Show Menu

5002 Case 8 Cheat Sheet by

Compression fracture of the thoracic spine


- 57 y.o. female
- Back pain; T/L junction
- Onset 1 day ago whilst bending forward cleaning the bath
- Sudden onset, excruc­iating pain
- Severe pain
- Nauseous w/ pain
- 10/10 onset
- Now 5/10
- Constant pain & nausea
AF: Any movement, painful to lie on back, couldn't sleep duet pain at night
RF: Rest, ice, gentle walking, parace­tamol & ibuprofen
AA: Movement; especially sudden
- Chiro treatment for previous "­rotator cuff" pain, treatment helped w/ US & home exercises, no manipulation
- IBS (upset tummy & nerves)
- Dizziness, GP diagnosed w/ vertigo
- Menopause 8 yrs ago (49)
- Osteop­orosis; diagnosed 5 yrs ago
- Prescribed medication (doesn't recall name) & calcium but doesn't take them (worried about side effects)
- Mother: osteop­orosis

Physical Examin­ation Findings cal

General observ­ations
- Mild swelling over T/L junction
- Appears tired & frail
- All movements guarded
- Extremely guarded
- Unable to lie supine due to pain
Tx & Lx ROM
- Unable to perform due to pain
Closed fist percussion
- Purpose: sympto­matic (sharp, sudden pain) compre­ssion fracture
- Findings: pain over T/L junction
- Pain over T11-12 & L1
- No pain
- Discomfort over the T/L area
- Genera­lised pain & tenderness over Tx spine
- Very TTP over T10-L2


Working diagnosis
- Compre­ssion fracture of the Tx spine
- Why a 57 y.o. would get a fracture so easily w/ such minimal trauma?
1. Extremely osteop­orotic: due to bone density loss, fracture compli­cat­ions, multiple fractures, underlying health conditions (chronic RA, hypert­hyr­oidism, GI disorders, prolonged use of steroids), hormonal factors (decline of oestrogen aka menopause, low testos­ter­one), lack of treatment, age
2. Pathol­ogical fracture (osteo­por­osis, cancer, bone infection, Paget's disease, osteog­enesis imperfect, osteom­alacia, genetic disorder, nutrit­ional defici­encies) & there's underl­ying, undiag­nosed cause for bone weakness
How does compre­ssion fracture affect her MSK manage­ment?
- Avoid high-v­elocity or high-i­mpact spinal manipulations
- Soft tissue & lifestyle focus
- Combined management plan w/ secondary healthcare profes­sional
What is vertigo?
- Dizziness charac­terised by a sensation of spinning, swaying, & tilting when standing still
- Possible issue w/ inner ear (balance), brain, sensory pathways
What other examin­ations could have been done?
- Assess for gait, balance & mobility (for fall prevention purposes to minimise further injury to osteop­orotic pt)
- Sensory examin­ation (pt cannot lie supine due to pain ∴ try lying down)
- Referral for MRI

Learning outcomes

Sx & Ssx:
- Height loss
- Back pain
- Fractures
- Stooped posture
- Decreased grip strength
- Routine assessment (not required if >40 y.o.)
- Avoid high-v­elocity or high-i­mpact spinal manipulations
- Soft tissue & lifestyle focus
- Refer to GP for osteop­orosis education / invest­iga­tions in younger pts
Management (if risk assessment suggest signif­icant fracture risk):
- Refer for imaging invest­iga­tions & medication advice
- Lifestyle advice: no smoking, alcohol consum­ption <2 units / day
- Food/diet: calcium & vitamin D intake
- Fall prevention (strength & balance training)
Why this pt so bad?
- Drop in oestrogen from menopause (causing bone loss, increasing risk of osteoporosis)
- Pt not taken their medication
- Underlying pathol­ogical cause?
Different types of fractures in the Tx spine:
- Compre­ssi­on/­ant­erior wedge (most common; due to osteop­orosis; post-m­eno­pausal, >50 y.o.)
- Burst (axial compre­ssion; can cause neurol­ogical deficits)
- Flexio­n-d­ist­raction (due to extreme forward bending force [RTA]; can cause posterior ligament tear)
- Pathol­ogical (caused by infect­ion­s/t­umours; full vertebral collapse)
Rotator cuff disorder (supra­/in­fra­spi­natus, teres minor, subsca­pularis - SITS):
- Rotator cuff tendin­itis: inflam­mation of the tendons of the rotator cuff muscles; typically caused by overus­e/r­epe­titive motions
- Rotator cuff tear: tear in one or more rotator cuff tendons, can be partial or complete
- Rotator cuff imping­ement: rotator cuff tendons & bursa compression
- Rotator cuff bursitis: inflam­mation of the bursa around the rotator cuff tendons
- Pain in shoulder: especially lifting or reaching overhead
- Weakness in the shoulder, making it difficult to lift or carry objects
- Limited ROM shoulder
- Clicki­ng/­popping when moving shoulder
- Swelli­ng/­ten­derness in shoulder
** Adhesive capsulitis (frozen shoulder) might present w/ Sx & Ssx suggestive of rotator cuff disorder, but in this condition passive ROM is limited as well**
- Medical Hx, physical exam: AF, RF, ROM, strength, tender­ness? swelling? deformity?
- Referral for imaging: MRI (gold standard), US, x-ray, CT
- If acute rotator cuff tear caused by trauma is suspected (trauma, pain, & weakness), refer!
- Rest (acute phase)
- Referral for cortic­ost­eroid injection
- Parace­tamol (if not helping, NSAIDs)
- Stretching & streng­thening of the rotator cuff & scapular muscles
- Manual therapy / mobili­sation
Difference between IBS & IBD
Irritable bowel syndrome (IBS):
- Functional GI disorder affecting colon
- Not associated w/ inflam­mation or damage to intestinal lining
- Presen­tat­ions: recurrent abdominal pain/d­isc­omfort, changes in bowel habits (diarr­hoea, constipation)
- Diagnosis: through Sx & exclusion of other conditions (no specific diagnostic tests)
- Manage­ment: dietary modifi­cations (avoid caffeine, alcohol, spice, fatty foods), medica­tions, stress management
Inflam­matory bowel disease (IBD):
- Chronic inflam­matory disorder affecting whole digestive tract (inc. Crohn's & Ulcerative Colitis)
- Inflam­mation & damage to intestinal lining
- Presented: abdominal pain, diarrhoea, rectal bleeding
- Diagnosis: medical Hx, physical exam, blood tests, imaging tests (endoscopy or colonoscopy)
- Manage­ment: medication (corti­cos­ter­oids, immuno­dul­ators), nutrit­ional support, surgery, lifestyle changes (exercise, avoid smoking & stress)
Menopause & treatment
- Ovaries stop producing eggs, levels of hormones (oestrogen &p­rog­est­erone) decrease
- Can contribute to osteop­orosis develo­pment (oestrogen regulates bone turnover [oestrogen drops = bone turnover increases = less bone density/mass])
- Sx & Ssx: hot flashes, night sweats, vaginal dryness, mood changes, sleep disturbances
- Treatment: hormone replac­ement therapy (HRT [slows down bone turnov­er]), non-ho­rmonal medica­tions (e.g. SSRIs [reduce hot flashes & improve mood]), lifestyle (regular exercise, reducing stress, avoid triggers [caffeine or alcohol])


No comments yet. Add yours below!

Add a Comment

Your Comment

Please enter your name.

    Please enter your email address

      Please enter your Comment.

          Related Cheat Sheets

          5002 Case 11 Cheat Sheet
          5002 Case 12 Cheat Sheet
          5002 Case 13 - Mrs Joan Lockley Cheat Sheet

          More Cheat Sheets by bee.f

          31 Commonly Seen Drugs Cheat Sheet
          6002 Ankle & Foot Cheat Sheet
          6002 Knee & Lower Leg Cheat Sheet