Review of common conditions of the Thoracic Spine and Ribs

1. Thoracic Spine
&
Rib/Costo-Vertebral jt’s

3. Movements of T Spine
 Observation (abnornal curves)
 Active/Passive analysis
 1° Rotation (facet angles)
 Most occurs → Lower TSP & T/L junc
 Not inhibited by ribs
 2° Flexion/Extension & Side Bending

4. Thoracic Spine facets

5. Scoliosis

6. Harrington Rods

7. Causes of Scoliosis in Children
 Idiopathic
 In about 8 out of 10 cases of
scoliosis, the cause is
unknown. This is medically known as
idiopathic scoliosis.
 However, researchers have found that
in about a third of idiopathic scoliosis
cases, the child has some family history
of the condition, which suggests a
genetic link to the condition.

8.  Neuromuscular conditions
 Most of the remaining cases of scoliosis are caused
by conditions that affect the nerves and muscles
(neuromuscular conditions), such as:
 cerebral palsy – a condition that is caused by brain
damage that occurs during birth or shortly afterwards
 muscular dystrophy – a genetic condition that causes
muscle weakness
 Children with these conditions may be unable to walk
or have difficulty remaining upright, both of which can
prevent their spine from developing normally.
 Congenital scoliosis
 Scoliosis present at birth is known as congenital
scoliosis. Congenital scoliosis is rare and are caused
by the bones in the spine developing abnormally in
the womb.

9. Scoliosis in Adults
 Many cases of adult scoliosis are thought to be milder cases of
idiopathic scoliosis that have only become apparent in later life. With
age, what was previously a very minor curve to the spine may in
later life become more pronounced.
 Degenerative scoliosis
 Caused by gradual damage to the various body parts that make up
the spine, such as the:
 vertebrae – the ridges of bone that help support the spine and neck
 discs
 ligaments – the bands of tissue that hold the vertebrae and discs.
 tendons
 Damage to one or more of these body parts can destabilise the
structure of the spine, causing it to curve abnormally. The discs of
the spine are known to narrow and weaken with age, which can
explain some cases of degenerative scoliosis.

10.  Other possible causes include:
 weakening of the bones of your spine
(osteoporosis); this is a common effect of the
ageing process
 damage to the spine that occurred during
surgery
 damage to the spinal cord that has resulted in
the loss of muscle function (paralysis)
 conditions that can damage the nerves and
muscles that are near to the spine, such as
motor neurone disease, multiple sclerosis
or Parkinson's disease

11. Causes of Thoracic Pain
 Facet/Costo-vertebral joint strain
 Para spinal muscle strain
 Thoracic annular strain/prolapse
 Scheurmann’s disease
 Fracture rib post/ SP/ TP/ Vert body
 Cardiac causes/ Peptic ulcer
 2° Carcinoma breast/TB (Potts
Disease)
 T4 Syndrome

12. Scheurmann’s Disease
 Epiphyseal osteochondritis/necrosis
 Vertebral body endplate
 Occurs during growth phase
 Leaves irregular endplate vertebral body
 In extreme cases Schmorl’s Node
 Disc Prolapses into vertebral body
 Vertebral collapse/ flexed T spine

16. Skeletal Tuberculosis

17. Movements of Ribs
 1 → 6 Pump Handle
 7 → 10 Bucket Handle
 11 & 12 Caliper Action

18. Causes of Rib Pain
 Overstrain to costo-vert joint
 Overstrain to intercostal muscles
 Respiratory Disease/Diaphragm
 Rib fracture (128 tuning fork)
 Costo-chondritis Tietze's Syndrome
 Shingles (rash)
 Cardiac problems