The thoracic spine between someones' shoulder blades is relatively easy to examine. You will need a little practice, so round up a family member as a guinea pig.
They need to lay flat on their face, preferably on a solid flat surface where they are safe from your dog licking their face, and you are not going to break your back examining them. If they can't reach the surface with their face, they can use a pillow.
Ask them to bend sideways as far as they can, while still staying flat, with both shoulders on the same horizontal level - with no rotation of their body.
Their head should be facing to he opposite direction to the side bending.
Grasp their back bones between your thumbs and forefingers. Follow the curve of their back bones up and down.
You should be seeing the bones describe an even, unbroken curve as in the figure on the right. It is sometimes easier to see from the red marks left by your fingers.
The figure on the left shows the simplest possible abnormality, where one thoracic spine joint is stuck and the bone above has swung to the left.
All the bones above his level describe the same curve. It appears that there is a side step in the curve.
I believe the posterior joint is stuck at this level, on the left side.
This diagram shows the bone above the stuck posterior joint. The joint has the dot in the P.) The dotted bone shows the original position. The solid line shows the side bending position.
The bone above the blocked joint has been pulled into right side bending, despite the stuck joint.
This is because the disc at the front is the strongest part joining the bones. The main part of the bone, at the front, has no option but to bend to the right.
The bone has swiveled on the stuck joint, rotating around it.
The part of the bone sticking out at the back has rotated to the left. This is the part you can feel.
There are more pictures to help visualize this at the end of the
lumbar spine page.
This finding is quite common. I probably see someone with exactly this problem most days.
More often, there are multiple joints stuck.
You can think of this type of problem as a spot where the thoracic spine has buckled or kinked. A technical term used is
subluxation, which assumes the joint is stuck somewhere in its' normal range of movement.
Spine injuries of this sort often cause upper back pain, although low back pain is more common in the setting of injury.
You can see exactly the same "step in the curve" in the lumbar spine, but it is not as obvious.
Having someone at home trained up to examine your back could be very useful.
These do not prove there is a hitched joint, but can be good pointers to where to examine in detail. The step in the curve can be quite difficult to pick, especially in elderly people with generally stiff backs.
Brush your fingers lightly and rapidly, back and forth over the skin, up and down each side of the thoracic spine.
You are looking for an area on one side, where increased perspiration on the skin gives it a tacky feel.
The free gliding of your fingers over the skin, feels restricted here.
Swelling over the bones is easier to feel in thin people. You use one finger and rub gently over each spinous process, to gauge the amount of padding over it.
Swelling is often restricted to just one or two bones, at the site of a stuck joint.
Scratch vigorously all over the upper back, then sit back and watch. The area which stays red longest will be at the level and on the side of, a blocked joint.
These examinations depend on changes in the function of the tiny nerves controlling the sweat glands and blood vessels, caused by the spinal derangement.
Various forms of dizziness can be partly caused by lesions down to about T6.
Pain can be referred to the front of your chest, so it feels like back and rib pain. Higher back pain and pain up your neck can come from between your shoulder blades.
Your shoulder blade muscles and their attachments to your arm bone, can become sore. See
shoulder pain pages.
You may feel unable to straighten up fully.
Taking a deep breath may hurt your chest.
Asthma may be aggravated, or breathing restricted in the absence of asthma.
Palpitations of the heart are frequent when T4/5 in stuck.
Rib margin and abdominal pain can be referred from T6 and below. This is suspected in abdominal pain diagnosis, when tenderness there is not diminished by tensing the abdominal muscles...
You can attempt to mobilize a stuck thoracic spine joint with a simple exercise.
Lay on the floor, draw up your knees and clasp your hands behind them, then roll gently back and forward.
AS WITH ALL THE ADVICE ON THIS SITE, YOU NEED TO CLEAR THIS WITH YOUR PERSONAL HEALTH PROFESSIONAL BEFORE USING THIS EXERCISE.
I think that Robin McKenzies' extension exercises work by loosening up these stuck joints.
You can stretch this part of your spine using the
forwards neck stretch, using your tummy muscles to pull your chest down, while keeping your lower back upright - so as to bend in the middle, rather than bending your whole body forwards. Just hang there until pain eases and then in the same position rock from side to side, rotating to face the side you rock towards each time.
There is a color photo of a subluxation on the thoracic outlet syndrome page
This is another set of pictures. The first shows the person's head sitting to the left, rather than directly above their T2 spinous process.
The other feature shown well is the tilt of her shoulders. We automatically keep our head upright for comfortable vision. the kinked joint has bent her spine, so it has to tilt below this.
This is immediately after mobilizing the joint.
These below show the two spinous processes marked. In the second photo I rubbed off the mark on T1 and re-marked it after the mobilization.
These two give an idea of the degree of sideways shift seen. It is fairly subtle, but would be more when side bending to the right, in this case.
My observation is that one rib will be further towards the back than that on the opposite side. This is usually on the side I believe is stuck.
I do not understand the exact mechanics of this, except that each rib articulates with a pair of vertebral bodies and so gets levered out of place by a subluxation.
There is a picture of the articulation of a rib with the thoracic spine on the musculoskeletal chest pain page of this site.
The position for examining ribs is face down, the same as above.
To examine for this, bend right down and look along the back from top or bottom. Put a finger on the back end of each of a pair of ribs, and assess how prominent each rib is.
Out at the sides of the chest one can rub on the intercostal muscles between the ribs, looking for one which is more tender.
Here one can also assess the spaces between adjacent ribs, to look for any that are closer together than on the opposite side.
One can also examine the
costo-chondral junctions for undue tenderness of one compared with the others.
Another way to assess the mechanical function of the ribs is to examine the person from the back, standing up and breathing fully in and out.
Place ones' hands flat on the sides of the persons' chest, at the lower ribs, middle and upper chest. Assess the amount of movement on the two sides, for any differences.
I usually leave the persons' ribs to look after themselves, unless pain persists after the spinal joints have been treated.
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