Thoracic Back Pain Flashcards
what are the characteristics/symptoms of NSTSP
1) Pain in the thoracic spine that is mechanically aggravated and not clearly caused by pathology/trauma/discal disease.
2) Unilateral
3) No objective neurological deficit
4) May be accompanied by referred pain.
5) May also involve shoulder, neck, Uex or low back pain
what are some commonly found associated findings when assessing the thoracic spine in those with thoracic spine pain
1) Thorax is a common site for degenerative change
2) Asymptomatic thoracic disc herniations are common
(Symptomatic are rare (5:1000 herniations))
3) Thoracic spine relatively common site for inflammatory, metabolic, infective and neoplastic conditions
list some risk factors for NSTSP
1) Female (5% male 15% female)
2) Age (increases with age)
3) Being tall
4) Frequent sustained trunk bending
5) Lack of variety in task/lack of recovery
6) Posture/use of back pack
7) Extended sedentary work
There are more red flags with thoracic back pain than LSP and CSP. list some key questions you kneed to ask to rule in/out any potential red flags.
1) Violent trauma
2) Minor trauma
3) First onset <20 or >50
4) Illness – fevers/chills/weight loss
5) Severe, constant, progressive pain
6) Non-mechanical
7) Severe morning stiffness
8) Severe/progressive neurological deficit in L.Ex
Loss of healthy function at an area can affect the other integrated areas.
Eg Upper rib dysfunction may affect scapular position and hence humeral orientation and rotator cuff action
Functional change/loss of agency can involve/affect any of the functions of the thorax.
(this is not a question, just something to remember)
what are the functions of the Thorax
1) Ventilation: this involves the ribs and Vertebrae
2) Locomotion: allows more rotation than other parts of spine (apart from Atlanto-axial joint) and plays a big role in use of upper limb via integrated movements of different joints in the area (scapular-thoracic joint, ac, SC.
3) Force transmission (force from arm - thorax)
4) Force dissipation: Compression/torque via ribs
5) Protection - Viscera/ribs
look up how the ribs move during respiration
extremely brief overview if unable to look up mechanism at any time
1st Rib – sliding articular movement
2nd-5th Ribs – Rotation articular movement – performing ‘pump handle’ movements.
6th-9th Ribs – sliding articular movement – performing ‘bucket handle’ movements.
Rotational effects on the rib cage
look up rib cage dysfunctions, especially first rib dysfunctions
list the pericardial ligaments that are related to the thorax
superior and inferior sterno-pericardial ligaments
superior and inferior diaphragm-pericardial ligaments
superior and inferior vertebra-pericardial ligaments
spheno-pericardium ligament
there-pericardium ligament
Provide 4 examples of common TSpine pain presentation and possible causes.
- Unilateral posterior thorax pain
Commonly spinal/paraspinal mechanical pain.
Evoked by stretching, associated with local tenderness, muscle tension.
- Anterior radiation of pain
- Rib strain - Intercostal muscle involvement
- Occasionally radicular pain, but rare - Interscapular pain – usually unilateral
- Referred pain – Dreyfus et al 1994
- Postural muscular strain/overuse/imbalance. - Anterior thoracic pain
- Tietzes syndrome
- Costochondritis
- Trauma – WAD (whiplash associated disorder)
unilateral posterior thorax pain causes.
Most likely a muscle, tendon or ligament strain/sprain.
in this case it will be aggravated by stretching the damaged soft tissue, relieved be contracting that muscle (spine extension most likely).
there will be some muscle tension
structure/area TTP
anterior radiation of pain (pain from posterior to anterior - traveling between ribs) causes?
most likely an intercostal muscle strain
It may be redicular pain
What is a radiculopathy?
What is radiculopathy?
Your spine is made of many bones called vertebrae, and your spinal cord runs through a canal in the center of these bones. Nerve roots split from the cord and travel between the vertebrae into various areas of your body. When these nerve roots become pinched or damaged, the resulting symptoms are called radiculopathy.
symptoms of radiculopathy?
When a nerve root is compressed, it becomes inflamed. This results in several unpleasant symptoms that may include:
- Sharp pain in the back, arms, legs or shoulders that may worsen with certain activities, even something as simple as coughing or sneezing
- Weakness or loss of reflexes in the arms or legs
- Numbness of the skin, “pins and needles,” or other abnormal sensations (paresthesia) in the arms or legs
Your specific symptoms will depend on where in the spine the nerve root is pinched. However, it’s also possible that you don’t experience any symptoms or you go through periodic flare-ups of symptoms
Radiculopathy Versus Neuropathy
Radiculopathy symptoms may overlap with those of peripheral neuropathy, making it difficult to pinpoint the source of the problem. Peripheral neuropathy is the damage of the peripheral nervous system, such as carpal tunnel syndrome that involves trapped nerves in the wrist. Radiculopathy is the pinching of the nerves at the root, which sometimes can also produce pain, weakness and numbness in the wrist and hand. Consult a spine specialist for an accurate diagnosis.
