Thoracic spine and chest wall

What are the causes of chest wall pain?
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Terms in this set (42)
What are the causes of chest wall pain?
a. Costochondritis
b. Muscle strains
c. Sternocostal dysfunction (2nd-7th joints)
d. Lower cervical dysfunction
e. Upper thoracic dysfunction
What are the causes of thoracic pain?
a. Myofascial pain syndrome
b. Postural strains
c. C/T junction- mid thoracic joint dysfunction
Pain radiates anteriorly because of?
a. Irritation of intercostals nerve root
b. Herpes zoster
c. Intercostal TrP's
Serious disorders?
a. Heart: MI, angina, pericarditis
b. Great vessels: Dissecting aneurism, pulmonary embolism, pulmonary infarction, pneumothorax, pneumonia, pleurisy
c. Oesophagus: oesophageal rupture, spasm or oesophagitis.
d. Subdiaphragmatic disorders: gall bladder, stomach, duodenum, pancreas, subphrenic collection
e. Infections: herpes zoster, pleurodynia, infective endocarditis, osteomyelitis, discitis, TB, epidural infections
f. Malignancies
What symptoms and signs should alert malignant diseases?
- Back Pain in older person
- Unrelenting back pain, unrelieved by rest
- night pain
- rapidly increasing back pain
- Weight loss, fever, malaise
- History of cancer
Most common form of cancer in thoracic spine?
Spinal mets
Somatic sources of referred pain?
Cervical facet joints and discs and nerve roots, often C5/C6 - C6/C7 level.
Visceral sources of pain? (1st card)
MI
TrPs
Angina
Peptic ulcer
Gall bladder
Pancreas
i. MI: substernal tightness, nausea, heaviness, across chest, left arm, clenched fist sign.
-TrPs in anterior chest wall have similar referral pattern, vary widely throughout day, aggrivated by stretching/ twisting.
ii. Angina: constant amount of exertion needed to produce pain
iii. Peptic ulcer: triggered or relieved by eating. Duodenal ulcer = lower thoracic etc.
iv. Gall bladder: refer to right interscapular region. Nausea and vomiting
v. Pancreas: refer T/L junction. Pancreatitis pain very severe - makes it hard to tell if back or abdomen origin.
Visceral sources of pain? (2nd card)
Kidneys
Oesophagus
Dissecting aneurism
Pulmonary embolism
Biliary or renal colic
vi. Kidneys: costovertebral area or flank.pyelonephritis or obstruction of ureteropelvic junction.
vii. Oesophagus: agg: bending, lifting, lying down. Reflux and spasm
viii. Dissecting aneurism: sudden, severe, midline. Retrosternally, interscapular. Pulse inequality. Tearing sensation.
ix. Pulmonary embolism: dramatic onset. Dyspnoea. Retrosternal pain, breathlessness, syncope.
x. Biliary or renal colic: abdominal pain waxing and waning with Tx pain.
Chest pain in children
Age?
Conditions?
Caused of musculoskeletal pain?
a. Mean age: 12 years
b. Common conditions: psychogenic pain, musculoskeletal disorders, cough induced pain, costochondritis, hyperventilation and asthma.
c. excessive training or minor trauma e.g rugby.