic mets from multiple myeloma?

A

history, clinical presentation, old films

if films are not helpful, do labs

55
Q

if the labs look like osteoporosis, what do you do?

A

adjust

56
Q

if the labs look like lytic mets, what do youdo?

A

bone scan
MRI
biopsy

57
Q

if the labs look lke multiple myeloma, what do you do?

A

PEP (urine and blood)
skeletal survey
MRI
biopsy

58
Q

PET scan

A

positron emission tomography

radiotracer such as fluorodeoxyglucose (FDG), which contains both sugar and radioactive elements

59
Q

what happens physiologically if someone has eosinophilic granuloma?

A

proliferation of Langerhans cells with an abuncance of eosinophils, lymphocytes and neutrophils. the cells produce prostaglandins which result in medullary bone resorption

60
Q

what are some symptoms of eosinophilic granuloma

A

pain, swelling and tenderness around lesion

malaise, fever, leukocytosis

61
Q

what are the ddx for decreased disc height?

A

joint disease
developmental
infection

62
Q

what is the ddx of ivory vertebra?

A

blastic mets
lymphoma
pagets

Diff Dx (17 decks)

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