Podcast
Questions and Answers
Which visceral pathology is associated with pain referral to the middle thoracic spine from the epigastric region?
Which visceral pathology is associated with pain referral to the middle thoracic spine from the epigastric region?
- Cholecystitis
- Peptic ulcer (correct)
- Cardiac ischemia
- Dissecting thoracic aneurysm
What characteristic is MOST indicative of arterial thoracic outlet syndrome (aTOS)?
What characteristic is MOST indicative of arterial thoracic outlet syndrome (aTOS)?
- Upper extremity edema
- Upper extremity ischemia (correct)
- Cyanosis
- Paresthesia
A patient presents with thoracic pain that increases with deep breaths and trunk movements, and is tender to palpation at the costochondral joints. What condition is MOST likely indicated by these signs/symptoms?
A patient presents with thoracic pain that increases with deep breaths and trunk movements, and is tender to palpation at the costochondral joints. What condition is MOST likely indicated by these signs/symptoms?
- Scoliosis
- Myofascial strain
- Rib sprain
- Costochondritis (correct)
Which of the following findings would be MOST concerning and warrant further investigation into potential systemic or inflammatory involvement in a patient presenting with thoracic pain?
Which of the following findings would be MOST concerning and warrant further investigation into potential systemic or inflammatory involvement in a patient presenting with thoracic pain?
A patient reports a sudden onset of severe, unrelenting chest pain that radiates to the upper back. The pain is not relieved by lying down. Which visceral pathology should be suspected?
A patient reports a sudden onset of severe, unrelenting chest pain that radiates to the upper back. The pain is not relieved by lying down. Which visceral pathology should be suspected?
What is a key characteristic of Scheuermann's disease regarding spinal alignment?
What is a key characteristic of Scheuermann's disease regarding spinal alignment?
Why should clinicians be aware of visceral pathologies when assessing thoracic spine pain?
Why should clinicians be aware of visceral pathologies when assessing thoracic spine pain?
Which of the following indicates the MOST appropriate intervention for scoliosis to prevent curve progression in skeletally immature individuals?
Which of the following indicates the MOST appropriate intervention for scoliosis to prevent curve progression in skeletally immature individuals?
A patient reports right upper quadrant pain that radiates to the scapula, occurring 1-2 hours after consuming a fatty meal. Which visceral pathology is MOST consistent with this presentation?
A patient reports right upper quadrant pain that radiates to the scapula, occurring 1-2 hours after consuming a fatty meal. Which visceral pathology is MOST consistent with this presentation?
Which of the following is characteristic finding of ankylosing spondylitis?
Which of the following is characteristic finding of ankylosing spondylitis?
Which of the following is an overuse injury that causes thoracic pain?
Which of the following is an overuse injury that causes thoracic pain?
What is a primary goal of physical therapy for a patient with scoliosis?
What is a primary goal of physical therapy for a patient with scoliosis?
Which of the following is the MOST likely mechanism of injury for a rib sprain/strain?
Which of the following is the MOST likely mechanism of injury for a rib sprain/strain?
When should a clinician suspect a non-mechanical cause of thoracic pain?
When should a clinician suspect a non-mechanical cause of thoracic pain?
What is a primary characteristic of neurogenic thoracic outlet syndrome (nTOS)?
What is a primary characteristic of neurogenic thoracic outlet syndrome (nTOS)?
What is a typical characteristic of pain associated with renal colic due to kidney stones?
What is a typical characteristic of pain associated with renal colic due to kidney stones?
Which of the following is MOST indicative of venous thoracic outlet syndrome (vTOS)?
Which of the following is MOST indicative of venous thoracic outlet syndrome (vTOS)?
What statement BEST reflects the goals of treatment in Scheuermann's disease?
What statement BEST reflects the goals of treatment in Scheuermann's disease?
Which of the following is MOST common contributing factor for compression fractures in the thoracic spine?
Which of the following is MOST common contributing factor for compression fractures in the thoracic spine?
What signs and symptoms are associated with esophageal cancer?
What signs and symptoms are associated with esophageal cancer?
What signs and symptoms are associated with rib sprain/strain?
What signs and symptoms are associated with rib sprain/strain?
A patient experiences upper extremity weakness along with pain and tingling in the hand when raising the arm overhead. What condition does these symptoms most likely indicate?
A patient experiences upper extremity weakness along with pain and tingling in the hand when raising the arm overhead. What condition does these symptoms most likely indicate?
A primary care physician recommends a patient seek an immediate checkup due an exacerbated scoliosis curve. Outside this, what other signs and symptoms could indicate immediate medical attention?
A primary care physician recommends a patient seek an immediate checkup due an exacerbated scoliosis curve. Outside this, what other signs and symptoms could indicate immediate medical attention?
Which of the following is the best course of action to treat a patient suffering from myofascial pain?
Which of the following is the best course of action to treat a patient suffering from myofascial pain?
A patient with kidney stones is likely to deal with what symptoms?
A patient with kidney stones is likely to deal with what symptoms?
What symptoms indicate visceral pathology from Cardiac Ischemia?
What symptoms indicate visceral pathology from Cardiac Ischemia?
Which of the following is a TRUE statement about Physical Therapy and Scoliosis?
Which of the following is a TRUE statement about Physical Therapy and Scoliosis?
What is the treatment and goal of compression fractures of the thoracic spine?
What is the treatment and goal of compression fractures of the thoracic spine?
Of the issues listed, which of the following all share the symptom of upper extremity paresthesia?
Of the issues listed, which of the following all share the symptom of upper extremity paresthesia?
What specific visceral pathologies present right upper quadrant pain?
What specific visceral pathologies present right upper quadrant pain?
Flashcards
Visceral Referral to T-spine
Visceral Referral to T-spine
Pain referred from the viscera to the thoracic spine due to shared sympathetic chain ganglion connections.
Thoracic Outlet Syndrome (TOS)
Thoracic Outlet Syndrome (TOS)
Compression and irritation of structures in the space between the clavicle and first rib.
Neurogenic TOS (nTOS)
Neurogenic TOS (nTOS)
Most common type of TOS, affecting the brachial plexus.
Arterial TOS (aTOS)
Arterial TOS (aTOS)
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Venous TOS (vTOS)
Venous TOS (vTOS)
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Scoliosis
Scoliosis
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Scoliosis Bracing
Scoliosis Bracing
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Rib Strain/Sprain
Rib Strain/Sprain
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Costochondritis
Costochondritis
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Costochondritis Symptoms
Costochondritis Symptoms
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Myofascial Strain/Pain
Myofascial Strain/Pain
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Compression Fracture
Compression Fracture
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"Dowager Hump"
"Dowager Hump"
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Scheuermann's Disease
Scheuermann's Disease
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Scheuermann's Disease Physical Therapy
Scheuermann's Disease Physical Therapy
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Study Notes
- The presentation discusses thoracic spine pathology
- Includes information on visceral pathology, thoracic outlet syndrome, scoliosis, rib strain/sprain, costochondritis, myofascial strain/pain, compression fracture, and Scheuermann's disease
Objectives
- Review common referral patterns in the thoracic spine
- Review common thoracic pathology
Overview of Thoracic Spine Pathologies
- Visceral Pathology
- Thoracic Outlet Syndrome
- Scoliosis
- Rib strain/sprain
- Costochondritis
- Myofascial Strain/Pain
- Compression Fracture
- Scheuermann's Disease (Juvenile Kyphosis)
Visceral Pathology
- The T-spine is a common area for referral from viscera due to connections with the sympathetic chain ganglion
- MUST be aware and screen for non-mechanical pain
Visceral Pathology - Cardiac Ischemia
- History of risk factors for CAD (coronary artery disease), or MI(myocardial infarction)
- Angina
- Nausea
Visceral Pathology - Dissecting Thoracic Aneurysm
- Sudden, severe, and unrelenting chest pain that can radiate to the upper back
- The pain is unrelieved with laying down
Visceral Pathology - Peptic Ulcer
- Boring (drilling) pain from the epigastric area to the middle thoracic spine
- Triggered or relieved with meals
- History of NSAID use
- A perforated ulcer can refer pain to the shoulder with irritation of the diaphragm
Visceral Pathology - Cholecystitis
- Results in right upper quadrant and scapular pain
- Fever, nausea, and vomiting can occur
- Pain often presents 1-2 hours after a fatty meal
Visceral Pathology - Renal Infection and Kidney Stones
- Produces renal colic/flank pain
- Fever, nausea, and vomiting are common symptoms
- Increased risk for kidney infection with ongoing UTI
Visceral Pathology - Neoplastic Conditions
- Over 50 years of age
- Previous history of cancer
- Unexplained weight loss
- Constant pain with no relief with bed rest
- Night pain
Visceral Pathology - Inflammatory Disorders
- Ankylosing Spondylitis involves limited chest expansion, less than 2.5 cm measured at the nipple line
- Sacroilitis
- Morning pain and stiffness
- Peripheral joint involvement
- Positive HLA-B27 blood test
Visceral Pathology- Inflammatory or Systemic Disease
- Temperature above 100 degrees
- Blood Pressure greater than 160/95mmHg
- Resting Pulse greater than 100 bpm
- Resting Respiration above 25 bpm
- Fatigue
- Osteomyelitis, diskitis, epidural infection, pericarditis
Thoracic Outlet Syndrome
- Compression and/or irritation of structures going down the arm
- Neurogenic TOS (nTOS): affects the Brachial Plexus
- Arterial TOS (aTOS): affects the Subclavian Artery
- Venous TOS (vTOS): affects the Subclavian Vein
- 8% of the population is reported to have
- Often a controversial diagnosis
- Occurs more in females than males
- Between 4:1 and 2:1 ratios
- Neurogenic is much more common than arterial/venous
- Can result from Cervical rib, remodeling after fracture of clavicle or 1st rib
- Can be caused by overuse/postural
Thoracic Outlet Syndrome - Signs/Symptoms
- Neurogenic TOS (most common):
- Paresthesia, pain, hand and UE weakness
- May have "hard" neuro signs that are consistent
- May lack neuro signs and have intermittent symptoms
- Arterial TOS:
- Paresthesia, upper extremity ischemia, claudication, decreased pulse
- Venous TOS
- Upper extremity edema, cyanosis, paresthesia
Thoracic Outlet Syndrome - Treatment
- Conservative: with manual therapy like 1st rib, T-spine, muscles
- Exercise through mobility and strengthening
- Postural modification
- Injections
- Surgery like 1st rib or cervical rib resection
Scoliosis
- Spinal deformity resulting in one or more lateral curves
- Includes rotation of vertebral segments
Scoliosis - Treatment
- Bracing can slow or stop the curve, but it CANNOT correct it
- Surgical intervention is considered for:
- 40-45 degree curve in growing children
- 50-60 degree curve in skeletally mature
- Physical Therapy can improve function/pain, but Will NOT change or correct the curve
Rib Sprain/Strain
- Usually results from trauma involving:
- Quick twisting movement
- Blunt force
- Fall
- Signs and symptoms:
- Pain in the thoracic region
- Can radiate laterally and anteriorly
- Achy or sharp pain
- Difficulty taking deep breaths
- Painful coughing/sneezing
- Limited rotation and/or lateral flexion
- Treatment:
- Time
- Conservative via manual, mobility, strengthening
- Injection - chronic
Costochondritis
- Inflammation of costochondral joints
- Generally idiopathic
- Adults aged 40-50
- Typically more common in females
- It is generally self-limiting, but can produce chronic pain
- Symptoms include:
- Anterior chest pain
- Pain with trunk movements, deep breaths, coughing
- Tender to palpation of the costochondral joints
- MUST rule out more serious causes of pain and check for abnormal vital signs
- Treatment:
- Pain modulation with medication and manual therapy
- Gentle exercise via relative rest
Myofascial Strain/Pain
- Trauma:
- Quick movements
- Blunt force
- Overuse:
- Extended time in a posture
- Too rapid increase in activity
- Connective Tissue Disorders
- Signs and symptoms:
- Tender to palpation
- Generalized ache, burning, sharp, tight symptoms
- Aggravated by movement/use
- Generally self-limiting
- One of the most common types of chronic pain
Compression Fracture
- Most common in postmenopausal women due to higher rates of osteoporosis
- Usually due to trauma although often seemingly minor (e.g., bending over, coughing)
- Long-term glucocorticoid use
- Signs and symptoms:
- "Dowager Hump"- Extreme kyphotic curve
- Severe, localized pain
- Occasionally, pain is absent
- Pain in the area overlying affected segment
- Treatment:
- Time/pain modulation
- Strengthening extensors
- Vertebroplasty
- CANNOT reverse the kyphosis
Scheuermann's Disease
- Rigid hyper-kyphosis most often seen in adolescents
- Tends to be more common diagnosis in males
- Can be non-painful
- Might predispose to myofascial pain, but evidence uncertain
- Treatment:
- Exercise
- Physical Therapy if less than 60 degree angle
- Bracing if there are angles greater than 60 degrees
- Slows progression, does NOT reverse
- Spinal fusion for greater than 75 degree angles
- Neurologic deficits/spinal cord compression
- Severe refractory pain
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