Thoracic Spine

  1. Describe potential non-mechanical causes of thoracic spine pain
    • Fracture (traumatic, fragility, pathological): spinal compression # most common "serious" pathology encountered in primary care, rib most commonly injured bone in thoracic region
    • Tumour: primary (uncommon), secondary (spinal metastases common in Thx/rib cage
    • Inflammatory: eg AS
    • Visceral: cardiovascular, lung, gall bladder, stomach, liver, pancrea
  2. Describe thoracic "red flags"
    • SOB/chest pain on exertion
    • Indicators of spinal cord compression - secondary to large thoracic disc protrusion, expulsed segment post fracture, bilateral paraesthesia, dysaesthesia, weakness, changes in balance/gait
  3. Describe a normal thoracic disc
    • Narrower (less height) than Cx and Lx - contributes to relative stiffness of thoracic region
    • Slightly wedged shaped (narrower anteriorly) especially in the mid thoracidc region (contributes to kyphosis)
  4. What are Schmorl's nodes?
    • Vertical herniations of disc material through endplates
    • Most common in Thx and Lx
    • Seen in all ages
    • Incidental finding and usually asymptomatic
    • Associated with Scheurmann's disease
  5. What is Schuermaan's disease and what does it result in?
    • Osteochondrosis of the secondary ossification centres of VBs
    • Endplate irregularity, anterior VB wedging (local increased kyphosis), Schmorl's nodes, loss disc space height
  6. Describe cervico-thoracic postural pain
    • Very common presentation
    • Dx: NSTx Pain
    • Classification: as a postural loading disorder
    • Diffuse cervico-thoracic pain especially upper and mid Thx
    • Gradual onset
    • Increasing pain during the day
    • Worse with sustained postures/loading, eased with movement/NWBing
  7. Describe thoracic spine "sprain"
    • Dx: NSTx Pain
    • Classification: not necessary in the inflammatory phase
    • Usually related to movement (quick, at extremes of range) under load
    • Sudden onset of pain (commonly unilateral)
    • Directional movement restriction
    • Pain with respiration
    • Significant local tenderness in region
    • Strong inflammatory response
  8. Describe acute "locked" thoracic joint
    • Dx: NSTx pain
    • Classifcation: movement impairment disorder
    • Similar to wry neck
    • Similar to presentation of acute thoracic "sprain" but mechanism assumes minimal tissue injry
    • Thoracic joint "locked" on waking
    • Mid-thoracic segments more common
    • High pain levels/irritable ++
    • Significant movement restriction (usually rotation)
    • Pain ++ with respiration common
    • Pathology unknown
  9. Describe non-acute mid-thoracic hyponmobility disorders
    • Dx: NSTx pain
    • Classification: movement impairment disorder
    • Insidious onset
    • Common in middle aged and older
    • Predominantly mid thoracic (T3-9) segments
    • Often more than one segment involved
    • Commonly bilateral symptoms
    • Ache at rest even at night
    • Stiffness AM
    • Movment impairment (ext, rot, LF)
Card Set
Thoracic Spine