Thoracic Spine

• Prevalence:

  • The least common researched area of the spine compared to the lumbar and cervical regions
  • Prolonged sitting or physical inactivity identified as a risk factors for the development of neck and thoracic spine pain (Cagnie et al., 2007)
  • The lifetime prevalence of isolated pain in the thoracic pain is relatively low, 13 – 17% compared to neck (40%) and low back pain (57%),(Heneghan et al., 2019)
  • Most common area in the spine to present as a red flag
• Anatomy & Function of thoracic spine:

  • Protection of thoracic viscera and spinal cord
  • Contributes to respiration
  • Support and assists movement of upper limb
  • Movement of trunk
  • Sagittal plane: Flexion 32 degrees, extension 26 degrees (Willems et al., 1996)
  • Coronal/frontal Planes: Lateral flexion: 26.50 degrees (Willems et al., 1996)
  • Transverse Plane: 85 degrees, 60% of all trunk rotation (Henegan et al., 2009)
  • consists of:
  • Of many different joints!
  • 12 vertebral segments, 12 pairs of ribs, Facet joints, Costovertebral & Costotransverse joints
• Thoracic Spine and Referral Pain:

  • Thoracic pain can be non-MSK in origin - which is why history, aggravating and easing factors are important to understand
• Thoracic Spine and Referral Pain:

  • Thoracic pain thats non mechanical and where theres associated chest and arm pain, we must consider cardiac and visceral referral
  • Cardiac Pain location: including epigastric pain, left neck radiating into throat and tongue +/- referral into the left upper limb
  • Exercise induced pain: Increased cardiovascular load irrespective to load on the Tsp may indicate cardiac origin
  • Visceral due to the autonomic nervous system and close relationship with the Tsp, particularly from T3 - T8
  • this must be triaged and screened before continuing physio