3/15/99

Orthopedics

 

Horner's Syndrome

1.      Ptosis—droopy eyelid

2.      Miosis—fixed constricted pupil

3.      anhydrosis—lack of sweating

·        unilaterally affecting the face

·        sympathetic dysfunction (lack of innervation on one side)

·        cervical chain ganglion is where innervation comes from

·        pancoast tumor—most common way to disrupt cervical chain ganglion; lung cancer

·        found in the apex of the lung field

·        blotchy calcifications

·        osteolytic (bony destruction)

·        get large enough and affect spinal areas

·        non-smokers

·        initially complain of upper back pain and referred shoulder pain

·        unilateral lesion

·        may originally treat for upper back and shoulder subluxation; won't get any better

·        late 20 y/o comes in w/symptoms

·        lack of innervation to the area causes to Horner's Syndrome

·        30% change of bone density to be visible on plain film x-ray (anything before 30% will not be seen or detected)

·        typically—high metastasis to bone

·        apex of lung have low blood supply

·        if caught early enough, low incidence of metastasis

·        surgically removal of tumor

 

Soto-Hall

·        orthopedic test

·        bring patient into flexion

·        acute trauma to spine

·        sprain/strain

·        fracture

·        disc lesion

·        start in cervical region

·        put palm on sternum to stabilize

·        relax head

·        passively bring head into flexion—stretch muscles

·        rule out spinal involvement

·        looking for cervical pain

·        local—soft tissue, ligaments, muscle damage

·        radiating into dermatomes down the arm—nerve root lesion—disc involvement

·        localized, focalized pain radiating—fractures (hair line)—bilateral

·        thoracic

·        flex up passively

·        strain/sprain

·        bruising

·        radiating along dermatome—nerve root lesion

·        lumbar spine

·        support w/knee

·        pain pattern and distribution

·        bring knees up the chest quickly and reflex--bilaterally

·        positive Kernig's sign—spinal cord involvement—could happen in any region

·        meningitis indicator

·        headache, sensitivity to light, neck stiffness, fever, vertigo, tinitis, red rash on body

·        most are streptococcus (Group A, b-hemolytic)

·        traumatic meningitis—Soto-Hall

·        flex spinal cord you are stretching the cord and causes pain

·        need to be treated medically

·        very dangerous for the patient

·        only takes 24hrs of inflammation to cause permanent damage to the cord

·        negative Kernig's

·        nerve root lesion

·        follow pain pattern