Thoracic Spine

Question 1

Prevalance of Tx pain?

Answer 1

Annual prevalence = 15% in adults (30-34% working adults)
Lifetime prevalence = 15-20%
Common in kids/adolescents

14-50% of chest pain presenting to ED is thoracic spine related

Question 2

What are risk factors for thoracic spine pain?

Answer 2

1. Heavy long duration monotonous tasks
2. Ergonomic/postural causes
3. Adolescents - Female gender, weight and chair height, backpack use

Question 3

What aspects of thoracic anatomy is relevant to assessment?

Answer 3

1. Rib cage attaches onto it - costotransverse + costovertebral joint
2. Accompanying movement of ribs with vertebra so pain could be coming from ribs or VBs

Question 4

Briefly explain the movement of the VBs

Answer 4

1. Mostly transverse motion
2. Sagittal movement is restricted compared to Cx/Lx

• flexion/extension increases as you go down the Tx and into the Lx
• rotation is the greatest in the upper and middle parts of Tx and reduces as you go into the Lx
• lateral bending stays about the same throughout from the Tx into the Lx

Question 5

What might cause serious pathology in the Tx?

Answer 5

1. Visceral
2. Cancer
3. Cord compromise (spinal cord is the narrowest in the Tx
4. Trauma (eg. osteoporosis/compression/burst fracture)

Question 6

Describe scoliosis

Answer 6

affects 2-4% of adolescents
85% of cases are idiopathic
>10º lateral curve of the spine with rotation
genetic influence

Question 7

How do you diagnose scoliosis?

Answer 7

Cobbs angle

Adams test looking for rib hump

Question 8

How does Cobb angle influence management?

Answer 8

<25º = observation
25-40º = brace+observation
>40º = surgery

Question 9

Describe Scheurmanns

Answer 9

Who - boys
What - fixed kyphosis deformity; vertebral endplate damage;
Where - thoracic spine
Why - genetics/some mechanical influence?

Question 10

Describe Scheurmanns

Answer 10

Who - boys 8-16 - often around 12-14 yrs old
What - fixed kyphosis deformity; vertebral endplate damage; not always painful
Where - thoracic spine
Why - genetics/some mechanical influence?
How - XR shows VB wedging anteriorly >5º on at least 3 VBs’ schmorl’s nodes; VB end plate irregularities

*higher risk of LBP in adulthood; adult thoracic pain who had Scheurmanns in adolescence

Question 11

How is Scheurmann’s different that a normal kyphosis?

Answer 11

Normal kyphosis:

• no imaging findings
• more flexible
• smoother curve instead of more pronounced curve wth Scheurmann’s

Question 12

How do you manage Scheurmann’s?

Answer 12

20-40º curve is normal

MIld (<60º) - monitor - adivce/posture/ex
Moderate - bracing/ex
Severe (>70-75º) - may require surgery

Question 13

What are some of the causes of anterior chest pain?

Answer 13

Cardiac
Nerve root
Costochondritis (slow onset)
Rib #/Costal cartilage injury (history of trauma)

Question 14

Describe the assessment for the thoracic spine

Answer 14

Looks
Feel - palpation of mm’s, rib heads, etc
Move - AROM/PROM/overpressure

Question 15

Describe the management of thoracic spine pain

Answer 15

• multimodal treatment more likely to yield pain reduction

- manipulation reduces pain but not clinically worthwhile