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C/T Pathology 2

Cervical & Thoracic Pathology 2

Inflammatory Disorders Ankylosing Spondylitis; Juvenile RA; RA; Osteoporosis?; Fibromyalgia?
Anklyosing spondylitis occurs where & affects who most? Affects the spine & SI joints; chronic inflammatory disease; Affects men > women; Age of onset < 40 yrs old
Where is there a high risk for fx with ankylosing spondylitis? Why? Problems in patients with this disorder? Lower c-spine, because of decreased mobility; High risk for instability in upper c-spine; May have iritis or photophobia
Juvenile RA causes what? Painful, swollen, stiff joints; destruction of articular cartilage; more pressure with joint contact; lots of abnormal tissue created
Rheumatoid Arthrtis Destruction of articular cartilage; weakening of ligaments, upper c-spine can be damaged by inflammation
RA most commonly affects which joints? OA, AA, uncovertebral joints; upper c-spine very unstable; can progress from pain & loss of ROM to instability
Osteoporosis Condition in which the skeleton contains a smaller total quantity of bone tissue than normal for the age, sex, and culture of the patient
Fibromyalgia Non-specific characterized by musculoskeletal pn, stiffness & easy fatiguibility, women > men; 20-50 yo; dx of exclusion
Traumatic Disorders Whiplash; Cervicogenic HA; Cervicogenic dizziness; Disc herniations; Fx's & Dislocations; SC Injuries (first 4 could also be mechanical)
Whiplash hyperextension injury to the neck; due to acceleration/deceleration; Children <8-10 yo have increased risk 2ndary to short neck & big head; may have slow onset & involve many structures
When do neuro s/sx begin with whiplash disorders? Stage 3; dysphagia, dysarthria. Also pain, stiffness, mm spasm, HA's, neurological (cranial, cervical, brachial)
Cervicogenic HA "Referred pn perceived in any part of the head caused by primary nociceptive source in the musculoskeletal tissues innervated by cervical nn"
Most pronounced hypomobility in c-spine is where? C0-1 & C0-5
Cervicogenic Dizziness Non-specific sensation of altered orientation in space & dysequilibrium originating from abnormal afferent activity from the neck; most often associated with flex/ext injuries
Red Flags & S/sx of Cervicogenic Dizziness *Ataxis; *Unsteady gait; Postural imbalance associated with neck pain; Limited neck ROM; HA's
Dizziness Test Patient seated & passively roate head; Holy head still while pt turns trunk left & rick; If dizziness only with passive head rotation, suspect inner ear problem Dizziness with both cases, suspect VBI
Where is the highest incidence of disc herniation in the thoracic spine? T7-8 > T6-7 > T9-10 *Apex of convexity of t-spine at T7-8
Most common symptom of disc herniation in t-spine? Anterior Chest Pain
Common Fx's of Spine Dens fx; Ring of atlas; Spondylolisthesis of axis; May lead to complete or incomplete SC lesion
Axis Fractures Hyperflexion injury can lead to dens fx Type 1: avulsion of odontoid tip; difficult to detect Type 2: fx thru base of dens; non-union complication Type 3: sub-dental injury; good prognosis
Hangman's Fx Hyperextension injury; Bilateral fx of pedicles of axis or pars Associated anterior subluxation/dislocation of C2 vertebral body Results from severe extension injury
Teardrop Fx Avulsion of anteroinferior corner of cervical vertebral body by ALL; often from diving into shallow water May be 2ndary to hyperflexion or hyperextension Typically at C2 Usually a traction injury from ALL/ant. A-A ligament
Clay-Shoveler's Fx Avulsion fx of SP of C7 or T1 Sudden load on flexed spine May be 2ndary to rotational injury Stable Flex/ext very painful Lig. nuchae probably pulls on SP of C7/T1 to cause avulsion fx
Neuropraxia? Axonotmesis? Neurotmesis? Conduction delay w/o disruption of nerve Damage to axon but not myelin sheath Damage to axon AND myelin sheath
Axial loading compression of all structures (C1 fx: Jefferson's)
Sidebending/Rotation C2-3 fx (Hangman's); Traction or compression of spinal nerve
Flexion/Extension Mid-cervical fx's/dislocations
Spinal Cord Injuries Birth: Erbs-Duchenne palsy, upper trunk lesion; Klumpke's palsy; C7-8 & T1 & stellate ganglion causing ptosis of eye Viral infections Sports Injuries GSW & Knife injuries, MVA Positional
Brachial Plexus injuries Upper trunk injuries are most common; Isolated middle trunk injuries very rare Kids mostly injury lower trunk
Vertebral osteomyelitis Elderly males; Associated with UTI, soft tissue infections, URI, immunocompromised pts; S/sx: high WBC, fever, high sed rate, localized spinal pain, mm spasm, loss of ROM Rx: antibiotics, surgery, rehab
Epidural abscess Males = females 2ndary to infection, epidural injection, catheterization S/sx: fever, spinal pn, local tenderness True medical emergency Prognosis: fair with early treatment
Congenital/Peds Pathology Klippel-Feil Syndrome; Down's Syndrome; Achondroplasia; Cervical rb; Infantile Torticollis
Klippel-Feil Syndrome No neck appearance; head appears to rest on thorax Fusion of C-spine, partial or total, unilateral or bilateral Abnormally lower hair line with short neck May be asymptomatic until adulthood until they develop instability or spondylosis
Down's Syndrome OA & AA defects; Silent killer- doesn't take much for dens to move & compress on SC Flex/ext films suggested
Achondroplasia Most common form of dwarfism Foramen magnum stenosis & sleep apnea in infant Spinal stenosis as adult
Cervical Rib Originates from costal process; Fuses with transverse process by age 10 Only 10% of people with cervical rib become symptomatic Most commonly occurs at C7 Can compress neuro & vascular structures Brachial plexus should run over the 1st rib
Infantile Torticollis Usually shortened SCM Plagiocephaly (skull & facial asymmetry) may be present
Acute Torticollis Disc derangement: wakes up in AM with deformity, mobs worsen pn, traction with extension helps, analogous to lateral shift in LB Facet joint dislocation Spasm of SCM Acute C2-C7 facet joint impingement C2-3 most likely affected; mobs highly effective
Created by: 1190550002