Clinical syndromes of Thoracic Spine

Question 1

possible traumatic causes of thoracic spine pain

Answer 1

VB, processes or posterior arch
ligt sprain
muscular strain

Question 2

possible degenerative causes of thoracic spine pain

Answer 2

Spondylosis (less commonly symptomatic here)
Facet Joint arthrosis
Scheuermann’s Disease

Question 3

possible inflammatory causes of thoracic spine pain

Answer 3

ankylosing spondylitis

Question 4

possible infectious causes of thoracic spine pain

Answer 4

TB
‘Shingles’

Question 5

possible mechanical causes of thoracic spine pain

Answer 5

Discogenic pain
Postural thoracic pain
Hypomobility syndromes

Question 6

examples of syndromes that cause thoracic spine pain

Answer 6

Thoracic Outlet syndrome
Thoraco-lumbar junction syndrome

Question 7

possible metabolic causes of thoracic spine pain

Answer 7

Osteoporosis
Paget’s Disease
Osteomalacia

Question 8

scheuermann’s disease

Answer 8

Structural Kyphosis – usually
Fairly fixed at apex
usually in lower thoracic spine

Question 9

describe shingles

Answer 9

Virus affecting nerve roots = Herpes zoster

Question 10

symptoms and stages of shingles

Answer 10

First: burning pain, tingling or itching in a single area about 48-72 hours before a rash develops. Sometimes confused with acute musculoskeletal dysfunction at this stage.
Second: red rash is quickly followed by the formation of vesicles, or small sacs filled with fluid
Contagious period (to those who have not had chickenpox): as new blisters form and old blisters heal
Rx: Anti-viral drugs & pain meds

Question 11

what to note in subjective exam

Answer 11

effect of breating in symptoms inspo vs expo, cough, sneeze,
consider juvenile arthritides/AS

Question 12

clinical patterns of discogenic thoracic pain

Answer 12

Predominantly severe pain – central,
unilateral or band around chest
(referred pain)
Pain on inspiration & / cough
P/E:
Central PA (>unilateral PA)
provocative & reactive,
PPIVM hypomobile & reactive segment
Axial compression provocative
+/- radiculopathy (not common)

Question 13

symptoms of hypomobility syndrome

Answer 13

mid-thoracic typically
hypo lateral flexion and rotation
associated with either flexion/extension restriction

Question 14

thoracolumbar junction syndrome

Answer 14

T12 / L1 cutaneous nerve supply means that pain is rarely felt in TL junction region and is more often referred to iliac crest region / groin.
Often in younger more mobile person, particularly if hyperlordotic

Question 15

physical ax of thoracolumbar junction

Answer 15

Lateral flexion / rotation will provoke symptoms
PAIVM examine will provoke

Question 16

thoracic outlet syndrome definition

Answer 16

A symptom complex characterised by pain, paraesthesia, weakness and discomfort in the upper limb which is aggravated by elevation of the arms or by exaggerated movements of the head and neck

Question 17

What is thoracic outlet syndrome caused by

Answer 17

repeated occupational stresses e.g. overhead arms
poor posture
trauma to shoulder e.g. clavicle #
cervical rib: 10 x more likely to have TOS

Question 18

clinical pattern of thoracic outlet syndrome

Answer 18

Arm swelling
Hand or arm weakness
Feeling of tiredness in the arm aggravated by performing overhead work
Tingling or numbness, especially in the middle, ring and little fingers
Radiating pain in the shoulder, arm or hand—commonly between the fourth and fifth fingers

Question 19

special tests for thoracic outlet syndrome

Answer 19

Roo’s test: Abd/Ext rotn – 1-3min elevated arm stress test: (+) = P1 & P&N
Low specificity  false positives
Adson’s test: deep breath & elevate chin & turn head x 30secs while monitoring radial pulse – NOT RELIABLE!
Costoclavicular compression: scapula retraction & depression while monitoring radial pulse – only positive for pulse change if vascular compromise present

Question 20

management of hypomobility

Answer 20

Manual therapy:
Treat as you find  mobilise most restricted / provocative movements to restore
Exercise:
Mobilising: Extension, Flexion, Rotation.
Strengthening: based on assessment
upper-mid thoracic spine - correct crossed syndrome
lower thoracic spine - consider lumbopelvic control, common pattern - excessive lordosis

Question 21

conservative management of thoracic outlet syndrome

Answer 21

rest +/- tape to position scapula
posture correction (as tissues tolerate)
patient education
muscle flexibility & control in neck, shoulder girdle
main component of rehab is the graded restoration of scapula control, movement, and positioning at rest and through movement (Watson 2010)

Question 22

surgical management of thoracic outlet syndrome

Answer 22

Scalenectomy
Scalenotomy
First rib resection