2 - SCREENING FOR REFERRAL OF Tx & CHEST

Question 1

Prevalence of Tx pain

Answer 1

Low prevalence compared to NP or LBP but often associated with serious pathology:
- 7-day prevalence: 5-50%
- 1 month prevalence: 1-35%
- 1 year prevalence: 4-35%
- Lifetime prevalence: 15-20%
More common in adolescents, especially females
Often associated with backpack use, postural strain, concurrent MSK complaint

Question 2

Why screening Tx pain matters

Answer 2

Close relationship to vital organs & lower mechanical flexibility makes it hotspot for serious pathology

Question 3

Indication of thoracic spine pain

Answer 3

Thoracic spine pain (TSP) indicates:
- Spinal tumors or metastases
- Infections (discitis, osteomyelitis)
- Fractures from osteoporosis
- Aortic aneurysm or dissection
- Visceral referral (heart, lungs, GI tract, kidneys)

Question 4

Goals of screening

Answer 4

Goals of screening
Triage
- Differentiate MSK vs systemic vs visceral origins
- Prioritize care based on urgency
- Risk management
- Detect signs requiring medical referral

Question 5

Red flags & referral criteria: steps & description of each

Answer 5

D FLAGS & REFERRAL CRITERIA
3-step decision making tool to help clinicians identify serious pathology:

1. Determine level of concern
   Consider evidence to support red flags, together with clinical (response to treatment, comorbidities) & patient profiles (age, sex…) when determining level of concern
2. Decide clinical action
   Based on level of concern
3. Consider pathway or emergency / urgent referral if indicated
   Know local referral pathways & pathways to access
   specialist care if indicated

Question 6

Overview of key red flags:
- red flags
- why it matters
- possible serious patho

Answer 6

Table

Question 7

MSK causes: mechanical dysfunction

Answer 7

Myofascial pain syndrome (MPS)
Minor intervertebral yes function (MID)

Table

Question 8

MSK causes: Degenerative disorders

Answer 8

Scheuermann’s disease
Thoracic scoliosis
Thoracic spinal osteoarthritis
Thoracic facet syndrome
Maigne’s syndrome
Diffuse idiopathic skeletal hyperostosis

Table

Question 9

MSK causes: MID vs TFS vs MAIGNE

Answer 9

Table

Question 10

MSK causes: traumatic disorders

Answer 10

Vertebral compression fracture
Thoracic disc herniation

Table

Question 11

Inflammatory & systematic disorders: spondyloarthropathies

• spondyloarthropathy spectrum
• ASAS

Answer 11

Table

Image

Question 12

Inflammatory & systematic disorders: spondyloarthropathies:
- different diseases

Answer 12

Ankylosing spondylitis
Psoriatic arthritis
IBD associated spondyloarthropathies
SAPHO

Question 13

Inflammatory & systematic disorders: infection condition:
- infectious spondylodiscitis

Answer 13

Infection of intervertebral disc & adjacent vertebrae (bacterial, fungal or post-surgical)
- Tx commonly affected in older adults > 50 or immunosuppressed patients
- Clinical signs: constant, deep thoracic pain (not relieved by rest), fever,elevated CRP
- May lead to abscess or SC compression if untreated

Table

Question 14

Inflammatory & systematic disorders: infection condition:
- thoracic herpes zoster

Answer 14

Reactivation of varicella-zoster virus
- Burning or tingling pain before rash
- Vesicular rash appears on trunk along thoracic dermatome or on face
- Post-herpetic neuralgia in some cases
- Treatment: antiviral therapy (acyclovir), pain management

Question 15

Referred visceral causes: cardia causes

Answer 15

Inferior myocardial infarction
Pericarditis

Table

Question 16

Referred visceral causes: pulmonary causes

Answer 16

Pleuro-pulmonary pathologies (pleural effusion, pleuritis, pulmonary embolism, lung tumor)
- Pain features: sharp, stabling, worsened by deep breathing, coughing or movement
- Often unilateral
- Associated signs: dyspnea, cough, hemoptysis, fever (depending on cause)

Question 17

Referred visceral causes: digestive causes

Answer 17

Gastric or duodenal ulcer
Pancreatitis
Digestive cancers

Table

Question 18

Referred visceral causes: vascular causes

Answer 18

Thoracic aortic aneurysm

Table

Question 19

Sport related causes: spine & sports:
- key concepts
- causes

Answer 19

Spinal pain frequents in athletes
Causes
- Macro-trauma (as fall, tackles)
- Micro-trauma (as repeated mechanical stress)
Sport revealing or worsening underlying pathology
Increasing trends: younger age of sports practice & longer athletic careers
Highly repetitive & specific movements (overuse, technopathies)
Elite sport prioritizes performance over health

Question 20

Sport related causes: spine & sports:
- segmental overload in young athletes
- thoracic or lower cervical disc herniation with thoracic referral
- costotransverse or costovertebral joint dysfunction

Answer 20

Table