C-T Spine and Shoulder Abnormalities 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 Rx: NSAIDs (adults), PT, massage 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): DDDC5-6 and C6-7 MC TTP lateral neck, limited cervical ROM, gait, Hoffman reflex, clonus, hyperreflexia, Babinski sign Rx: supportive, NSAIDs, cervical pillow/roll, traction, ESI or facet injections, surgical decompression and/or fusion Myelopathy: caused by compression on SC= clumsiness in and gait imbalance (older men) Cervical Stenosis Produced by growth of bone spurs, protrusion of ligamentum flavum, and/or disc herniation =narrowing of neural foramen & stenosis of cervical spinal canal Often asymptomatic Narrowing of sagittal until acute diameter of cervical canal hyper-flexion/extensi on of c-spine C5-6 segments MC involved Imaging: plain films, MRI if radicular sx or myelopathy sx EMG: to localize nerve root involved Types: -congenital: funnel shape of cervical canal -developmental: weight training -acquired: spondylosis, spurs, disc bulge/herniation 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/paresthe sias 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* -young adults: HNP (herniated nucleus propulsus) “herniated disc” -older patient: foraminal narrowing d/t DDD -short course of NSAIDs and/or oral steroids -cervical traction at PT -NO manipulation of Dx tests: plain XR- MRI or spine! CT w/ intrathecal contrast “myelogram” confirms dx -EMG/NCS Thoracic spondylosis Thoracic back pain; worse w/ sitting/bending forward -occasional weakness/numbnes s in extremities DDD of T-spine Plain XRs and/or MRI Conservative- NSAIDs, PT Thoracic disc herniation 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 Adult spinal deformity T11-12 MC level Dx: plain films and MRI Deformity, TTP, muscle weakness Dx: full length spine XRs Conservative: 5cm)KYPHOSIS -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 Rib fracture Shoulder Osteoarthritis (OA) If diagnosed as an adolescent, curve needs to be followed into adulthood! Causes: -high-energy trauma (MVA or fall from height) -diminished bone strength (osteoporosis, tumors, infections, steroid use) Inspect for swelling/ecchymosis, TTP Fracture pattern-stability and likelihood of nerve involvement Dx: AP/lat XR of spine, CT w/ reconstruction for surgical planning if needed Compression fractures (MC): -generally stable; usually wedge shaped= kyphosis -RF: osteoporosis, smoking, estrogen def, white/Asian petite Burst fx: explosion of vertebral body Flexion-distraction injuries: high-velocity injury (MVA) Pain w/ Causes: fall, MVA, inspiration/coughing, chronic coughing (stress swelling, bruising fx) 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 15-25 deg: XR every 3-6 mos 25-40 deg: bracing >40 deg and failed conservation tx= operative referral Compression: Unstable flex/distraction or burst fx= hematoma/step-off of SP Burst: Flexion-distraction injuries: TTP, shallow breathing for comfort GH OA: shoulder muscle atrophy, TTP over joint lines, decreased ROM, crepitus Reassurance, rest, ice, NSAIDs, activity restriction/modification NSAIDs, glucosamine/chondroitin , PT, CS injection -arthroplasty (for GH OA) AC joint OA: TTP over AC -subacromial joint, + scarf test decompression, distal clavicle resection (for Dx: AP/axillary films AC joint OA) revale decreased joint Shoulder Dislocation Complications: -recurrent dislocations from labral injury -bony injury (Hill Sachs, Bankart) -RCT (if >40 y/o) -NV injury Destruction of joint cartilage resulting in joint space narrowing, pain and loss of ROM space, osteophytes, sclerosis Anterior = 95% -MOI: fall or forceful throwing motion Considerable pain w/ any movement, supports arm in neutral position (ant dislocation) Posterior (