Thoracic Flashcards
Costochondritis
Painful swelling of costal cartilage and its articulations. More diffuse than tietze’s syndrome
🠶 Anterior chest pain that is bilateral and affects the middle ribs close to the sternum
🠶 Cause not clear - preceding upper respiratory infections and excessive coughing have been described in some patients – repetitive microtrauma? Other soft tissue strains. Infections URTI (inflam’/immune response or mechanical?)
🠶 In primary care costochondritis has been found to account for 13% of presentations with chest pain, and this may be more as chest wall pain accounts for 20% and much of this may be costochondritis.
🠶 More common >40 years of age
Tietze ’s syndrome
Rare inflammatory condition that causes pain and swelling in the costal cartilages, especially where the ribs connect to the sternum (breastbone). It primarily affects the 2nd or 3rd rib joints and is similar to costochondritis but with noticeable swelling.
Tietze’s syndrome usually affects young adults under 40
2nd or 3rd costochondral junction
Swelling often accompanies costal pain which may last after any pain and tenderness has gone
T 4 Syndrome
T2-T7 joint dysfunction (posterior facet syndrome) may cause a referred or reflex phenomenon in the arms and hands
🠶 Age 30-50
🠶 4:1 female
Signs and symptoms
🠶 Upper back stiffness, dull achiness
🠶 Upper extremity numbness and/or paresthesia, may have associated headaches
🠶 Aggravated by prolonged sitting, sustained reaching etc
🠶 Sometimes at night or on rising
Thoracic Sprain and Strain
Examination
🠶 Altered spinal end play and muscle splitting, tenderness
🠶 Flexion of the head and thoracic spine usually produces pain over the posterior elements of the spine.
🠶 Motor and sensory deficits are rare
Intercostal Strain
🠶 The intercostal muscles lie between the ribs and are responsible for aiding respiration and maintaining the integrity of the rib cage
🠶 Excessive exertion or straining usually causes intercostal muscle injury
Thoracic disc disorder
lthough a somewhat neglected clinical problem, thoracic disc prolapses can be of significant clinical importance due to the high incidence of spinal cord compression with central and centrolateral prolapses
🠶 Maximum age incidence is found in the fifth decade of life (N.B. lumbar peak at 20-40)
🠶 2:1 male to female incidence
🠶 More common between T9-12
Signs and symptoms
🠶 Varies with the location of the lesion in the canal
🠶 Small prolapses are capable of producing significant neurological deficit
🠶 Root symptoms may mimic intra abdominal and intrathoracic pathology
🠶 Intercostal neuralgia
🠶 Presents with tenderness along the course of the intercostal nerve
🠶 Discogenic root pain in both thoracic and lumbar regions often present as pain which is felt only in the
distal part of the affected dermatome
Scheuermann`s Disease
Currently it is believed to be the result of vertebral growth plate trauma during the adolescent period with interruption or cessation of further growth. Wedging of greater than 5 in three consecutive vertebrae is the x-ray indicator
The incidence rate in the general population has been suggested as high as 8%
There is a small male predominance and familial tendency
The midthoracic region is affected 75% of the time.
The Thoracolumbar region is affected 25% of the time
Signs and Symptoms
🠶 13-17 male (process is ‘burned out’ by 18?)
🠶 Presents with symptomatic thoracic pain and fatigue; postural deformity
🠶 On postural assessment there is usually an exaggerated cervical and lumbar lordosis, with a hyperkyphotic thoracic region
