At the completion of this chapter,the reader will be able to:
Describe the vertebrae, ligaments, muscles, and blood and nerve supply that comprise the thoracic intervertebral segment.
Outline the coupled movements of the thoracic spine, the normal and abnormal joint barriers, and the responses of the various structures to loading.
Perform a detailed objective examination of the thoracic musculoskeletal system, including palpation of the articular and soft tissue structures, combined motion testing, position testing, passive articular mobility tests, and stability tests.
Evaluate the total examination data to establish the diagnosis and estimate the prognosis.
Describe the common pathologies and lesions of this region.
Apply manual techniques to the thoracic spine using the correct grade, direction, and duration.
Describe intervention strategies based on clinical findings and established goals.
Design an intervention plan based on patient education, manual therapy, and therapeutic exercise.
Evaluate intervention effectiveness in order to progress or modify an intervention.
Plan an effective home program, including spinal care and therapeutic exercise, and instruct the patient in this program.
The thoracic spine serves as a transitional zone between the lumbosacral region and the cervical spine. Despite the fact that the thoracic spine has not enjoyed the same attention as other regions of the spine in terms of research, it can be a significant source of local and referred pain. The thoracic spine is the most rigid region of the spine and, in this area, protection of the thoracic viscera takes precedence over segmental spinal mobility. In addition, the thorax is an important region of load transfer between the upper body (the head, cervical spine, and upper extremities) and the lower body (the lumbopelvic region and lower extremities).1,2
Because each thoracic vertebra is involved in at least six articulations, and as many as thirteen, establishing the specific cause of thoracic dysfunction involved may not always be possible. This task is made more difficult because of the inaccessibility of most of these joints.3
The thoracic spine (Fig. 27-1) forms a kyphotic curve between the lordotic curves of the cervical and lumbar spines. The curve begins at T1–2 and extends down to T12, with the T6–7 disk space as the apex.4 The thoracic kyphosis is a structural curve that is present from birth.5 Unlike the lumbar and cervical regions, which derive their curves from the corresponding differences in intervertebral disk (IVD) heights, the thoracic curve is maintained by the wedge-shaped vertebral bodies, which are about 2 mm higher posteriorly than anteriorly.
The thoracic spine and rib cage. (Reproduced with permission from Morton DA, Foreman KB, Albertine KH: The Big Picture: Gross Anatomy, McGraw-Hill, 2011.)
At the thoracolumbar junction, typically located between T11 and L1, the changes in curvature from one of kyphosis to one of lordosis vary quite widely according to posture, ...