Presentation of lower thoracic back pain:
- 12 y/o M
- Dull ache w/ sitting
- Sharp pain with leaning back
- No radiation
Scheuermann’s Kyphosis
What condition?
- 12-15y/o M
- From rapid bone growth (developmental)
- Wedge shaped vertebra
- Structural kyphosis
Scheuermann’s Kyphosis
How do you dx Scheuermann’s Kyphosis?
Anterior wedging
(>5deg in >3 adjacent vertebral bodies)
What is used to guide tx of Scheuermann’s Kyphosis?
Cobb angle
(measures whole curvature of spine in order to determine overall impact of anterior wedging)
What is the Cobb Angle?
Used to determine the maximum angle of curvature= overall impact of antior wedging
–> guides tx of Scheuermann’s Kyphosis
How do you tx Scheuermann’s Kyphosis? (3)
- Stretching/strengthening
- Bracing (if kyphosis >55-60deg until skeletally mature)
- +/- surgery (rarely used)
What condition?
Scheuermann’s Kyphosis
What are the 5 indications for surgical correction of Scheuermann’s Kyphosis?
(sx rarely utilized)
- Skeletal maturity
- Rigid deformity
3. Kyphosis >75deg
- Pain unresponsive to conservative care
- Unacceptable appearance
What condition?
- Insidious onset anterior CP
- Pain increases w/ inspiration
- Breathing restricted due to pain
- “Knife through chest into back”
- No other assoc. sxs
Costovertebral Dysfunction
What is Costovertebral Dysfunction?
Rib hypomobility/ “subluxation”
(functional disruption of the costovertebral and costosternal articulations)
Which condition?
- Sharp stabbing pain
- Unilateral
- Anterior and posterior (“knife stabbing through chest to back”)
- +/- radiate laterally along dermatome
- Increased pain w/:
- deep breathing
- Coughing/sneezing/laughing
Costovertebral dysfunction
What 4 things are seen on PE in a pt w/ Costovertebral Dysfunction?
- Reproducible pain
- PA mobilization of adjacent vertebra (inc. pain, hypomobility)
- Protective mm. spasm
- Restricted trunk ROM
How do you manage Costovertebral Dysfunction? (4)
- NSAIDs
- Acetaminophen
- Muscle Relaxants
- Manual therapy (PT/DC/massage therapy)
What condition?
- >40y/o
- Idiopathic
- Unilateral
Costochondritis
What is the MCC of MSK anterior chest pain?
Costochondritis
What ribs are most commonly affected in costochondritis?
2nd-5th ribs
What is costochondritis?
Inflammation of costochondral or chrondrosternal junction
Which condition?
- Sharp, aching or pressure like pain
- Anterior (NOT posterior)
- +/- radiate laterally
- Reproducible pain
- No overlying discoloration/swelling
- NO ROM restriction
Costochondritis
What condition?
- <40y/o
- Idiopathic (h/o of preceding illness w/ coughing)
- 2nd-3rd ribs MC
Tietze syndrome
What is Tietze Syndrome?
Inflammation of costochondral or costosternal junction
H&P of what condition?
- Sharp, aching or pressure
- Anterior
- +/- radiate laterally
- Reproducible pain
- _Swelling overlying involved joints**_
- NO ROM restriction
Tietze Syndrome
What is unique about Tietze Syndrome?
Swelling overlying the involved joints
How do you tx both Costochondritis and Tietze Syndrome?
1. NSAIDs
2. Acetaminophen
3. Activity modification
- Refractory= Lidocain/Corticosteroid injection
What is the course of Costochondritis and Tietze syndrome?
Variable course (usually <1yr, CW tenderness tends to linger)
