Thoracic
spine
Look
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.
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.