Lecture 3: Thoracic Spine

Question 1

What would you be finding out in the patients history with thoracic pain?

Answer 1

Age related?- sclerosis (female)
-mechanism of injury 
-refferal site 
-pain on inspiration/ expiration 
-radiations 
-posture 
-skin lesions 
RED FLAGS -vital signs

Question 2

What are the red flags in back pain? 
features?
Signs?
Symptoms
thoracic pain

Answer 2

fetaures:

• previous history malignancy (however long ago)
• Age 50 with NEW onset pain
• weight loss (unexplained)
• previous long standing steroid use
• recent serious illness
• recent significant infection

Signs:

• Saddle anaesthesia
• reduced anal tone
• hip or knee weakness
• generalised neurological defecit
• progressive spinal deformity
• urinary retention

Symptoms:

• non-mechanical pain (worse at rest)
• thoracic pain
• fevers, riors
• general malaise
• urinary retention

Question 3

Observation of the thoracic spine:

Answer 3

Any kyphosis/ scoliosis/ gibbus/ dowagers hump/ scapula windings, chest deformities, Skin (shingles, psoriasis)
-breathing patterns slide 11

Question 4

What should you look for in patients history?

Answer 4

• age eg Scheuermanns 13-16 years
• mechanism of injury? Compression rib fracture?
• Dural pain is worse with cough/ sneeze/ strain
• search the history for clues of reffered pain (worse with digestion? Dyspnea? Temp)

Question 5

ROM’s

What are the range of motions you should screen?

Answer 5

Active ROM’s of the Thoracic Spine.

• forward flexion (20-45%)
• extension (25-45)
• side flexion, left and right
• rotation left and right (35-50%)
• costovertebral expansion (3cm to 7.5cm)
• Rib motion (bucket handle)

Question 6

Clinical Issue T6 area. Tell me about it

Answer 6

• common placee to experience pain and tightness
• if there is alteration of menial biomechanics, palpation around T6 are often revealed tenderness and stiffness.
• major blood vessels for thoracic cord and meninges comes in just under T6. Canal here quite narrow and dura mater thickest here.