Ortho Path Lecture 9

Front 1

What is another name for pectus carinatum?

Back 1

Pigeon chest

Front 2

*Which way is the sternum projecting with pigeon chest?

Back 2

Sternum projects forward and downward (like the heel of a boot)

Front 3

Is the anterior-posterior dimension of the chest increased or decreased with pigeon chest?

Back 3

Increased

Front 4

*How does pigeon chest effect breathing?

Back 4

Impairs effectiveness of breathing by restricting ventilation volume. Respirations are inefficient.

Front 5

What is the treatment for pigeon chest?

Back 5

Bracing - direct pressure to the area 14 - 24 hours/day

Front 6

What is another name for pectus excavatum?

Back 6

Funnel chest

Front 7

*Which way is the sternum projecting with funnel chest?

Back 7

Sternum pushed posteriorly by an overgrowth of the ribs

Front 8

Is the anterior-posterior dimension of the chest increased or decreased with funnel chest?

Back 8

Decreased

Front 9

*What can potentially happen to the heart with funnel chest?

Back 9

The heart may be displaced

Front 10

What happens to the sternum during respiration with funnel chest?

Back 10

On inspiration, a depression of sternum occurs with respiration

Front 11

Is there a potential for kyphosis to develop in those who have funnel chest?

Back 11

Yes

Front 12

What is the treatment for funnel chest?

Back 12

Nuss bar or saline/silicone implant

Front 13

*Which way is the sternum projecting with barrel chest?

Back 13

Sternum projects forward and upward

Front 14

Is the anterior-posterior dimension of the chest increased or decreased with barrel chest?

Back 14

Increased

Front 15

*Is barrel chest secondary to any conditions?

Back 15

Yes, emphysema or COPD (chronic bronchitis)

Front 16

How does barrel chest effect breathing?

Back 16

The bronchi are narrowed and there is a decreased compliance of the lung

Front 17

What type of athlete is commonly seen with a barrel chest?

Back 17

Competitive swimmers

Front 18

*Is a disc prolapse common in the thoracic spine?

Back 18

Disc prolapse extremely rare in thoracic spine due to thick PLL and rib head

Front 19

If a disc prolapse were to happen in the thoracic spine, what are the three most common areas?

Back 19

(1)T7-8, (2)T6-7, (3)T9-10

Front 20

Do males or females have a greater incidence for OA?

Back 20

Males

Front 21

What is the peak age of incidence of OA?

Back 21

40's (30 - 60 range)

Front 22

How does OA/DJD start?

Back 22

With dehydration of the discs

Front 23

Where can the pain be with a disc bulge?

Back 23

Posterior, anterior, or radicular

Front 24

*If a patient's pain shoots through the chest and feels like a heart attack, what is the likely spinal source of pain?

Back 24

Discal

Front 25

*If a patient's pain refers horizontally around the chest what is the likely spinal source of pain?

Back 25

Synovial joint (rib out)

Front 26

*If a patients pain is in the plane of the ribs in the intercostal space what is the likely spinal source of pain?

Back 26

Nerve root (shingles)

Front 27

With a disc bulge, what are the patient's movements like?

Back 27

All movements are severely limited and extremely painful

Front 28

*Where is a common location for myelopathy of the spinal cord?

Back 28

Spinal canal is very small at T6-9 levels

Front 29

How would the patient present with a disc bulge?

Back 29

Patient presents in a flexed posture, unwilling to move, spasm, breathing difficult, increased pain with compression and decreased with traction

Front 30

*What is tuberculosis of the spine?

Back 30

Bacterial infection that spreads from the lung to the spine

Front 31

*What is the infection called once tuberculosis has infected the spine?

Back 31

Pott's disease

Front 32

*Where is the most common site for Pott's disease?

Back 32

Most common sites are lower thoracic and upper lumbar vertebrae

Front 33

*How and where does Pott's disease progress?

Back 33

Slow and progressive bone destruction in anterior vertebral body

Front 34

Do any other pathologies accompany Pott's disease?

Back 34

Accompanied with generalized osteoporosis

Front 35

What is osteochondrosis?

Back 35

An umbrella term to describe an interruption of the blood supply usually due to a growing epiphysis. Avascular necrosis falls under this umbrella.

Front 36

*When osteochondrosis called when it occurs in the spine?

Back 36

Scheuermann's disease

Front 37

Is Scheuermann's disease common or uncommon?

Back 37

Is fairly common but poorly understood

Front 38

Does Scheuermann's disease affect boys or girls?

Back 38

Affects both boys and girls

Front 39

When does Scheuermann's disease usually begin?

Back 39

Usually begins at puberty and progresses during adolescence. Is inherited in some cases.

Front 40

*How many vertebral bodies does Scheuermann's disease effect?

Back 40

Commonly involves 3 or 4 anterior vertebral bodies in mid to lower thoracic region (looks sort of like compression fractures).

Front 41

Are patient's with Sheuermann's disease susceptible to any other pathologies?

Back 41

Patient's usually end up hyperkyphotic and are more susceptible to early OA.

Front 42

Does Sheuermann's disease continue to spread throughout the spine?

Back 42

No, it usually stops after 3 - 4 vertebrae.

Front 43

*What is a Schmorl's node?

Back 43

It is a growth disturbance of the anterior aspect of the endplate (epiphyseal plate) on the vertebral body.

Front 44

*How does a Schmorl's node develop?

Back 44

Avascular necrosis affects the endplate/vertebral body. *Herniation of the IVD occurs through the endplate and into the vertebral above.

Front 45

What is the result of a Schmorl's node?

Back 45

This results in less disc material between vertebral bodies.

Front 46

How does Sheuermann's disease result in wedge-shaped vertebral bodies?

Back 46

The anterior VB stops growing

Front 47

*Are the symptoms with Sheuermann's disease mild, moderate, or severe?

Back 47

Symptoms are usually mild. No treatment is usually required. Patient will complain of diffuse, achy mid back.

Front 48

What is thoracic outlet syndrome (TOS)

Back 48

Consists of a group of distinct disorders that affect the nerves of the brachial plexus and various nerves and blood vessels between the base of the neck and axilla. For the most part, these disorders have very little in common except the site of occurrence.

Front 49

What are four other names for TOS?

Back 49

(1)Cervical rib syndrome, (2)Costo-clavicular syndrome, (3)Scalenus anticus syndrome, (4)Hyper-abduction syndrome

Front 50

What is the most common cause of TOS?

Back 50

Cervical rib syndrome

Front 51

*Where do the nerves of the brachial plexus emerge from?

Back 51

The neurovascular bundle emerges through a triangle formed by the scalenus anterior, scalenus medius and the first rib. It passes behind anterior scalene and over first rib (neurovascular bundle).

Front 52

Which way might the neurovascular bundle be pushed if there is a cervical rib (elongated TVP of C7) or a fibrous band extending from C7 TVP to the first rib?

Back 52

Upwards

Front 53

*Which part of the brachial plexus is usually effected by TOS?

Back 53

Lower part of the brachial plexus is usually affected (usually C8-T1)

Front 54

Is it possible to have no symptoms during examination?

Back 54

Compression is intermittent so there may be no neurological deficit upon examination.

Front 55

*What are four factors that can worsen the symptoms of TOS?

Back 55

*(1)Drooping shoulders (poor posture) (causes shortened scalenesO, (2)Widened or abnormal insertions of scalenes, (3)Pancoast’s Tumor (lung cancer) (pushes up & compresses structures), (4)Full abduction of upper extremity

Front 56

*Is TOS more common in men or women?

Back 56

Women

Front 57

Is the onset of TOS gradual or sudden?

Back 57

Gradual

Front 58

*Are nerve compressions more or less common than vascular symptoms?

Back 58

More

Front 59

*What does a nerve compression result in?

Back 59

Causes tingling & numbness in the little finger and medial hand and forearm

Front 60

What can longterm compression result in?

Back 60

Weakness in hands in severe cases

Front 61

What are two vascular symptoms of TOS?

Back 61

(1)Coldness of fingertips, (2)Discoloration of fingertips

Front 62

What is the most common test for TOS?

Back 62

Adson's test

Front 63

Which muscle does Adson's test examine?

Back 63

Anterior scalenes

Front 64

Describe the five steps of Adson's test.

Back 64

(1)The examiner locates the radial pulse, (2)The patient rotates head toward the tested arm, (3)The patient then extends the head while the examiner LR and extends the shoulder, (4)The patient is instructed to take a deep breath and hold it, (5)A positive test is indicated by a disappearance of the radial pulse.

Front 65

What test would examine the middle scalenes?

Back 65

Halsterd's test

Front 66

What is the difference between Adson's test and Halsterd's test?

Back 66

Adson's: Ipsilateral rotation of head

Halsterd's: Contralateral rotation of head

Front 67

Which muscle does Allen's test examine?

Back 67

Middle scalene

Front 68

Describe the three steps of Allen's test.

Back 68

(1)The examiner flexes the patient’s elbow to 90 degrees while the shoulder is extended horizontally and rotated laterally, (2)The patient is asked to turn their head away from the tested arm (can extend neck as well), (3)The radial pulse is palpated and if it disappears as the patient’s head is rotated the test is considered positive

Front 69

Is there any special treatment for rib fractures?

Back 69

There is usually no special treatment unless the organ (lung etc.) is injured

Front 70

What are three types of MOI of rib fractures?

Back 70

(1)Direct trauma to chest wall, (2)Indirect injury, (3)Pathological fractures

Front 71

What direction are rib fractures usually?

Back 71

Anterolateral

Front 72

What is the recovery time for rib fractures?

Back 72

Usually heals without immobilization in 6-8 weeks. Tape can help (left on for 2 - 3 days at a time)

Front 73

What are four complications of rib fractures?

Back 73

(1)Pneumothorax, (2)Hemothorax, (3)Rupture of the liver, (4)Rupture of the spleen

Front 74

What is pneumothorax?

Back 74

Lung puncture. Presence of gas(as air) in the pleural cavity.

Front 75

What is hemothorax?

Back 75

Artery puncture. Presence of blood in the pleural cavity.

Front 76

*Where are vertebrae fractures common?

Back 76

Lower thoracic and upper lumbar region

Front 77

Describe a compression fracture.

Back 77

Hyperflexion force compresses the anterior part of the vertebra and leads to a compression fracture. Compression fractures can occur after minimal trauma in the osteoporotic spine.

Front 78

What could cause a compression fracture?

Back 78

A fall from height, landing on the feet or buttocks → hyperflexes the spine.

Front 79

Describe a burst fracture.

Back 79

Heavy compression on the spine which pushes the disc into the body of the vertebra above and/or below can result in the vertebral body exploding in all directions.

Front 80

*What are the three classifications of spinal fractures?

Back 80

(1)Wedge compression, (2)Vertebral compression (burst), (3)Fracture-Dislocation

Front 81

*How does a wedge compression fracture occur?

Back 81

When the spine is in the flexed position, compression forces from below or from above cause the spine to suddenly flex beyond it’s normal range

Front 82

Where is the compression greatest?

Back 82

The compression is greatest on the concavity of the curve and the anterior portions of the vertebral bodies.

Front 83

What are the symptoms of a wedge compression fracture like?

Back 83

Symptoms are mild often allowed to heal on their own. Stable fracture.

Front 84

*How does a vertebral compression (burst fracture) occur?

Back 84

When the spine is relatively straight and compression forces are vertical, the result isa burst type of fracture the vertebral body. The intervertebral disc is driven into the cancellous bone of the vertebral body and the fracture fragments burst out in all directions.

Front 85

Can the spinal cord be damaged from a vertebral compression (burst fracture)?

Back 85

Spinal cord may be damaged or impinged by bony fragments

Front 86

What is the treatment for vertebral compression (burst fracture)?

Back 86

May require surgery to remove fragments

Front 87

*How does a fracture-dislocation occur?

Back 87

Posterior longitudinal ligaments are torn, the posterior facet joints may be fractured, the upper part of the involved vertebral body seems to be sheared off and the spinal column is dislocated and completely unstable.

Front 88

*What kind of forces are applied during a fracture-dislocation?

Back 88

Violent spinal injuries have a rotary and sometimes a lateral force superimposed on a flexion force. The spine is literally torn apart.

Front 89

What happens if there is a fracture-dislocation in the thoracic region?

Back 89

In the thoracic region the spinal cord is almost always transected. Results in some form of neurological deficit → Paraplegia.

Front 90

*What is herpes zoster?

Back 90

Shingles. It is an acute infection of the dorsal root ganglion.

Front 91

How does herpes zoster/shingles present?

Back 91

Pain and skin vesicles (small bladder or sac containing liquid) occur in the distribution of the cutaneous nerve.

Front 92

*Which nerves are most commonly affected by herpes zoster/shingles?

Back 92

Thoracic nerves most commonly affected

Front 93

*What is the cause of herpes zoster?

Back 93

Caused by virus that is responsible for chicken pox (varicella)

Front 94

Who is most commonly affected by herpes zoster?

Back 94

People over age 50 are commonly affected

Front 95

What can occur before the pain of herpes zoster begins?

Back 95

May be fever or malaise before pain starts

Front 96

*Describe the pain of herpes zoster?

Back 96

Pain is constant, severe, and *burning & itching for a few days (along nerve). Aggravated by light touch (clothing may bother). Usually unilateral and usually one nerve root affected.

Front 97

What is the timeline of herpes zoster?

Back 97

Pain→Rash→Vesicles with exudate - all within 3 - 5 weeks

Front 98

What is costochondritis?

Back 98

An inflammation of a rib or the cartilage connecting a rib

Front 99

What are two other names for costochondritis?

Back 99

(1)costosternal syndrome, (2)anterior chest wall syndrome

Front 100

*Is there any swelling with costochondritis?

Back 100

No swelling present

Front 101

What is the cause of costochondritis?

Back 101

Cause unknown but patient complains of pain in region of costochondral junction. The pain may become diffuse and more severe.May follow injury to chest wall or associated with other rheumatic disease.

Front 102

*What is Tietze’s syndrome?

Back 102

Inflammation with swelling of the costochondral cartilages of the upper front of the chest

Front 103

Is Tietze’s syndrome more or less common than costochondritis?

Back 103

Less

Front 104

Which area does Tietze’s syndrome usually affect?

Back 104

It usually affects the second or third costochondral junction which will be tender.

Front 105

What are the treatments for Tietze’s syndrome?

Back 105

Rest, analgesics, cortisone shot

Front 106

What is CRPS characterized by?

Back 106

Characterized by severe burning pain in the hand or foot, hyperesthesia (very sensitive to touch),swelling and vasomotor changes (abnormal swelling in region of pain)

Front 107

*What is the cause of CRPS?

Back 107

Cause seems to be an imbalance in the autonomic nervous system. *Trauma is the typical cause (even mild trauma→CRPS)

Front 108

What age is CRPS most common?

Back 108

Most common in people ages 40-60

Front 109

What are the two different mechanisms thought to cause CRPS?

Back 109

(1)Altered sympathetic outflow (T1-12), (2)Regional inflammation

Front 110

How does CRPS initially present following trauma?

Back 110

Initially there is hyperemia and edema.

Front 111

How does the body degenerate from CRPS?

Back 111

The patient avoids all movements of the affected part. This leads to disuse atrophy of the muscles and disuse osteoporosis of the bones.

Front 112

How many stages of CRPS are there?

Back 112

Three

Front 113

Does CRPS tend to start regional or local?

Back 113

Tends to start regional.

Front 114

What is the treatment for CRPS?

Back 114

Within the first three months of signs to improve prognosis: Analgesics, corticosteroids, spinal stimulation (light anesthesia is given to patient)