Learning outcome
- Thoracic scoliosis
- Mb. Scheuermann
- Intercostal myalgia
- Interscapular myalgia
- Referred pain from thorax and skeleton
- Pain from intervertebral disc
Standard tests
- Inspection
- Active movement
- Passive movement
- Isometric movement
- Palpation
Case 3
You work as an intern doctor (LIS 1) at a general practitioner's office. The next patient is a 40-year-old man, previously healthy. He reports that he performed a heavy lift at work two days ago. He felt immediate pain between his shoulder blades. Pain radiates from the thoracic spine to the chest. The pain has not subsided. The pain worsens with deep inhalation and with twisting of the back.
Back examination
Perform a standard back examination with focus on clinical findings in the thoracic spine.
Thoracic inspection
Thoracic active movement
Thoracic passive movement
Isometric movement thoracic
Thoracic palpation
Clinical findings
- The patient reports localized pain between the shoulder blades during active movement, especially when rotating to the right.
- With passive rotation at the extreme point of the range of motion to the right, the same pain radiation.
- Pain on deep inspiration radiating forward toward the chest region on the right side.
- In prone position, tenderness on palpation between the shoulder blades and pain on attempting Spring test at levels Th8-10.
What is wrong with the patient?
Thoracic intervertebral disc strain is a likely cause of the patient's complaints. Disc herniation in the lower part of the thoracic spine accounts for between 0.2-5% of all disc herniations in the back. It causes pain radiating around the chest and can also cause abdominal pain.