Dorsal Spine Theory PDF

Dorsal Spine Dorsal spine Kyphosis=> Poor mobility. Visceral and spinal protection. Dorsalgia: Becoming more frequent=> Bad posture. Incidence of back pain: 15% (56% lumbar and 44% cervical).  Rib pain Clinical Visceral pain processes Chronic discogenic dorsalgia...

Dorsal Spine Dorsal spine Kyphosis=> Poor mobility. Visceral and spinal protection. Dorsalgia: Becoming more frequent=> Bad posture. Incidence of back pain: 15% (56% lumbar and 44% cervical).  Rib pain Clinical Visceral pain processes Chronic discogenic dorsalgia Chronic dorsalgia of facet origin  Rib pain Intercostal neuralgia Herpes Zoster Intercostal Neuralgia  Intercostal Neuralgia Pain at the sides of the costal grill caused by irritation and compression of the intercostal nerve. More frequent at the middle intercostal levels (4th-10th). Compressive neuropathy Prevalence 15% Thoracic pain incidence => 3-22% Post-surgical=> Prevalence of chronic pain 40%, with intercostal neuralgia being the most frequent type of complaint. Dalton Fazekas; Maksym Doroshenko; Danielle B. Horn. Intercostal Neuralgia. National Library of medicine. Intercostal Neuralgia: Factors involved Women (1.5:1) Inmunosuppression Sciatica Muscle/bone injuries. Lung diseases=> nerve damage. Intercostal Neuralgia: Body chart Deep stabbing pain. Irradiation forwards (belt) Allodynia to light touch  Intercostal Neuralgia : 24 hours behavior Intermitent or constant pain Functional limitation: restriction of superficial breathing. Limitation of trunk movements Schepelmann's sign=> homolat lumbodorsal flex Worsens with sport Paresthesias with tingling, same distribution as pain (less frequent).  Neuralgia intercostal: Current and past history Always cute onset: oSurgery (43%) oHerpes Zoster (28%) oTrauma Iatrogenic causes, neoplastic, pregnancy, sciatica, posture... Breathing related Intercostal: Special questions Costal Fx => Acute intercostal neuralgia. Visceral pain Pleuritic pain=> contralateral trunk mov Herpes Zoster  Intercostal neuralgia: Herpes Zoster Vesicating and painful skin rash. Inactive chickenpox => Latent=> Attacks=> Reactivation in the nerves. 30% population Herpes Zoster: Factors involved Any age, but from 60 y. o. Weakened immune system due to medication or disease Most frequent complication: Post-herpetic neuralgia(10-15%) => severe pain with persistent character. Herpes Zoster: Body chart Tingling, pain and burning Herpes Zoster: 24 hours behavior Skin patches=> Small blisters=> Ulcers=> Crusts 2/3 weeks=> Infrequent scarring. o The rash usually involves a narrow area of the spine around the front of the ventral region or chest. o The rash may involve the face, eyes, mouth and ears. It may also include: Fever and chills General malaise Headache Joint pain Swollen lymph nodes Herpes zoster: Current and past history Chickenpox before the age of 1 year Hematologic cancer Visceral pain  Visceral pain Chronic visceral pain is one of the most common causes of morbidity in the general population. High association with oncologic and post-surgical pathology. Examination>=> Abnormal neuromusculoskeletal pattern=> Suspect! DIFFERENTIAL DIAGNOSIS  Visceral pain Differentiating characteristics: Not all viscera cause pain. Sx not always associated with visceral damage Diffuse and poorly localized Causes referred pain => difficult Dx Able to trigger vegetative and motor reflex responses  Visceral pain There does not have to be a structural alteration in the viscera for pain to appear: Loss of mobility in visceral fasciae=> Adherences. Scar=> deep adherences, general fibrosis. Visceral spasms Diaphragm Circulatory injury=> Angiospasm, tension, abdominal pressure,... Parasympathetic neurovegetative system Local nerve involvement Psychological involvement  Visceral pain: Factors involved Localized pathologies: Cardiac, pulmonary, genitourinary... Food habits or intolerances. Related to bowel or bladder fullness or constipation. Associated with urination or defecation. Visceral pain: Body chart  Visceral pain: 24 hours behavior Cardiac pathologies: dorsalgia with chest tightness, sometimes there is also pain in the left shoulder. Pneumothorax: acute dorsal pain next to the spine with difficulty breathing and coughing. Peptic ulcers: dorsalgia in the lower part of the thoracic area, which occurs with fasting and improves with eating and drinking. Pneumonia: throbbing dorsalgia between the scapulae, which increases when inhaling or coughing, but not with movement. Usually associated with other Sx: malaise, colic, nausea, chills, fever, sweating...  Visceral pain: Current and past history Possibility of acute onset: Traumas Associated with food intolerances Medication: Various reactions. Worsens when lying supine Visceral pain: Special questions oChronic abdominal wall pain oMusculoskeletal pathology oFibromyalgia oFood intolerances Dorsal joint dysfunction Discogenic origin dorsalgia Facet origin dorsalgia Costochondral pain Dorsal joint dysfunction: Discogenic origin Dorsal joint dysfunction: Discogenic pain The intervertebral disc is subjected to less movement than the cervical or lumbosacral disc: Rotations=> Main mov Flex-ext=> Severely restricted Tilts=> Severely restricted Compressions Slides=> Very restricted  Dorsal joint dysfunction: Discogenic origin 1. Initial phase : Loss of nucleus turgor=> annulus bulging=> displacement of the external fibers pressed by the nucleus pulposus 2. Status phase: Changes in the nucleus pulposus => instability => osteophytes=> osteoarthritis. 3. Late phase: Disc fibrosis => stiffness and hypomobility. Pain has a mechanical or biochemical origin Dorsal joint dysfunction: Discogenic pain Complex clinical condition, characterized by pain in the dorsal area, d ue to a degenerative disc disorder. Less common than cervical and lumbar=> Herniated discs=> RARE=> 0.5% => 1 in 100.000 inhabitants. Dorsal discogenic pain=> Traumatism  Discogenic pain: Factors involved Family history (61% genetic) 50-80 y.o. Excessive muscular tension due to sports practice Heavy object load Muscle weakness or inhibition=> Lack of support Smoking Obesity=> Does not affect Dorsal discogenic pain: Body chart Dorsal discogenic pain: 24 hours behaviour Pain when forced expiration Pain with prolonged sitting Overhead work Carrying weights Discogenic pain: Current and past history Trauma Change of use, overuse, disuse?  Discogenic pain: Special questions Trauma Osteopenia, cancer, infections Scoliosis, spondilolysthesis, stenosis Athrosis Dorsal joint dysfunction: Dorsalgia of facet origin  Dorsalgia of facet origin Facet pain comes from any of the structures that form the articular facet: fibrous capsule, synovial membrane, hyaline cartilage and bone. Aging=> joint wear and tear (Osteoarthritis/osis) => Friction=> Facet pain sdre  Dorsalgia of facet origin Pain distribution does not correspond with dermatomes or radicular motor innervation=> diffuse pain. Facet wear rarely causes pain by itself=> gradual development=> gradual stiffness. Dorsalgia of facet origin: Factors involved From the age of 30=> wear and tear Obesity Direct trauma Impact sports Muscle weakness Dorsal extension movements Overuse Presence of other diseases (gout, arthritis, ifection) Damage from injury, whiplash or wrong sleeping posture Family history Dorsalgia of facet origin: Body chart Dorsalgia of facet origin: 24 hours behavior Pain is aggravated with prolonged standing and with hyperextension, tilt and contralateral rotation movements. Also associated with breathing. Pain improves with supine and spinal flexion. May be asymptomatic Dorsalgia of facet origin: Current and past history Repetitive movements Continuous low-intensity injuries over time Job? Dorsalgia of facet origin: Special questions Espondilosis Costochondral joint dysfunction Costochondral joint dysfunction "Costochondritis"=> 2nd to 5th, hypersensitivity "Tietze's syndrom"=> 2nd and 3rd joint, temperature Benign and painful inflammation of the costochondral junction, usually on the left side. Edema+ erythema Adults: Most frequent in the costal cartilage of the second, third and fourth ribs. Early ages: Last costal cartilages. Uncommon=> less than 5:100,000. Costochondral joint dysfunction: Factors involved Children from 10 years old Adults 30-40 years old "Tietze Syndrom"=> Women over 40 years old "Costochondritis"=> Equality gender < 35-40 y. o. Chondrochondral and chondrocostal joint involvement, or perichondrial inflammation. Costochondral joint dysfunction: Body chart Sharp, stabbing pain that can be disabling Sometimes accompanied by erythema and sensitivity to heat  Costochondral joint dysfunction: 24 hours behavior Pain in left side of sternum, involves more than one rib. Worse at the beginning of the day More localized in sternal junction Sharp, intense; sensation of pressure Occasionally spreads to arms and shoulders Worsened by deep breathing, coughing, sneezing, or any chest wall movement Costochondral joint dysfunction: Current and past history Acute and sudden onset. Sometimes progressive Repetitive or blunt/penetrating trauma, Cx Diseases: Candida albicans, Salmonella, E Coli. Physical stress Recurrent episodes Rheumatic diseases COVID Costochondral joint dysfunction: Special questions Anxiety, stress Heart problems