Tuesday, October 27, 2009

The Amazing Thoracic Spine

Although the literature states that thoracic spine derangements are relatively rare and are usually disguised as cervical derangements it is important to perform a thorough mechanical diagnosis and therapy assessment to rule these out. I had a recent patient with a three week history of intermittent left upper thoracic pain that did not radiate and was only affected when lying on the left side and when raising the left arm or lifting. Her symptoms were basically in the left upper trapezius region and she could have essentially been either a cervical or shoulder derangement as well. The importance of finding concordant signs and then assessing repeating movement testing is critical to determine the effective exercise. Although I initially focused on the cervical spine due to major limits with cervical retraction, upon the patient’s second visit no significant change in symptoms or functions were noted. It was at that time that we further explored the thoracic spine and found a directional preference of flexion which is a rather rare direction of preference but response to movement is what dictates where we go.


The patient returned on their third visit with all symptoms abolished and all range of motion restored to within normal limits with one simple thoracic flexion exercise. I had nothing else to offer as she could not provoke any pain with any direction of movements or with any resistance and she could lift as much weight as she wanted. She was discharged with home exercise program.

Just when you think you’ve seen every type of mechanical derangement in the spine, there is always something new to test your evaluation abilities.

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