Thoracic Spine Pathology Notes on outline view Gail

Thoracic Spine Pathology Notes on outline view Gail Molloy Manual Therap y Institut e Internat ional

Pain Classifications (Mc. Nabb) Viscerogenic- slow pain, hard to localize or intense unremitting pain, stabbing Vasculogenic - diffuse, aching, poorly localized, may be referred Neurogenic- the intense pain of neuropathy, cord signs in stenosis/tumor Psychogenic Spondylogenic and Systemic Manual Therap y Institut e Internat ional

Viscerogenic Pain - Heart - Lung -Pleura -Diaphragm - Gall Bladder - Kidneys - Spleen - Pancreas - Liver Manual Therap y Institut e Internat ional

Viscerogenic Pain Manual Therap y Institut e Internat ional

Vasculogenic Pain Thoracic Aortic Aneurysm Abdominal Aortic Aneurysm Manual Therap y Institut e Internat ional

Thoracic pain patterns: referred pain. Cardiac (from Goodman & Snyder) Manual Therap y Institut e Internat ional

Neurogenic Pain Manual Therap y Institut e Internat ional

Pancoast Tumor, Horner’s Syndrome Manual Therapy Institute International

Psychogenic Pain Emotional overtones / Somatization Emotionally ill can also have organic disease ? Sx magnification & “fear of re injury” Manual Therap y Institut e Internat ional

Spondylogenic Pain Osseous Soft Tissue Articular Manual Therap y Institut e Internat ional

Cervical Z-Joint Pain Patterns Manual Therap y Institut e Internat ional

Thoracic Spine Referral Patterns Manual Therap y Institut e Internat ional Kellgren Feinstein

Spondylogenic Pain Structural Scoliosis Manual Therap y Institut e Internat ional Kyphosis

Spondylogenic: osseous. Scheuermann’s Disease Manual Therap y Institut e Internat ional

Systemic Pathology Manual Therap y Institut e Internat ional Primal Pictures©

Spondylogenic: soft tissue-disc Manual Therap y Institut e Internat ional

Pneumothorax • Sudden sharp chest pain on the ipsilateral side • SOB • Feeling of tightness in chest • Rapid heart rate Manual Therap y Institut e Internat ional

Pathology: Major Concerns • • Thoracic pain only related to activity or stress Wedging/local kyphus Severe bilateral LE pain in elderly Spinal cord S & S Manual Therap y Institut e Internat ional

Pathology: Major Concerns • Pulsating abdomen – dissecting aortic aneurysm? • Unusual pattern of stiffness • Severe chest wall pain, no articular motion pain Manual Therap y Institut e Internat ional

Referred Pain • Aortic aneurism o o Felt in chest radiating to the back Usually sudden unrelenting o o Ant chest pain/heaviness Occasional nausea Pain radiating into the back May be exertional • Myocardial ischemia

Peptic Ulcer • • Posterior wall of stomach or duodenum Boring pain in epigastric and mid throacic region Pain effected by eating Causes: o Prolonged NSAIDs

Inflamed Gallbladder • • Right upper quadrant and right infrascapular region Moderate fever, nausua, and vomiting Sx 1 -2 hrs after a heavy meal. Right UQ pain.

Pancreatitis • Pancreatitis: pain around T/L junction. • Kidney and Renal: referred to costovertebral junction and flank area. Usually accompanied by fever, nausea, vomiting and renal colic.

Other serious referral sources • • Infection, Fractures, neoplasms, inflammatory disorders Spinal metatstasis Primary tumors are less common

Ankylosing Spondylitis • • Halmark sign, limited chest expansion Sacroillitis, morning stiffness Men 3: 1, onset 15 -40 years old 90% have a positive HLA-B 27, High false positive rate

Fracture • Types: traumatic and osteoporotic. • Osteoporosis risk factors : Caucasian, smoking early menopause, thin body build sedentary lifestyle, steroid treatment, excessive caffeine or ETOH o Spontaneous fractures w caused by trivial strain o Men and women over 60 presenting with acute thoracic pain need to be considered. o

Imaging referral • In cases where cancer or fracture are suspected