Upper Back and Thoracic Spine Trauma
Clinical Monograph 23
By R. C. Schafer, DC, PhD, FICC
Upper-thoracic spasms and trigger points are common within the milder complaints heard in a chiropractic office. Typical posttraumatic injuries of the posterior thorax involve the large posterior musculature, thoracic spine, spinocostal joints, and tissues supporting and mobilizing the scapula (especially the rhomboids). Upper right abdominal quadrant ailments (eg, gallbladder, liver) commonly refer pain and sometimes tenderness to the right scapular area.
BACKGROUND
Severe biomechanical lesions of the thoracic spine are seen less frequently than those of the cervical or lumbar spine. But when they occur, they may be serious if related to disc protrusion or a dynamic facet defect. Shoulder girdle, rib cage, spinal cord, cerebrospinal fluid flow, and autonomic visceral problems originating in the thoracic spine are far from being scarce. Common biomechanical concerns are the prevention of thoracic hyperkyphosis, flattening, or twisting, as each can be suspected to contribute to both local and distal, acute and chronic possibly health-threatening manifestations.
Thoracic Fixations
The study of the thoracic spine is often perplexing. It was Gillet’s opinion that many fixations found in the thoracic spine were secondary (compensatory) to focal lesions in either the upper cervical spine or the sacroiliac joints. Thus, a maze of potential variables exists. Empiric evidence has suggested that many thoracic problems have their origin in its base, the lumbar spine or lower, while others are reflections of cervical reflexes. Also, a thoracic lesion may manifest symptoms in either the cervical or the lumbar spine. Foremost in an examiner’s thoughts should be the recognition that the thoracic spine is the structural support and sympathetic source for the esophagus, heart, bronchi, lungs, diaphragm, stomach, liver, gallbladder, pancreas, spleen, kidneys, and much of the pelvic contents. Referred pain and tenderness from these organs to the spine are common.
Screening Thoracic Vertebral Fractures
Thoracic fractures occur most frequently at the T12 transitional area, next in the midthoracic (kyphotic apex) region. Most are compression fractures with collapse of a vertebral body. Midthoracic fractures generally result from falls on the pelvis or when the head is severely forced between the knees.
Fractures of the thorax sometimes occur during convulsions or seizures and usually occur in the T5–T7 region. The mechanism is strong abdominal contraction accompanied by paraspinal cervical and lumbar spasm. This places the midthoracic area under severe compression forces.
Gozna/Harrington point out that bending moments and axial compressive forces produce compressive normal stresses that are cumulative at the anterior portion of the thoracic spine. They feel this fact explains the high incidence of spinal fracture in the thoracic region.
Soto-Hall Test
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