[MDDR] Thoracic Spine

Question 1

What are some typical findings associated with thoracic spine dysfunction?

Answer 1

• Pain (central or unilateral)
• Limited ROM (active/passive (one or more segments)
  (note: hypo-mobility in tx region may cause hyper mobility in cx or lx regions)
• Postural dysfunction
  (kyphotic spine; tight pec m/s; & scapulothoracic instability)

Question 2

According to Brukner & Khan what are some common causes of dysfunction of the thoracic spine

Answer 2

• intervertebral joint sprain (disc/facet joint)
• Paraspinal muscle sprain
• Costovertebral joint sprain
• Scheurmann’s disease (adolescents)
• Vertebral fracture

Question 3

Causes of pain & limitation of movement in the Tx Spine

Answer 3

1) Trauma (vertebral body/rib #)
2) Degenerative conditions
3) Inflammatory disorders
4) Metabolic conditions (i.e. osteoporosis)
5) tumour (assess category 2 red flags)
6) Syndromes
7) Postural thoracic pain
8) Referral of symptoms (i.e. visceral or lower cx spine)

Question 4

Degeneration conditions are possible causes of pain and limitation of the tx spine

What are some degenerative conditions?

Answer 4

1) Spondylosis (degeneration of the IVD)
2) Arthrosis (degeneration of the facet joint)
3) Scheuermann’s Disease (osteochondrosis of the spine)
Prognosis: OA spine

Question 5

In Scheuermann’s Disease patients present with?

Answer 5

Pain in Tx region and accentuated Tx kyphosis

Question 6

What is an inflammatory disorder affecting the tx spine?

Answer 6

Ankylosing Spondylitis which is chronic inflammatory disease of the axial skeleton that can result in progressive ossification of the spine.

Patient would present with low back pain and stiffness, reduced spinal mobility (function) and reduced energy/fatigue

Question 7

What is T4 syndrome?

Answer 7

Spondylitic/osteochondritic lesion from t3,4,5 region
Involves inflammation of bone and joint surfaces
Results from trauma, infection or rheumatoid disease

Question 8

Clinical features of T4 syndrome?

Answer 8

• Diffuse arm pain and sensory symptoms
• Distal limb pain worse at night
• Increased tx kyphosis
• Poor posture
• Forward head posture
• Tight scalenes/pecs
• Local tenderness on thoracic palpation with marked stiffness with PAIVM