Quiz 2 Thoracic Spine Flashcards
Components of thoracic spine examination
History, systems review , and tests and measures
Scheuermanns disease
13-16 yrs
Scoliosis most common in
Adolescent females
AS (spine will fuse)
18-45 yrs
When getting the chief complaint, need to differentiate Thorax pain
Thoracic back pain, rib pain, and chest pain
Pain between scapula
Clear cervical spine first
Pain that follows the path of the ribs
Thoracic nerve root involvement
Localized pain
Is it associated with motion restriction? Facet pain can be local or referrred?
Most intense area of pain was
1 segment inferior and slightly
lateral
Zygapophyseal
Stiffness
Joint (often facet issue in spine)
Through the chest , sharp or stabbing
Nerve root involvement
Achy - poorly localized
Vascular or visceral
Sharp, well localized
Musculoskeletal
Dull and achy- well localized
Tendinous
Deep and boring
Bone
Mechanism of injury or mode of onset
◦ Trauma/sudden/related to specific event:
determine activity, position, direction, magnitude of forces related to injury
Spinal loads with cumulative or repetitive stress and biomechanical creep loading may
cause tissues to
fatigue/damage
the result of complex
beneficial). In fact, a cornerstone of TNE interaction among physiologic,
is to de-emphasize local tissue issues, psychological, and social risk factors =
but rather focus on the biological and perpetuate or ↑ pain experience
physiological processes involved in a
Chronic pain
Populations reporting highest prevalence of thoracic pain
◦ Healthcare workers – 77% lifetime
◦ Manufacturers – 47% at 3 mo. and 38% at 1 week
◦ Manual laborers – 38% at 1 mo.
◦ Performing artists (point) – 44%
Aggravating and/or alleviating factors
24 or 48 hour pain behavior
◦ Breathing (inspiration and/or expiration
◦ Activities using UEs ◦ Worsen throughout day and relieved
refers to any type of back pain with rest = mechanical pain
caused by placing abnormal stress
refers to any type of back pain with rest = mechanical pain
caused by placing abnormal stress and strain on muscles and soft tissues of the spine
Mechanical back pain
Generally musculoskeletal problems better in
Morning/eased by rest
Thoracic wall pain*
51%
Vertebral osteomyelitis commonly targets the
T-spine
+ test helps rule in condition
Specificity : SpIn
- test helps rule out condition
Sensitivity (snOut)
Symptoms for cardiovascular causes
◦ Deep, boring pain or throbbing and pulsating
◦ Lack of aggravating factors linked to movement along with increased pain with cardiac output (exertion)
◦ Distal to the subclavian artery
◦ Severe, acute, anterior chest pain radiating to
upper back ◦ Radial pulses may be unequal
Abdominal aortic aneurysm
Can present as isolated mid-thoracic back pain
◦ Heart sympathetic innervation: T1 - T4
◦ T2-T4: intercostal nerves - the sensory component of the sympathetic supply to the heart passes to
the same sensory root as these, hence feeling a band of pain across the chest when having a heart
attack. ◦ T1 is dragged into the upper limb, hence the referred pain in the arm during a heart attack.
Angina and MI
