Term
| What are 3 forms of mechanical thoracic pain? |
|
Definition
sprain/strain
compression fracture
postural syndrome |
|
|
Term
| What are 8 forms of non mechanical thoracic pain? |
|
Definition
osteoid ostoma
Scheuermann's disease
T4 syndrome
herpes zoster
osteoporosis
fibromyalgia
metastasis
referred pain from viscera |
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|
Term
| Thoracic spine is also involved with __ chain |
|
Definition
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|
Term
| Thoracic pain may be caused by a referred pain from the |
|
Definition
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|
Term
| C8-T5 will be referred pain from the |
|
Definition
|
|
Term
| T3-T5 will be referred pain from the |
|
Definition
|
|
Term
| T5-T8 will be referred pain from the |
|
Definition
|
|
Term
| T7-T9 will be referred pain from the |
|
Definition
|
|
Term
| T6-T10 will refer pain from the |
|
Definition
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|
Term
| T9-T11 will refer pain from the |
|
Definition
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|
Term
| T9-L2 will refer pain from the |
|
Definition
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|
Term
| Thoracic pain may be as common as other areas but because it tends to be ____it is less reported |
|
Definition
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|
Term
| ___ and ___ are less common in the thoracic spine due to restricted movement and protection from the rib cage |
|
Definition
| Disc herniation; nerve root compression |
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|
Term
| What are 3 common thoracic condtions |
|
Definition
| fracture, postural imbalance, or sprain/strain |
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|
Term
| Red flag of fever is associated with |
|
Definition
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|
Term
| Red flag of history of cancer is associated with |
|
Definition
|
|
Term
| Red flag of history of unexplained weight loss is associated with |
|
Definition
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|
Term
| Red flag of history of lower limb spasticity is associated with |
|
Definition
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|
Term
| Red flag of progressive pain, worse at night is associated with |
|
Definition
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|
Term
| Schmorl’s nodes, limbus bones, 3 > vertebra |
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Definition
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|
Term
| Step defect, trauma, kyphosis, osteoporosis |
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Definition
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|
Term
| Pain worse at night, better with aspirin, youth |
|
Definition
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|
Term
| Trigger pts, tight pecs, weak midback, desk job |
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Definition
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|
Term
| Structural +Adams, Functional (-)Adams postural |
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Definition
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|
Term
| Subluxation, glove-like hand numbness, MRS (-) |
|
Definition
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|
Term
| Pain and rash along a thoracic dermatome |
|
Definition
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|
Term
| Usually asymptomatic, increased in kyphosis |
|
Definition
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|
Term
| 11/18 tender points, fatigue, wince reflex |
|
Definition
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|
Term
| Deep boring pain, wakes up at night, progressive |
|
Definition
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|
Term
| Trauma, pain on sternal compression |
|
Definition
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|
Term
| Spine disease affecting the adolescent |
|
Definition
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|
Term
| What is the etiology of scheurmanns disease |
|
Definition
| unknonwn, but may be as a result of trauma to the vertebral growth plate. |
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|
Term
| Scheurermanns disease is more common in |
|
Definition
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|
Term
| Scheuermanns disease is more common in the area of the |
|
Definition
|
|
Term
| scheuermanns disease may be asymptomatic or it may present with what symptom |
|
Definition
|
|
Term
| What ortho test will be positive for scheuermanns disease |
|
Definition
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|
Term
| What is the classic triad of scheuermanns disease |
|
Definition
schmorls nodes
limbus bones
irregular end plates
*must have 3 or more vertebrae* |
|
|
Term
| What is the management of scheuermanns disease |
|
Definition
| co manage with orthopedist |
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|
Term
| When co managing a patient of scheuermanns what exercises would be helpful |
|
Definition
| focus on strenghening back extensors; such as anterior muscles and hamstrings. |
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|
Term
| Milwaukee brace recommended for curves greater than |
|
Definition
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|
Term
| Surgery for curves greater than |
|
Definition
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|
Term
| Fracture of the vertebral body, usually following trauma |
|
Definition
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|
Term
| What causes a compression fx in older patients |
|
Definition
osteoperosis
malignancy
*possibly following stepping off a step or sneezing* |
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|
Term
| In young patients compression fx are caused by |
|
Definition
| trauma; especially a hyperflexion injury |
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|
Term
| What are 2 alternative causes of compression fx |
|
Definition
long term corticosteroid use
hyperthyroidism |
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|
Term
| Compression fx are most common in the |
|
Definition
thoracic
some do happen in the lumbar |
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|
Term
| What is the clinical picture of compression fractures |
|
Definition
| sudden back pain and increased kyphosis. |
|
|
Term
| What ortho will be + in a compression fx |
|
Definition
| spinal percussion will elicit pain |
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|
Term
| What will xray show with a compression fx |
|
Definition
|
|
Term
| If the posterior elements of a compresson fx are compressed then you may suspect |
|
Definition
|
|
Term
| What is the management of a compression fx |
|
Definition
co manage with orthopedist
Adjust above and below |
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|
Term
| What exercises should you avoid with compression fx |
|
Definition
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|
Term
| Healing of a compression fx should be within |
|
Definition
|
|
Term
| Small benign neoplasia enclosed by dense reactive sclerotic bone |
|
Definition
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|
Term
| What is the etiology of osteoid ostoma |
|
Definition
| unknown; 10% benign bone tumor; 90% between teens and twenties. |
|
|
Term
| Where is an osteoid ostoma usually located |
|
Definition
1 cm in diameter and located near the ends of the femur and tibia
(although all bones may be affected) |
|
|
Term
| Who has predilection for osteoid ostoma |
|
Definition
|
|
Term
| What is the most common presenting symptom of osteoid ostoma |
|
Definition
| pain at the affected site |
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|
Term
| When is the pain felt with osteoid ostoma |
|
Definition
| pain may be worse at night and characteristically relieved by aspirin |
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|
Term
| What is seen on xray with osteoid ostoma |
|
Definition
| small lucent area (nidus <2cm) surrounded by dense sclerotic bone |
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|
Term
| What is needed to diagnose osteoid ostoma |
|
Definition
|
|
Term
| Who manages osteoid ostoma |
|
Definition
| orthopedic surgeon and co manage |
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|
Term
| Midback pain caused by poor posture |
|
Definition
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|
Term
| What is the etiology of postural syndrome |
|
Definition
| Poor posture and working at a desk. The anterior muscles become tight and the posterior muscles become stretched and weak. |
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|
Term
| What makes postural syndrome better |
|
Definition
|
|
Term
| What may be seen on postural exam with a patient with postural syndrome |
|
Definition
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|
Term
| What will examination reveal with a patient with postural syndrome |
|
Definition
| trigger points in the upper and middle traps rhomboids, levator scapulae, and pectoralis |
|
|
Term
| What posterior muscle will be weak with postural muscles |
|
Definition
|
|
Term
| What is the management of postural syndrome? |
|
Definition
chiropractic adjustments
deep massage
postural advice
exercise
stretch tight muscles and strengthen weak ones |
|
|
Term
| What must be addressed to cure postural syndrome |
|
Definition
|
|
Term
| Syndrome consisting of a myriad of symptoms associated with hypomobility of one or more vertebral segments between T2 and T7; almost always includes T3 or T4 |
|
Definition
|
|
Term
| What is the etiology of T4 syndrome |
|
Definition
| unknown; possible sympathetic dysfunction; may have previous trauma |
|
|
Term
| T4 syndrome is more common in |
|
Definition
|
|
Term
| The complaint of T4 syndrome may include |
|
Definition
| unilateral or bilateral upper chest or thoracic pain |
|
|
Term
| Parasthesia or vague pain associated with T4 syndrome will appear in a ___ fashion |
|
Definition
|
|
Term
| Glove like parasthesia occurs in the |
|
Definition
| hand, hand and forearm, or the entire arm |
|
|
Term
| In addition to the main symptoms of T4 syndrome what are 4 associated symptoms |
|
Definition
headaches
difficulty breathing
swelling in upper extremity
weakeness of grip |
|
|
Term
| Examination of T4 syndrome will reveal |
|
Definition
| tender hypomobile segments between T2 and T7 |
|
|
Term
| What orthos are positive for T4 syndrome |
|
Definition
Springing (pushing on) T3 or T4 may replicate symptoms
Neurological exam is normal |
|
|
Term
| What investigations are found with T4 syndrome |
|
Definition
| WNL on chest, cervical X-rays; CBC, ESR, EMG and nerve conduction are normal |
|
|
Term
| What is the management of T4 syndrome |
|
Definition
chiropractic adjustments
heat modalities
postural advice
exercises |
|
|
Term
| Viral infection of peripheral nerve |
|
Definition
|
|
Term
| What is the etiology of herpes zoster |
|
Definition
| Activation of HHV 3-varicella-zoster virus lying dormant in the Dorsal Root Ganglion (DRG) |
|
|
Term
| Herpes zoster may be associated with |
|
Definition
| immunosuppression; cancer, AIDS, and stress |
|
|
Term
| What is the clinical picture of herpes zoster |
|
Definition
| unilateral chest, face, or abdominal pain followed by the appearance of a vesiculo-pustular rash along a dermatome |
|
|
Term
| The dermatome pattern with herpes zoster may appear |
|
Definition
|
|
Term
| When investigating herpes zoster look for __ |
|
Definition
|
|
Term
| What tests should be ordered as a follow up testing with herpes zoster |
|
Definition
| Chest x-ray, Prostatic Specific Antigen, Fecal Occult Blood, CarcinoEmbryonic Antigen and HIV/ELISA |
|
|
Term
| What is the management of herpes zoster |
|
Definition
| Refer to the hospital if the ophthalmic division of the trigeminal nerve is involved. On average this condition lasts a week |
|
|
Term
| Generalized decrease in bone density throughout the skeleton |
|
Definition
|
|
Term
| What is the etiology of osteoporosis |
|
Definition
decreased estrogens in postmenopausal females
decreased growth hormone in males |
|
|
Term
| The clinical picture of Osteoporosis is |
|
Definition
| asymptomatic unless there is an associated fx which may present with backache or chest pain |
|
|
Term
| What may be physically seen with osteoporosis |
|
Definition
decrease in height
increasing kyphosis
Some patients will have a dowager hump |
|
|
Term
| What orthos will be positive with osteoporosis |
|
Definition
| Tenderness on spinal percussion if there is underlying Fx |
|
|
Term
| What will xray show with osteoporosis |
|
Definition
| radiolucency, osteopenia, thin cortices, wedge-shaped or biconcave vertebrae in compression fractures, Ward’s triangle |
|
|
Term
| What will provide a quantitative measure of bone density |
|
Definition
| Duel Energy Xray Absorptiometry (DEXA) |
|
|
Term
| What is the measurement of a DEXA with osteoporosis |
|
Definition
| >2.5 standard deviation; serum calcium and phosphate are normal and alkaline phosphatase will be elevated in fx |
|
|
Term
| What is the management of osteoporosis |
|
Definition
| Advise on diet supplementation with Calcium, Phosphorus, Vitamin D, exposure to sun and weight-bearing exercise |
|
|
Term
| Does a smoker increase the symptoms and risk of osteoporosis |
|
Definition
|
|
Term
| Can you adjust a patient with osteoporosis |
|
Definition
yes; proceed with caution to prevent serious injury
**use low force** |
|
|
Term
| Chronic widespread musculoskeletal pain disorder with multiple tender points |
|
Definition
|
|
Term
| What is the etiology of fibromyalgia |
|
Definition
|
|
Term
| Who is mainly affected by fibromyalgia |
|
Definition
|
|
Term
| Fibromyalgia has a higher incidence in people with |
|
Definition
|
|
Term
| ACR diagnostic criteria of fibromyalgia is pain greater than |
|
Definition
|
|
Term
| Fibromyalgia pain is pain greater than 3 months plus |
|
Definition
| 11 out of 18 possible tender points around neck, shoulder, anterior chest, elbow, lower back, hip, knees |
|
|
Term
| Fibromyalgia is often associated with |
|
Definition
| fatigue, insomnia, stiffness, and headache |
|
|
Term
| What worsens symptoms of fibromyalgia |
|
Definition
|
|
Term
| What ortho is positive with fibromyalgia |
|
Definition
|
|
Term
| What is the management of fibromyalgia |
|
Definition
| A holistic approach with chiropractic adjustments, diet, Vitamin D supplements, exercise and stress management is helpful in some patients |
|
|
Term
| Secondary malignant deposits far away from the primary site |
|
Definition
|
|
Term
| What are common sites of metastatic cancer |
|
Definition
| breast, lung, thyroid, kidney and prostate cancers |
|
|
Term
| What is the most common primary site of metastatic cancer in males |
|
Definition
|
|
Term
| What is the most common primary site of metastatic cancer in females |
|
Definition
|
|
Term
| What bone tumors are most common |
|
Definition
|
|
Term
| What is the clinical picture of metastatic cancer |
|
Definition
| nocturnal bone pain with or without unintentional weight loss |
|
|
Term
| What orthos are positive with metastatic cancer |
|
Definition
| spinal percussion with associated fractures |
|
|
Term
| What will xray show with metastatic cancers |
|
Definition
| osteolytic or osteosclerotic lesions in the affected bone in 60% of patients with proven metastatic disease |
|
|
Term
| What sign may be seen with xray of metastatic cancers |
|
Definition
| Owl winking sign (missing pedicles) |
|
|
Term
| Before changes are seen on xray how much bone must be lost |
|
Definition
|
|
Term
| What will be elevated with metastatic cancers |
|
Definition
| alkaline phosphatase in the presence of normal AST [SGOT] and ALT [SGPT] is seen |
|
|
Term
| What will a bone scan show with metastatic cancer |
|
Definition
| Technetium 99 will show hot spots in osteoblastic tumors |
|
|
Term
| Who manages a patient with metastatic cancers |
|
Definition
oncologist
co-manage after (do not adjust locally) |
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|
