3/8/99

Orthopedics)

 

Herpes zoster

·        Affects nerve root

·        Most infective nerve root lesion

·        Exposure to virus outbreak of chicken pox or already have immunity

·        Chicken pox

·        Mild viral infection in children

·        Deadly in adults

·        Lasts about 2 wks

·        Systemic viral infection

·        Varcella zoster

 

Shingles

·        Remains in DRG

·        Activated by stress symptoms

·        Affects nerve root of the DRG

·        Mainly found in the thoracic region

·        Unilateral disorder

·        Can affect other areas (lumbar, cervical, cranial nerves, sacral)

·        Initial signs--pain and tenderness in b/w the shoulder blades, back pain

·        Over the course, burning sensation b/w shoulder blades

·        Sore acheness along dermatomes

·        Burning along dermatome area in a couple of day

·        2-3 days appearance of vesicles

·        not very common to have radiation along dermatome

·        herniate a thoracic disc

·        2wks to 8 months

·        improve nutrition and overall health

·        UV light can lead to scarring

·        Alovera gel help, vit A and E

·        Lots of vitamins

·        Vesicles open and leave susceptible to secondary infections

·        Clear/cloudy filled pouches

·        Pustules--bacterial skin infections—none found in Herpes zoster

·        Can't catch if touch the open vesicles

·        If have never had chicken pox as a child, you are at risk of contracting Varcella virus

·        Can only contract chicken pox

 

Chest deformities

1.      Pectus carinatum—pigeon chest

·        T1-6

·        Increase a-p

·        More pronounced w/age

·        Sternum more anterior

·        Genitcal/hereditary

 

1.      Pectus excavatum—tunnel chest

·        Sternum pushed inward

·        Decrease a-p dimension of the chest

·        Hyperkyphosis

·        Hereditary/genetic

·        Cardiovascular problems

·        Heart is displaced left and superior

·        Pulmonary aa and v; aorta

·        May require surgery in early teens if bad enough

3.  Barrel Chest Deformity

·        Developmental

·        Emphysema

·        Compromise pulmonary tissue

·        Intercostal, diaphragm over active

·        Help to breath

·        Increase a-p and lateral

·        Gasping for air

·        End stage

·        Chest expansion decrease to 1-1.5 inch

·        Destroy alveoli

·        Decrease gas exchange

·        2 types

·        problem w/inspiration and expiration

·        will affect biomechanics of respiration and thoracic spine

4.  Asthma

·        decrease chest

·        problem w/inspiration

·        brochospasm of smooth muscle

·        restrictive lung disorder

·        will affect biomechanics of respiration and thoracic spine

5.      Pleurisy

·        Inflammation of the pleura that surrounds the lung (parietal and visceral)

·        Restrictive lung disorder

·        Pain and discomfort during breathing

·        Previous history of respiratory disease or episode

·        Healthy person doesn't get

·        Orthopedic test—Schepelman's Sign

·        Sit

·        Laterally bend to each side

·        Point to any pain or discomfort

·        Doc stands behind

·        Passive movement

·        Adhesions b/w pleura

·        Can't move will cause pain and discomfort

·        Classic Dx

·        Bend to the left and pain on the right at the convexity

·        Bend to left and pain on the left w/no history of respiratory pathology, no pleurisy

·        Bend to the left and pain on left, trauma, compress soft tissue, stretch right side –structures—nerve root lesion

·        Bend to left, pain on right, paraspinal mm or ligamentous, trauma/inflammation

·        Bend to left w/dermatome pattern, disc lesion

·        Fracture—hurt like hell no matter what you do (spinous percussion)

·        Bone bruise—severe bruising over the bone can mimic several different conditions—inflammation of area eliciting other symptoms