Musculoligamentous strains (mainly postural)
Serious disorders not to be missed
Is the patient trying to tell me something?
Yes, quite possible with many cases of back pain.
Take a history analysing pain characteristics to differentiate between chest pain due to vertebral dysfunction (musculoskeletal strain) and that caused by myocardial ischaemia.
Also drug history, family history, occupational history and questions about red flags that point to serious disease.
The LOOK, FEEL, MOVE, MEASURE clinical approach applies to the thoracic spine. The emphasis is on palpation-central and laterally.
The movements and their normal ranges are:
The commonest site of pain is the costovertebral articulations of the spine.
Pain of the thoracic spine origin may be referred anywhere to the chest wall.
The older patient should be regarded as having a cardiac cause until proved otherwise.
Thoracic back pain is frequently associated with cervical lesions that refer to the upper back.
The thoracic spine is the commonest site in the vertebral column for metastatic disease.