B4U1 - Ortho Chart PDF

C-T Spine and Shoulder Abnormality Presentation Explanation of abnormality Physical Exam findings/Dx Treatment Cervical Strain/Sprain Worse w/ motion Soft tissue injury: muscle or ligamentous Location of pain: non-radicular, non-focal posterior neck pain (non-radiating) TTP, limited ROM, no neuro de...

C-T Spine and Shoulder Abnormality Presentation Explanation of abnormality Physical Exam findings/Dx Treatment Cervical Strain/Sprain Worse w/ motion Soft tissue injury: muscle or ligamentous Location of pain: non-radicular, non-focal posterior neck pain (non-radiating) TTP, limited ROM, no neuro deficits Tx for whiplash: soft collar, NSAIDs, massage, cervical traction, U/S, PT Assoc sx: HA Dx tests: if trauma (AP/lat/odontoid)-lateral may show spasm (no lordosis) Whiplash (MC mechanism of injury-MVA) -acceleration/deceleration w/ rapid flex/ext of c-spine -trapezius muscle spasm -may be associated w/ ligamentous & muscular injury sprain) -pain may be delayed for several hours Torticollis “Wry neck” Localized pain/spasm in trapezius, SCM Pain reproducible w/ palpation of trapezius or SCM Cervical Spondylosis (DDD, c-spine arthritis) Posterior shoulder pain Limited, ROM, neck/shoulder pain worse w/ upright activity, radiating radicular pain, myelopathy Degenerative disc disease (arthritis): DDD- C5-6 and C6-7 MC TTP lateral neck, limited cervical Rx: supportive, NSAIDs, ROM, gait, Hoffman reflex, clonus, cervical pillow/roll, traction, ESI hyperreflexia, Babinski sign or facet injections, surgical decompression and/or fusion Imaging: plain films, MRI if radicular sx or myelopathy sx Myelopathy: caused by compression on SC= clumsiness in and gait imbalance (older men) Produced by growth of bone spurs, protrusion of ligamentum flavum, and/or disc herniation =narrowing of neural foramen & stenosis of cervical spinal canal EMG: to localize nerve root involved Rx: NSAIDs (adults), PT, massage Cervical Stenosis Often asymptomatic until acute hyper-flexion/extension of c-spine Narrowing of sagittal diameter of cervical canal Cervical Disc Herniation Can be neck pain or radicular Nucleus pulposus extruded through annulus fibrosis See radiculopathy slide Conservative or surgical tx, depending on severity -can try NSAIDs or oral steroids, traction, epidural steroid injection first Cervical radiculopathy Neck pain and radicular pain w/ numbness/paresthesias in distribution of cervical nerve root Referred neurogenic pain in the distribution of a cervical nerve root associated numbness, weakness, or loss of reflexes Decreased cervical lordosis, mild dec in neck ROM; extension and axial rotation= shoulder/arm pain -must assess motor, sensory, DTRs, UMN signs Spontaneous resolution of all/most sx occurs w/in 2-8 weeks in most patients *often pain relieved w/ placing hand on top of head* Thoracic spondylosis Thoracic back pain; worse w/ sitting/bending forward -occasional weakness/numbness in C5-6 segments MC involved Types: -congenital: funnel shape of cervical canal -developmental: weight training -acquired: spondylosis, spurs, disc bulge/herniation -young adults: HNP (herniated nucleus propulsus) “herniated disc” -older patient: foraminal narrowing d/t DDD Dx tests: plain XR- MRI or CT w/ intrathecal contrast “myelogram” confirms dx -EMG/NCS DDD of T-spine Plain XRs and/or MRI -short course of NSAIDs and/or oral steroids -cervical traction at PT -NO manipulation of spine! Conservative- NSAIDs, PT extremities Thoracic disc herniation Adult spinal deformity Axial back pain OR chest pain & thoracic radicular pain (band-like chest or abdominal pain along intercostal nerve) -15-20% bowel/bladder changes 10 deg)- SCOLIOSIS -sagittal plane: (sagittal imbalance >5cm)- KYPHOSIS T11-12 MC level Localized tenderness, dermatomal sensory changes, myelopathy Dx: plain films and MRI Deformity, TTP, muscle weakness Dx: full length spine XRs -CT, CT myelogram Mean age= 60, M=F Causes: -scoliosis: idiopathic (T) vs. degenerative (L) -kyphosis: osteoporosis, DDD, scoliosis T-spine fractures Mod-severe back pain, worse w/ motion, +/neurogenic sx Activity modification, PT, symptomatic tx, operative tx if indicated Causes: -high-energy trauma (MVA or fall from height) -diminished bone strength (osteoporosis, tumors, infections, steroid use) Fracture pattern-stability and likelihood of nerve involvement Compression fractures (MC): -generally stable; usually wedge Conservative: 40 deg and failed conservation tx= operative referral If diagnosed as an adolescent, curve needs to be followed into adulthood! Inspect for swelling/ecchymosis, TTP Compression: Unstable flex/distraction or burst fx= hematoma/step-off of SP Dx: AP/lat XR of spine, CT w/ reconstruction for surgical planning if needed Flexion-distraction injuries: Burst: shaped= kyphosis -RF: osteoporosis, smoking, estrogen def, white/Asian petite Burst fx: explosion of vertebral body Flexion-distraction injuries: high-velocity injury (MVA) Rib fracture Pain w/ inspiration/coughing, swelling, bruising Shoulder Osteoarthritis (OA) Causes: fall, MVA, chronic coughing (stress fx) TTP, shallow breathing for comfort Reassurance, rest, ice, NSAIDs, activity restriction/modification Glenohumeral OA: posterior shoulder pain worse w/ activity and at night AC joint OA: pain over superior aspect of shoulder, pain lying on affected side or reaching across body GH OA: shoulder muscle atrophy, TTP over joint lines, decreased ROM, crepitus NSAIDs, glucosamine/chondroitin, PT, CS injection -arthroplasty (for GH OA) -subacromial decompression, distal clavicle resection (for AC joint OA) Destruction of joint cartilage resulting in joint space narrowing, pain and loss of ROM Shoulder Dislocation Complications: -recurrent dislocations from labral injury -bony injury (Hill Sachs, Bankart) -RCT (if >40 y/o) -NV injury Recurrence: traumatic has a greater risk w/i 2 years AC joint OA: TTP over AC joint, + scarf test Dx: AP/axillary films revale decreased joint space, osteophytes, sclerosis Anterior = 95% -MOI: fall or forceful throwing motion Considerable pain w/ any movement, supports arm in neutral position (ant dislocation) Posterior (