Thoracic spine

Look

  Skin and soft tissues

  There are no common lesions in the thoracic spine which can be seen in the skin or soft tissues.

  Bone

  The thoracic spine is normally convex, and straight in the sagittal plane.

If it is very convex and painful the patient may have Scheuermann’s disease, a condition of unequal growth of the front and back of the spine which presents in adolescence.

Lateral curvature of thoracic spine accompanied by rotation is called scoliosis. As the patient bends forward to touch their toes the associated rib hump increases in size. This is diagnostic of scoliosis.

  Feel

Skin, soft tissues and bone

In cases of possible trauma to the thoracic spine the patient should be immobilised on a spine board. A full check of distal neurology should be performed if the patient is alert enough to co-operate. When the time comes to examine the thoracic spine, the patient should be log-rolled using at least three trained staff working as a team. The whole length of the spine should be palpated for tenderness and steps. If any are found the patient should be kept on a spine board until all the necessary investigations have been performed. The spinal cord lies in the thoracic spine so neurological damage may appear as an upper motor neuron lesion in the lower limbs and/or a lower motor neuron lesion in nerve roots originating from the thoracic spine. Any sensory loss may spread progressively (the apparent level of the lesion rises) in the hours after the injury. A very careful examination of perineal sensation should be performed. Preservation of function in these sacral roots (central sparing) is a good prognostic sign that some recovery may occur over the next months.

Move

Active, passive and stability

There are no simple tests for mobility or stability of the thoracic spine and, indeed, if stability is in doubt the thoracic spine should be not be moved. It should be immobilised while investigations are performed to avoid the risk of causing further neurological damage.

A full neurological examination of the lower limbs will be needed if neurological damage in the thoracic spine is possible. Immediately after the injury there may be spinal shock with reduced power and tone. This will mimic a lower motor neuron lesion. Later, the picture of an upper motor-neuron lesion will appear with hyper- reflexia and clonus. Clonus is tested by smartly dorsiflexing the ankle, If the gastrocnemius contracts more than once or twice, then clonus is present.