Thoracic spine Flashcards
1
Q
General thoracic spine pain (PI, PE, Treatment)
A
Patient interview and physical assessment:
- Can come form rib injuries usually trauma
- Radiating pain
- Thoracic nerve root pain
- Pain on inspiration and/or expiration
- Pain around chest (costovertebral), cervical spine or scapula
- Arm movements
- Aggravating activities
- Effect of posture
- Can have neurological signs
- Pain and restriction with AROM and repeated/sustained movements
- PPIVM’s
- PAIVM’s
Treatment
- Heat, TENS, analgesics, taping to deload or limit painful movement
- Gentle mobility exercises (archer stretch, seated rotation, gentle extension: sustained)
- Rotation PPIVMS
- Joint mobilisations as acute pain settles
- PAIVMS
- Manipulations
2
Q
Thoracic spine hypomobility
A
Diagnosis:
- Gradual onset
- Can arise from prior injury or respiratory disease
- Ache at rest and stiff in morning
- Aggravated by sustained postures and end of range movement
- AROM of extension, rotation, lateral flexion and rib movement is impaired
- Can get neurological signs
- Stiff PPIVMS
Treatment of instability:
- Manipulationsof hypomobile segments above and below
- Stabilisation exercises: multifidus
- Muscle length stretches and strengthening
- Add scapular exercises (lower traps, serratus)
- Tx extensor mobility and strengthening
- Taping for support
- SNAGS
- Respiration – deep breathing exercises
- PAIVMS above or below
- PPIVMs
3
Q
Scheuermann’s disease
A
- Uneven growth of thoracic vertebra
- Wedging, decreased height and increased curvature
- Curve in upper thoracic spine = more disfiguring
- Curve in lower Tx spine – more painful
Diagnosis:
- ROM of spine (forward flexion in particular)
- Observation and palpation
- Neurological exam
- Muscle length testing
Treatment:
- Postural exercises
- ROM exercises if restricted
- Can recommend a brace
- Hip and back extensor muscle strengthening
4
Q
Scoliosis
A
-One of more lateral curves thoracic/lumbar spine
Diagnosis:
- Does not correct with forward bend
- Assess rib symmetry and rib contours
- ROM of trunk
- Pain
- Curves in spine
- X-ray
Treatment:
- Don’t often need treatment unless painful or threat to spinal cord (surgery)
- Can brace in younger years
- Stretches and exercises dependent on level, side and amount of spinal deformity
5
Q
Thoracic outlet syndrome
A
Patient interview
- Local pain (cervico-thoracic)
- Shoulder, neck, hand symptoms/pain/weakness
- P&N’s, numbness, pain
- Worse with sitting, carrying objects, overhead activities
- Vascular symptoms sometimes
- Pain/symptom reproduction with hyperabduction/external rotation test
Treatment -Address local structures o 1st rib and upper Tx spine mobility o Scalenes/pec minor muscle length exercises o Consider breathing mechanics -Correct posture -Soft tissue and trigger pointing over sensitive tissues -Scapulothoracic joint mobilisations -Thoracic extension exercises -Neuro-mobility for brachial plexus
6
Q
Rib stress fracture
A
-Repetitive upper extremity torsion or upper extremity (UE) weight bearing
Diagnosis
- MRI
- Bone scan
- Pain and limited ROM with Thx ext. R rot. and R LF e.g.
- TOP
- Poor expansion and shallow breathing
- PAIVMS: pain
- PPIVMS: hypomobile
Treatment:
- Rarely heal if modification or complete rest from causative activity for 4-6 weeks
- Rest from aggravating activities
- Address mechanics and training schedule, equipment (involve coach)
- Look at kinetic chain – thoracic-lumbar spine relative flexibility and muscle
- Maintain flexibility in lower back, legs and hips
- Begin light UL strength
7
Q
Thoracic disc protrusion
A
Patient interview:
- More common over age of 50
- Repetitive loading in extension or semi-flexion
- Acute episodes with remission
- Referral pain common (lower abdomen, iliac crest, upper buttock, lateral thigh)
- Shooting pain to anterior hip
- Can present with neurological signs
Treatment:
- Restore mobility of thoracic spine
- Joint mobilisations if medically cleared (PA centrally over SP and TP above or below irritated segment)
- PPIVM
- Soft tissue massage over tense structures (trigger points and myofascial release)
8
Q
Side strain injury
A
Diagnosis:
- Pain and tenderness on opposite side to the throwing arm over lower lateral costal margins
- Sudden sharp pain during a throw/delivery
- Tear of internal oblique from its rib or costal cartilage attachment (at 11th rib)
- Pain with breathing, pain on palpation over lower 4 ribs usually along mid-axilla line, pain with LF and rotation
Treatment:
-Pain relief – analgesics, ice, taping
-Once tenderness is resolved
o Tx spine mobilisations
o Tx spine mobility exercises + deep breathing
o Commence isometric abdominal and oblique exercises
o Progress to isotonic side flexion
9
Q
Osteoporosis of thoracic spine
A
Signs and symptoms:
- Height loss
- Dowager’s hump
- Postural changes
- Decreased ROM Lx, Tx, shoulder elevation
- Chronic back tiredness, fatigue and pain
- Loss of muscle strength of scapular stabilisers, trunk extensors, hip extensors and abdominals
- Decreased aerobic and functional capacity
Treatment:
- Focus on prevention
- Education and pain management (Heat/ice/NSAIDS)
- Gentle massage (effleurage),
- TENS
- Gentle spinal mobilisations
- Braces or postural taping
- Exercise and resumption of activity
- Spinal extension exercises: isometrics and progress to load bearing
- Resistance training
10
Q
Non-mechanical causes of thoracic spine pain
A
- Fracture (Traumatic such as # vertebrae or rib)
- Fragility (related to osteoporosis)
- Tumour: primary (less common) and secondary (spinal metastases)
- Inflammatory (ankylosing spondylitis)
- Visceral (abdominal organs, post-surgery, viral such as Shingles)
11
Q
Conditions of mechanical thoracic pain
A
- Cervico-thoracic postural pain
- Thoracic spine acute sprain
- Acute ‘locked’ joint
- Mid-thoracic instability
- Thoracic hypomobility disorders
- Rib Stress Fractures
- Side Strain
- Costochondritis and Tietze’s syndrome
- Thoracic osteoporosis
12
Q
Cervico-thoracic postural pain
A
Signs and symptoms:
- Diffuse cervico-thoracic pain +/- occipital headache
- Gradual onset
- Increasing pain during day
- Worse with sustained postures
- Over or under-active muscles
- Poor posture (can influence pain, muscle tightness, joint stiffness)
Treatment:
- Modify any inappropriate muscle activity and treat impairments
- Spinal flexor or extensor strengthening
- Shoulder girdle muscles strengthening
- Relaxing over active muscles with stretching, soft tissue massage, trigger points, heat
- Strengthening ‘under active muscles’ often thoracic extensors, scap retractors, serratus anterior
- Postural retraining
- Work set up
13
Q
Acute thoracic ‘sprain’
A
- Usually related to movement under load
- Sudden onset of pain (commonly unilateral)
- Directional movement restriction (related to direction of injury force)
- Pain with respiration (CV and CT joint involvement)
- TOP
- Strong inflammatory response (initially pain at rest)
Treatment:
- Heat, TENS, analgesics, taping to deload or limit painful movement
- Gentle mobility exercises (archer stretch, seated rotation, gentle ext.
- Rotation PPIVMS
- Joint mobilisation as acute pain settles
14
Q
Acute ‘locked’ thoracic joint
A
Symptoms
- Cervical wry neck
- Locked on waking or with trivial incident (low load)
- Mid-thoracic segment pain
- Very irritable
- Significant movement restriction (unilateral)
Treatment:
- Manipulation (PAIVMS)
- Heat
- Rotation and extension mobility exercises
15
Q
Mid-thoracic instability
A
MOI:
- Excessive rotation to unrestrained thorax
- Thoracic rotation forced against fixed rib cage
Signs and symptoms
- Localised central mid Tx pain can radiate around chest in dermatomal distribution
- May get sympathetic signs and symptoms: cold, sweating, burning, nausea
- All movements aggravate pain especially contralateral rotation
Treatment
- Mobilisation or manipulation through PAIVMs of hypomobile segments above/below
- Stabilisation exercises of multifidus isometric concentric
- Add scapular exercises with thorax in neutral (lower traps, serratus)
- Tx extensor strengthening
- Taping
