2/1/99

Orthopedics III

 

Spinous percussion-done throughout the entire spine

·         percuss on spinous process and the paraspinal muscles

·         indicates fracture in vertebrae, immediately x-ray patient

·         acute disc bulge and thoracic sprain/strain will also give a positive spinous percussion test

 

 

Ankylosing Spondylitis (Marie Strumpel’s Disease)

·         15-20 y/o

·         predominantly men (2:1)

·         presenting chief complaint—stiffness upon rising in the morning, low back pain, hip pain (SIJ), w/ absence of trauma

·         autoimmune disorder, runs in the family

·         pain at night to the point of waking you up,

·         ADL (activities of daily living) affected

·         Positive orthopedics tests—Hibbs (hip and SI), Nachalas, Elys, mild diffuse low back pain, hard to locate

·         X-rays

·         Bamboo spine

·         Inflammation and cloudy appearance of SIJ

·         Waxes and wanes (cycling of symptoms)

·         May flare up for a while and then disappears, some may have problems through adulthood

·         Ice to decrease inflammation, physical therapy

·         Acute—HVLA is contraindicated, soft tissue techniques are acceptable

·         Lasts for 2-3 days, when inflammation is down, can adjust

·         Build up  of calcium is scar tissue in joints

·         Leads to fusion of SIJ if too many recurrent episodes (ankylosing)

·         Starts in SIJ and moves up the spine

·         See bony projections on x-ray after a couple years—syndesmophytes

·         Start inferior and move superior (not osteophytes)

·         Grow up and attach to the vertebral body above fusing the 2 segments together

·         Completely encircles the vertebrae

·         Occurs through the disc space and calcifies the disc

·         Entire areas becomes fused

·         Altered biomechanics, affects facets and these eventually fuse

·         Do not want to try and break up the area once it has fused an area

·         Will move up to the thoracic spine

·         Affects the costovertebral and costotransverse joints (ribs)

·         Fusion of the ribs to the spine and decrease respiration

·         Causes cardiopulmonary distress

·         Die of cardiorespiratory problems (pneumonia and congestive heart failure)

 

Orthopedic Test

·         Chest expansion

·         Classic Dx when a decrease in chest expansion

·         Use a tape measure around the chest

·         Men—at the nipple line

·         Women—just above the nipple line on the breast

·         Have the patient inhale

·         Record the diffence

·         Normal valves—men is 2 inches; women 1.5 inches

·         Smoking can also cause a decrease in chest expansion

·         Subluxation (rib, vertebrae)

·         Muscle spasm

·         Fractures

·         Bruising, inflammation

 

Cervical Spine

·         Loss of motion

·         Calcification of the transverse ligament (fusion of odontiod to C1)

·         Do not adjust upper cervical spine due this calcification

·         If transverse ligament is clear on x-ray, it is okay to adjust them

 

 

Tx

·         Decrease inflammation

·         Adjust—life long chiro patients

·         Chronic inflammatory condition

·         Need to adjust after an inflammatory episode to decrease the fibrous adhesions

·         This will decrease the chance of anklyosing

·         Increase movement

·         Need to be seen at least once a week

·         Need exercises for at home to stretch muscles and ligaments esp. in pelvic areas

·         Supplements—chondrotin sulfate, vit B, antioxidents

·         Need to come in esp when they are feeling good

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