Ortho Cervical and Thoracic spine

Study Guide: Cervical and Thoracic Spine

Cervical Spine and Thoracic Spine Diagnoses

1. Acute Cervical Sprain (Whiplash)

• Definition: Muscular strain of the cervical spine from sudden trauma, e.g., motor vehicle accidents (MVA) or sports.

• Symptoms:

  • Localized joint pain, stiffness.

  • Muscle spasm due to extreme ROM stress.

  • Can progress to chronic pain if untreated.

• Demographics:

  • Common in young athletes, MVA victims, or trauma patients.

• Common Treatments:

  • Gentle ROM.

  • Deep neck flexor strengthening.

  • Pain control (e.g., modalities sparingly).

  • Postural correction and education.

• Red Flags/Precautions:

  • Fractures, dislocations, cervical arterial dysfunction (5 D’s: Dizziness, Diplopia, Dysarthria, Dysphagia, Drop attacks).

  • 3 N’s: Nausea, Nystagmus, Numbness.

2. Cervical Radiculopathy

• Definition: Nerve root compression or inflammation causing neurologic symptoms in the upper extremities (UE).

• Symptoms:

  • Pain starting in the neck and radiating to the arm (often positional).

  • Sensory changes, weakness, and reflex deficits.

  • Commonly affects C6 (25%) and C7 (60%).

• Demographics:

  • Rare under 30.

  • Peak incidence: Ages 45-54.

• Common Treatments:

  • NSAIDs, corticosteroids.

  • Physical therapy: Nerve glides, cervical retraction, strengthening.

  • Invasive: Epidural steroid injections, ACDF (surgery).

• Special Tests: Spurling’s Test (provokes symptoms with lateral flexion and axial load).

• Red Flags/Precautions:

  • Progressive neurological deficits or signs of myelopathy.

  • Consider imaging if red flags are present.

3. Spondylosis

• Definition: Degenerative joint or disc disease (DJD, DDD) causing wear and tear.

• Symptoms:

  • Aching axial pain, mid-cervical discomfort, medial scapular pain.

  • Severe cases may cause myelopathy.

• Demographics:

  • 90% of individuals over age 60 have degenerative changes.

  • Onset common after age 30.

• Common Treatments:

  • Flexion-based exercise programs.

  • Strengthening cervical stabilizers.

  • Postural and ergonomic education.

• Precautions: Avoid end-range extension in severe cases.

4. Thoracic Outlet Syndrome (TOS)

• Definition: Compression of the brachial plexus or subclavian vessels between the clavicle and first rib.

• Symptoms:

  • Night pain, paresthesia, UE weakness.

  • Symptoms may follow the ulnar/median nerve path.

• Demographics:

  • Common in individuals with poor posture or those performing repetitive overhead work.

• Common Treatments:

  • PT: Postural correction, scalene stretches, scapular retraction, thoracic extension.

  • Surgery for severe cases.

• Special Tests:

  • Adson’s Test, Roos Test.

• Precautions:

  • Avoid prolonged postures or activities that worsen symptoms.

5. Kyphosis

• Definition: Excessive thoracic spine convex curvature.

• Symptoms:

  • Postural hump or forward-leaning upper back (e.g., Dowager’s hump in osteoporosis).

  • Pain due to muscle imbalance.

• Demographics:

  • Common in older women, postmenopausal patients, or those with osteoporosis.

• Common Treatments:

  • Strengthen scapular retractors (e.g., rhomboids, mid/lower trapezius).

  • Stretch anterior shoulder and pectoral muscles.

6. Scoliosis

• Definition: Lateral curvature of the spine, named based on convexity.

• Symptoms:

  • Asymmetry of shoulders, pelvis, or ribs.

  • May cause back pain or difficulty breathing in severe cases.

• Demographics:

  • Structural scoliosis: Often idiopathic and appears in adolescence.

  • Non-structural scoliosis: Reversible and posture-related.

• Common Treatments:

  • <20°: Monitor.

  • 20-40°: Bracing for progression.

  • 45°: Surgical correction.

7. T4 Syndrome

• Definition: Dysfunction of the T2-T7 region, often due to a hypomobile joint segment.

• Symptoms:

  • Pain or paresthesia in a glove-like distribution.

  • No segmental pattern.

  • Night pain.

• Demographics: Common in women (3:1 ratio).

• Common Treatments:

  • Joint mobilization/manipulation.

  • Graded exercise approach.

Posture Assessment

• Key Observations:

  • Cervical spine alignment: Forward head posture is common.

  • Thoracic spine: Kyphosis or scoliosis may affect posture.

  • Scapular positioning: Look for asymmetry or winging.

• Structures to Consider:

  • Tight: Pectoralis major/minor, suboccipitals, upper trapezius.

  • Weak/Lengthened: Deep neck flexors, scapular retractors (rhomboids, mid/lower traps).

Cervical Spine ROM

• Normal ROM (using inclinometer or goniometer):

  • Flexion: 45°

  • Extension: 45°

  • Side-bending: 45°

  • Rotation: 60-80°

• Where Motion Occurs:

  • Upper cervical spine:

    • OA joint: 50% of flexion/extension.

    • AA joint: 50% of rotation.

  • Lower cervical spine: Provides most side-bending.

Red Flags and Contraindications

1. Red Flags:

   • Neurological deficits (e.g., gait changes, clonus, Babinski).

   • Sudden onset of dizziness, tinnitus, or vision changes.

   • Signs of vascular insufficiency or spinal cord compression.

2. Precautions:

   • Avoid end-range extension in cervical instability.

   • Post-surgical or fracture healing considerations.

Summary: Special Tests

• Spurling’s Test: Radiculopathy.

• Adson’s Test, Roos Test: Thoracic Outlet Syndrome.

• ULTT (Upper Limb Tension Test): Nerve involvement.

This guide provides a comprehensive foundation for understanding cervical and thoracic spine conditions, their presentations, and management strategies. Let me know if further elaboration is needed!