Thoracic Spine Flashcards
(43 cards)
Name 2 risk factors for development of neck and thoracic pain
Prolonged sitting, physical inactivity
How many vertebrae are in the T-spine?
12
Name 4 functions of the T-spine.
Movement of the trunk
Contributes to respiration
Protection of thoracic viscera and spinal cord
Support and assists with movement of the upper limb
How many degrees of flexion, extension, lateral flexion and rotation can the T-spine achieve?
Flexion: 32
Extension: 26
Lateral flexion: 27
Trunk rotation: 85
What is non-specific thoracic back pain?
Most common type of thoracic related back pain
Unlikely to be because of a serious problem such as cancer, infection, fracture, or as part of more widespread inflammation
Nociceptive in origin
Range of sources; Intervertebral joint structures (IVD, Rib articulations, Z- joint), muscle and soft tissue.
What the mechanism of injury (MOI) of non-specific thoracic back pain?
Gradual onset: no specific incident, will report sustained posture (increased sitting/unaccustomed postures) or a recent change in activity (type, amount, technique)
Acute sudden: will report injury after a specific movement that involves lifting/rotation
What are the key impairments of non-specific thoracic back pain?
Loss of ROM - limited by pain/stiffness (soft tissue, muscle, articular)
Loss of strength & endurance - movement direction specific or activity related
What are the subjective features of non-specific thoracic back pain?
Symptoms between/around medial border of the scapulae, unilateral/bilateral
Rib involvement if symptoms 2 inches from midline +/- referral into rib
Mechanical in nature: Agg by activity or specific movements
What are the objective features of non-specific thoracic back pain?
Reduced ROM– particularly rotation and side flexion
Pain with breathing – may indicate rib involvement
Pain reproduction on accessory assessment
Posture and activity Ax: Altered movement/loading related to aggravating and easing factors
How would you manage non-specific thoracic back pain (specifically advice/education)?
Explain what is wrong: self limiting, will improve with time
Address fears and unhelpful beliefs
In the acute phase: Relative rest, encouragement of early (safe) return to activity
How would you manage non-specific thoracic back pain (symptom control)?
Reduce load/movement into aggravating positions
Encourage active pain free mobility, particularly those that ease symptoms
Postural education: Encourage changes in posture and positions regularly
Manual Therapy may be indicated for short term pain relief – never in isolation
How would you manage non-specific thoracic back pain (building capacity)?
- Restore normal movement: Address limitations in ROM
Exercises to increase mobility – particularly thoracic rotation and side flexion
Manual therapy for short term benefit may be indicated – never in isolation - Restore deficits in strength
Exercises to improve muscle strength and endurance within the thoracic spine: thoracic rotation, extension
Exercises to improve muscle strength and endurance involved scapulothoracic function: Rhomboids, serratus anterior, Trapezius - Postural control and advice
Particularly relevant to those who present with gradual onset related to sustained activities and postures
How would you manage non-specific thoracic back pain (return to function)?
- Advanced rehabilitation to build strength and conditioning in order for sufficiently strength, mobility and control towards specific goal/function/sporting activity
- Increase load and resistance particularly into previously identified impairments – ensure capacity is there
- Graded return to activity
What is thoracic outlet syndrome (TOS)?
What factors aggravate it?
Symptoms of pain, paresthesia, weakness and discomfort in the upper limbs caused by pressure on neurovascular structures (subclavian vein/artery/lower trunk of the brachial plexus) by upper ribs, clavicle or scalenes
- Elevation of the arms and related movements of the head and neck
What population does TOS mainly affect?
Female: male 4:1
30-40 years
Neurological structures affected 95-98% of the time
Vascular structures affected 2-5% of the time
What are the 3 possible site of entrapment in TOS?
Scalene triangle/interscalene space
Costoclavicular space
Subcoracoid (retropectoralis minor) space
What are 6 possible reasons that TOS develops?
Muscle length changes in scalenes and pecs which compress the neurovascular structures
Posture: that reduces the thoracic outlet space causing increase kyphosis & increased CT junction flexion
Occupational: repetitive overhead activities
Traumatic: post-fracture (clavicle, 1st rib, AC joint), whiplash
Congenital abnormalities: enlarged 1st rib tubercle/ cervical rib
What is/how does arterial TOS occur?
Compression of subclavian artery by the scalene triangle by a congenital 1st rib.
Arterial entrapment between the pec major tendon and humeral head (in active people)
How to recognise arterial TOS?
Change in blood pressure >20mmHg between arms
Symptoms: numbness, coolness, palor, (unusual paleness) non-radicular pattern of pain, no shoulder/neck symptoms
What does a non-radicular pattern of pain mean?
A pattern of pain NOT along the line of the nerve or distribution of a nerve root.
Possible complications of arterial TOS?
Claudication during activity/rest, turbulent blood flow and vessel dilation can cause arterial thrombosis (blood clot) and distal embolization (the detachment of athero or atherothrombotic fragments from the atherosclerotic plaque and their dislodgement downstream the peripheral portion of the coronary tree) can cause acute distal upper extremity ischemia.
How does venous TOS occur?
What are the symptoms of venous TOS?
Compression of the subclavian vein in the subclavian/costoclavicular space by the clavicle and 1st rib causing a disruption of blood flow.
Deep pain on movement/rest in the upper limb, chest, shoulder
Swelling and cyanotic discolouration (lack of O2 in the blood)
How does arterial or venous TOS develop (during what activity)?
Repetitive upper limb activities
Under what structures is there compression in neurogenic TOS?
What are the symptoms?
A compression of the
upper plexus (C5-7) or - (symptoms= with radiations into the chest, periscapular region, head and radial nerve distribution)
lower plexus (C8-T1) - (symptoms in ulnar forearm, hand, axilla and anterior shoulder region)
Compression of these nerve roots in the scalene triangle.
- Pain in neck, traps, arm +/- referral into chest & occipital headache
- Paraesthesia widespread in the upper limbs and fingers
