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C/T Pathology 2
Cervical & Thoracic Pathology 2
| Question | Answer |
|---|---|
| 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 |
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