Acute Thoracic Spine

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Acute Thoracic Spine
2014-02-17 23:03:25
Acute Thoracic Spine
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  1. Traumatic Kyphosis (Anterior Burst Fracture)
    • Consider this differential diagnosis when there is a hx of falling from a height
    • May be associated w/ Schmorl's nodes and ankle fractures
  2. Schmorl's Nodes
    Intrusion of nuclear material (NP) into the vertebral body

    • Indicates:
    • High compression forces (trauma), usually accompanied by a loud pop
    • Weakening of vertebral bodies and cartilaginous endplates through aging or disease (Scheuermann's osteochondrosis)

    May lead to later spondylosis
  3. Scheuermann's Disease
    • Anterior portion of epiphyseal plates of 3 or 4 mid-thoracic vertebral bodies fail to grow, resulting in exaggerated kyphosis
    • Onset = puberty
    • Self-limiting at skeletal maturity
    • Associated w/ presence of Schmorl's nodes
    • Surgical correction not required unless kyphosis > 60 degrees
  4. Sprengel's Deformity
    • One scapula fails to descend during development
    • Small, high, downwardly rotated and adducted scapula
  5. Pectus Carinatum
    • a.k.a. "pigeon chest"
    • Increased A-P diameter
    • Typically asymptomatic
  6. Pectus Excavatum
    • a.k.a. "funnel chest"
    • Decreased A-P diameter
    • May be symptomatic due to reduced thoracic volume
  7. Barrel Chest
    • A-P diameter = M-L diameter
    • Result of emphysema, COPD, involvement of accessory respiratory muscles, & decreased efficiency of diaphragm due to lung expansion
  8. Differential Diagnosis of Thoracic Spine: Mechanical
    • Pathologic fracture
    • Aortic aneurism (complaint of strong, throbbing sensation)
    • Sepsis
  9. Differential Diagnosis: Visceral
    • C8-T8: heart
    • T1-T4: c spine
    • T3-T10: lungs
    • T5-T9: stomach
    • T6-T10: liver, gallbladder, duodenum & ascending colon
    • T7-T9: pancreas
    • T7-T10: spleen
    • T9-T11: appendix
    • T9-T12: kidneys
  10. Differential Diagnosis: Sympathetic
    Sympathetic ganglion pronounced in thoracic spine @ costovertebral jts
  11. Influence of Ribs
    • Add 30% to spinal stiffness in flex
    • Add 100% to spinal stiffness in ext
    • Ribs & sternum add 300% to thoracic spine's ability to sustain axial loading
  12. Rib Motion
    • Upper ribs - pump handle
    • Lower ribs - bucket handle
    • Floating ribs - caliper motion
  13. Contraindications to Costovertebral Joint Manipulation
    • Neoplasm
    • Trauma
    • Infection