NEWS

 

 

Thoracic Spine Pain

Friday March 5 2010

 

Pathology:

  • The most common musculoskeletal problems of the thoracic spine are disorders of the thoracic

intervertebral joints (disc and facet joints) and rib articulations. These can contribute to local and referred pain in the thoracic

spine region.

 

  • A typical presentation of these intervertebral problems is hypomobility of one or more

intervertebral segments, plus or minus muscle spasm in the paraspinal or scapular musculature.

 

  • Pain in this region can frequently be referred around the side (lateral) and front (anterior) of the

chest wall.

 

 

 

History:

  • Athlete complains of pain between or around the shoulder blades (scapula)   centrally or to

one or both sides of the blades.

 

  • Pain may occur suddenly as a result of a sudden movement or may come on gradually over time.

 

  • Pain is commonly aggravated by rotation and side bending of the thoracic spine.

 

  • The thoracic spine is closely associated with the internal organs that lie directly below its

skeletal framework. These internal organs can also refer pain into the thoracic spine region so need to be considered

when determining the cause of pain in this region.

 

    

 

  

Examination:

  • Observation looking for any abnormalities i.e increased thoracic curvature “hunch back

posture” or “scoliosis”

 

  • Active Movements – in all directions noting pain and reduced mobility i.e forward, backward,

side bend and rotation as well as combinations of these movements

 

  • Neural Tissue testing- to assess the involvement of the thoracic spinal nerves as a cause of

pain i.e slump test

 

  • Palpation- of all joints and musculature in the area as a cause of pain
  • Checking the joints above and below the thoracic spine as a cause of pain i.e neck and lumbar

spine.

 

  • Special Tests i.e springing of the ribs, cough and sneeze, maximal inspiration.

 

                                         

 

 

Investigations:

  • Xray- may be useful when determining intervertebral growth plate abnormalities (Scheuermann’s

disease).

  • CT and MRI scans are rarely indicated for routine mechanical thoracic spine pain. They may help

confirm the presence of a thoracic disc prolaspe.

 

Atypical pain patterns unresponsive to routine management should be investigated, even in a young athlete to help

diagnose the cause of the thoracic pain.

 

Common causes of Thoracic Spine Pain:

1)      Costovertebral/Costotransverse Joint Disorders- may be an acute mechanical joint sprain where there is

entrapment of small synovial folds which occupy the fringes of the joint cavity or a degenerative disorder i.e osteoarthritis

or an inflammatory disorder ankylosing spondylitis (bamboo spine). The athlete presents with localised tenderness and

restricted mobility of the joints. Management is aimed at restoring joint mobility with mobilisation/manipulation.

 

2)      Scheuermanns Disease- is characterised by multiple end plate irregularities “wedging” involving 4 or more vertebral

bodies. Clinically the athlete presents with pain in the thoracic region and demonstrates an excessive thoracic curve

(kyphosis). It is the most common cause of pain in the thoracic spine in adolescents. Management is aimed at preventing

the posture deformity (excessive thoracic kyphosis) and the athlete may need to wear a brace to help decrease the thoracic

curvature.

 

3)      T4 Syndrome- is characterised by diffuse arm pain and sensory symptoms i.e pins and needles or numbness in the

upper arm. These symptoms could be due to intervertebral joint problems around the upper thoracic region T1-T4

intervertebral spinal levels. Symptoms may arise from the autonomic nervous system with its close proximity of the

sympathetic trunk to the thoracic spine. The athlete presents with poor posture especially characterised by forward

protruding head position and rounded shoulders with hypomobility of the upper/mid thoracic spinal segments.

Management is aimed at restoring the hypomobility of the upper/mid thoracic spinal segments and stretching tight

musculature around neck and upper thoracic spine.

 

Thoracic Spine Disc Prolaspe- is a rare occurrence with the most commonly affected region being the larger lower

thoracic spine segments. Clinically the athlete presents with localised thoracic spine pain plus or minus referred pain in the

distribution of the thoracic spinal nerve.  Management can be a conservative approach or in severe cases may require

surgical intervention.