Thoracic Common Conditions

Pain from zygapophyseal joint dysfunction can radiate how many levels above and below?

- Above = 1/2 level - Below = 2-3 levels

What are risk factors for Intercostal Neuritis?

- Adults over 70 - Immunocompromised - Underlying malignancy - Organ transplant - AIDS

What is the most common fx in the thoracic spine?

- Anterior wedge compression fx - Burst fx *between 9th and 10th vertebral bodies*

What are some intervention ideas for intercostal muscle injury?

- Anti-inflammatories - Avoid motions that hurt

Zyapophyseal joint dysfunction causing a facet impingement has what clinical manifestation?

- Blocking feeling - Pain/guarding from trapped facet capsule

What is the clinical presentation of TOS?

- Diffuse arm and shoulder pain (especially when elevated above 90 degrees) - Pain localized in neck, head, face, UE - UE paresthesia - Arm feels heavy and fatigued - Swelling - Discoloration/ulceration - Neural sx's > Vascular sx's

What is the clinical presentation of intercostal neuritis?

- Fever - Chills - Headache and malaise - 1-2 days of pain, itching and hyperesthesia - Skin eruption appear 4-5 days after other symptoms

Zygapophyseal joint dysfunction causing a facet sprain has what clinical manifestation?

- Hx of trauma - Limited ROM - Swelling may cause foraminal stenosis or DDD

Thoracic vertebral fx occur from what two motions?

- Hyperflexion - Axial loading

Dorsal Nerve Root irritation may be caused by what two processes?

- Infection (shingles) - Mechanical (bone spur, etc)

Muscle strains produce localized pain and tenderness exacerbated with what 2 things?

- Isometric testing - Passive stretching

Why are rib fractures scary?

- Lacerate lungs - Lacerate brachial plexus - Injure liver, spleen

What is the clinical presentation of a dorsal nerve root irritation?

- Lateral/Anterior chest wall pain - Hx of back pain - Pain aggravated by UE exertion - Numbness/tingling - Atrophy

How does RA clinically manifest itself in the thoracic region?

- Pain and deep swelling - Possible sublux - Xray important to rule out instability * People w/ RA have delicate joints *

What are clinical findings of intercostal muscle injury?

- Pain b/w ribs that is WORSE with movement, inspiration or cough - Tender to palpation

What are clinical features of rib dysfunction?

- Pain with deep breathing, sneezing or coughing - Pain with trunk rotation - Localized pain approx 3-4 cm from midline

PT intervention for precordial catch syndrome includes what?

- Postural re-education - muscle imbalance exercise - mobilize hypomobile segments

If a PT suspects steroid abuse, what should they do?

- Report it to a coach or physician

What are the clinical characteristics for costochondritis?

- Sharp, stabbing pain along front edges of sternum - May radiate down left arm and upper back *Resembles a heart attack*

How does precordial manifest itself?

- Sharp, stabbing pain in precordial and L parasternal region - Does NOT radiate - Usually last a few seconds

What are the clinical characterisitcs of Tietze's Syndrome?

- Sudden or gradual onset of upper anterior chest pain - Inc. HR, BP - Pain radiating down left arm - Pain aggrevated by sneezing, coughing, deep inhale, twisting

What are RF for costochondritis?

- Trauma - Repetitive motion

What are the clinical findings for T4 syndrome?

- local tenderness - + slump, ULTT - Depression or prominent spinous process - local stiffness of one segment

Which costochondral joints does costochondritis typically effect?

2-5

If TOS sx's fail to respond to PT treatment within _____ months, surgery should be considered

4 months

Precoridal catch syndrome typically occurs in what age group?

Adolescents

What imaging is helpful in identifying rib dysfunction?

CT scan

A potential muscle impairment of scoliosis would be mobility impaired on the (concave/convex) side of the curves?

Concave

A potential source of symptoms with scoliosis occurs from muscle fatigue on )convex/concave) side?

Convex

In early stages of OA, DJD, and spondylosis, the thoracic spine is ______mobile

Hyper

In the late stages of OA, DJD, and spondylosis, the thoracic spine is _________mobile

Hypo

In the middle stages of OA, DJD, and spondylosis what begins to form within the thoracic spine?

Osteophytes -- need to be careful because osteophytes can impinge on SC

What age group does costochondritis most often effect?

Over 40 y/o

Initial interventions for thoracic muscle strains include strength and passive stretch into which direction?

PAINLESS

What is a clinical finding of Scheuermann's Disease?

Pain with thoracic ext and rotation

Intercostal muscle injuries typically occur from direct trauma, but can also result from sports such as ?

Rowing

What disease involves a defect to the ring apophysis of vertebral body and anterior wedging of affected vertebrae?

Scheuermann's Disease

With scheuermann's, end plates can crack allowing disc to protrude into the vertebral body, this is called what?

Schmori's node

Most ribs can sublux ant/post, but 1st rib can sublux in which direction?

Superior

What is a difference between Tietze's and costochondritis?

Tietze's = under 40 y/o Costochondritis = 40 or older

What other condition is very similar to costochondritis?

Tietze's Syndrome

Does T4 syndrome typically occur in men or women more?

Women

Where there is _______________ there will be compensatory ______________

hypomobility, hypermobility

In precordial catch syndrome, where does pain originate?

pleura