Thoracic Pathology

Question 1

T disc lesions: Are lesions more common in upper or lower thoracic discs?

Answer 1

Lower thoracic is more likely to have disc lesions than upper thoracic due to increased weight bearing; most common is TL junction; more common on convex side due to flexion

Question 2

Thoracic nerve root lesions occur due to:

Answer 2

disc lesions, facet injuries/swelling, osteophytes, scarring, etc.

Question 3

Thoracic nerve root lesions

Answer 3

1) Neurological symptoms: numbness, pins & needles
2) distal pain (sternum) is more painful than proximal (spine)
3) Upper T-spine, referral into UE depending on location

Question 4

Facet joint dysfunction of thoracic spine symptoms

Answer 4

1) Acute is unilateral, localized sharp pain; distal pain (sternum) is LESS painful than proximal (spine); chronic should have pain as dull, aching
2) Should be NO neurological symptoms
3) Pain with coughing, sneezing, or deep breathing

Question 5

Common injury associated with facet joint dysfunction?

Answer 5

MVA seatbelts!

Question 6

Thoracic ligament injuries

Answer 6

1) Pain from ligamentous structures commonly are vague, ill-defined, spread around the area
2) No distal symptoms, no neuro symptoms

Question 7

Rib fracture - p 270

Answer 7

xxx

Question 8

Rib muscle injuries

Answer 8

1) true muscle injuries are uncommon
2) can have trigger points, especially around scapula
3) Referral could be due to Cloward areas of C3-6 disc lesions

Question 9

Thoracic outlet syndrome

Answer 9

1) Brachial plexus getting trapped, compressed between anterior & middle scalenes
2) Often have poor posture, tightness and weakness in opposite muscles
3) Elevated 1st rib
4) Compressors - pain with overhead work
5) Releasors - pain at night as everything releases
6) rule out carpal tunnel

Rule TOS out if getting symptoms into arms: test with ROOS & Cyriax

Question 10

T4 Syndrome

Answer 10

1) Idiopathic - potential autonomic or mechanical with facet (ZPJ) joints
2) Dull, aching glove syndrome (doesn’t follow dermatomes); sensory testing is normal though
3) Usually unilateral
4) May or may not have neuro symptoms as pins and needles
5) rule out carpal tunnel

Question 11

Thoracic hypomobility

Answer 11

1) very stiff
2) unilateral pain
3) Treated well with mobs and manipulations, foam roller extensions
4) key with flexed posture jobs, common with weekend warriors, suddenly getting in shape
5) Irritates anterior thoracic spine

Question 12

Thoracic fracture

Answer 12

1) Most common is fx in thoracic spine is a compression fx; often occurs with a fall
2) Can be significantly painful and result in individuals with increased kyphosis

Fix with vertebroplasty (cement into weakened vertebrae small holes) and

p. 272

Question 13

Scheuermann’s Disease

Answer 13

abc p 272

Question 14

What in cervical spine can refer to the thoracic spine?

Answer 14

1) Discs (would expect to see pain b/w shoulder blades at inferior angle; central pain is generally disc related)
2) Facet (not huge distance traveled, unilateral)