Key facts and checkpoints

• The commonest site of pain in the spine is the costovertebral articulations especially the costotransverse articulation (Fig 34.1).

• Pain of thoracic spinal origin may be referred anywhere to the chest wall, but the commonest sites are the scapular region, the paravertebral region 2-5 cm from midline and, anteriorly, over the costochondral region.

• Thoracic (also known as dorsal) pain is more common in patients with abnormalities such as kyphosis and Scheuermann's disorder.

• Trauma to the chest wall (including falls on the chest such as those experienced in body contact sport) commonly lead to disorders of the thoracic spine.

• Unlike the lumbar spine the joints are quite superficial and it is relatively easy to find the affected (painful) segment.

• The intervertebral disc prolapse is very uncommon in the thoracic spine.

• The older patient presenting with chest pain should be regarded as having a cardiac cause until proved otherwise.

• If the chest pain is non-cardiac, then the possibility of referral from the thoracic spine should be considered.

• The thoracic spine is the commonest site in the vertebral column for metastatic disease.

• Scheuermann's disorder, which affects the lower thoracic spine in adolescents, is often associated with kyphosis and recurrent thoracic back pain. Always inspect the thoracic spine of the younger patient for kyphosis and scoliosis.

• Palpation is the most important component of the physical examination.

costotransverse articulation facet joint co&tocenLral articulation

Fig. 34.1 The functional unit of the thoracic spine co&tocenLral articulation inter vertebral disc

Fig. 34.1 The functional unit of the thoracic spine

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