Evaluation of The Thoracic Spine

Differential Diagnosis

Most Common

1. Intervertebral Disc Sprain (disc or apophyseal joint)

2. Paraspinal Muscle Strains

3. Costovertebral Joint Sprain

4. Scheuermann's Disease (adolescents)

Less Common

1. Posterior Rib Fractures

2. Thoracic Disc Prolapse

3. T4 Syndromes

Not to be Missed

1. Cardiac Chest Pain

2. Peptic Ulcers

3. Tumor (breast / metastasis)

History

• Firmly establish chief complaint

• Distribution of pain or numbness

• Nature of onset: insidious versus sudden

• Aggravation by movement (rotation / lateral flexion)

• History of trauma

Examination

Always remember to examine the joint below Lumbar Spine and Above Cervical Spine

Inspection

1. From Behind

2. From the Front

3. From Each Side

Palpation

1. Spinous Processes

2. Apophyseal Joints

3. Costovertebral Joints

4. Paraspinal Muscles

Motion

Note that range of movement is measured determined actively first, if there is a deficiency, move on to passive range of motion. Any deficits should be measured with a goniometer. Note should be made of discrepence between active and passive movement.

Muscles

Measurement of muscle strength using the Oxford (MRC) Scale.

1. Flexion

2. Extension

3. Rotation

4. Lateral Flexion

NeuroVascular

1. Check and Grade reflexes

2. Check Pulses

3. Check strength of Distal Nerves (radial / median / ulnar)

4. Check sensation of Distal Nerves (radial / median / ulnar)

Special Tests

1. Cough / Sneeze Test

Investigations

1. Plain Films may be advisable for acute trauma or in patients with nerve root syndromes. They may also demonstrate the presence of intervertebral growth plate abnormalites in Scheuermann's disease, or suggest neoplastic disease.

2. CT or MRI is rarely needed but may confirm disc disease.

Index

Whois Dr Frankenstein

Search Judy