THORACIC SPINE

Sterno-Clavicular Joint (SCJ)

The SCJ is a normal, synovial, ball and socket type joint where the clavicle (collar bone) joins the sternum, just below the neck.

There is movement at the SCJ as the shoulder moves, especially above shoulder height and sideways, away from the body. The ligaments that support the joint can be strained and the cartilage within the joint may be damaged with shoulder and chest trauma. The joint can be affected by arthritis and can also be dislocated.

The SCJ is a strong, stable joint that is rarely injured, except in heavy, body contact sports.

Physiotherapy can be used in the treatment of SCJ injury, particularly joint mobilisation or manipulation

Rib/Spine Joints

There are two joints between each rib and the spine:
(i.) The costo-vertabral joint (CVJ)
(ii.) The costo-transverse joint (CTJ)

These joints are located in the back, where each rib articulates with the adjacent vertebra. There is a small amount of movement at these joints as the back moves and as the chest expands with breathing.

Occasionally, one or more of these joints can become painful and stiff. This is often associated with back strain and muscle spasm.

Physiotherapy can be used to treat pain arising from these joints, particularly joint manipulation. This can reduce stiffness and muscle spasm, restoring pain free movement to the spine and chest.

Intercostal Muscle Strain

Between the ribs, there are muscles that help in chest and trunk movement, as well as breathing. These can be felt as the soft areas between each rib.

Like all muscle, the intercostals can be strained and may also go into spasm. This can be a painful condition, limiting chest movement and affecting breathing.

Physiotherapy can help ease the pain associated with this condition and with gentle stretching, restore movement to the chest wall.


Rib Cartilage and Sterno-Costal Joint

Starting from the top, the first seven pairs of ribs attach to the sternum by the costal cartilage. These are known as the “true ribs”. The next three pairs do not attach to the sternum, but are attached to the true ribs by costal cartilage. The next two pairs “float”, without any attachment at the front of the chest.

Where the true ribs attach to the sternum is called the sterno-costal joint (SCJ). The part of the rib at the front of the chest, closest to the sternum is cartilage rather than bone. It is joined to the bony part of the rib at the costo-chondral joint (CCJ).

Therefore, the front, central part of the chest is mostly cartilage rather than bone. It is fairly flexible, allowing it to absorb some impact, without fracturing, as bone would. None the less, rib cartilage, the SCJ and CCJ can be injured.

It is injured mostly with direct force, such as from the steering wheel in a car accident, or quite often in contact sports such as rugby league and union. Rib cartilage injuries may cause difficulties with breathing, bending and twisting the trunk, coughing, sneezing and sometimes a crunching or grinding sound with direct pressure.

These injuries are best treated with rest and pain-relieving medication. Physiotherapy may be helpful in pain relief and assisting to gently mobilise and stretch once the injury has settled.

Scoliosis

Scoliosis is a sideways curvature of the spine. It is a very common spinal abnormality and it is mostly benign (harmless). Many people have a mild scoliosis all their life without noticing it, and it usually not painful.

Scoliosis varies greatly in size. Severe scoliosis is usually detected early in childhood and if it doesn’t improve as the child grows, it may be corrected with bracing or surgery.

Most scoliosis is mild to moderate and requires no action, unless there is back pain. We can often see subtle signs of scoliosis with shoulders not appearing level, or one side of the pelvis a little higher (or lower, depending on your perspective). In women, breasts may seem uneven in height and the bra strap annoyingly slips off the shoulder.

If you stand behind someone with scoliosis, and ask them to bend forward with their knees straight, the sideways curvature of the spine can be easily observed. There may also be a “winged” scapula, or shoulder blade. The curvatures are most often in the middle part of the spine, known as the thoracic spine. The lower back (lumbar) and neck (cervical spine) may also have curvature, but these are usually compensating for the main scoliosis in the thoracic spine.

Some health professions, particularly chiropractors, claim that scoliosis can be rectified with treatment, usually manipulation of the spine, often conducted over many years. When this intervention fails, they may also claim that the curvature will worsen without regular manipulation.

There is no evidence that spinal manipulation either rectifies, “cures”, or prevents worsening of the curvature. Patients should be wary of practitioners making such claims and seek a second opinion.

Scoliosis may contribute to back pain as it is often associated with localised muscle and soft tissue contracture (tightening), muscle wasting causing weakness, and generalised spinal stiffness, usually around the “apex” of the curvature. Physiotherapy can be very helpful at relieving the pain that may result from these consequences of scoliosis, through soft tissue and joint manipulation, heat, electrotherapy and exercise.

Exercise is particularly important in managing the pain, stiffness and “knock-on” effects of scoliosis to other parts of the body.

Mid-back Pain

The mid-back, or thoracic spine, can become painful for a variety of reasons. Muscle and joint strain, arthritis, degenerative disc and joint disease, pain related to work postures, and osteoporosis, may all contribute to pain in this region of the back.

Problems with the thoracic spine may also lead to "referred pain" felt over the chest wall, including the sides and front.

Using a variety of treatments, including massage, stretching, joint mobilisation, spinal manipulation, heat, electro-therapy and exercise, physiotherapy can be very effective at managing pain in this region.

Scapula (shoulder blades)

The shoulder blades, or scapulae, are a common site of pain. The complex muscular and soft tissue attachments of the scapulae, to the neck, thoracic spine and shoulders, can increase the risk of strain and fatigue.

Though rare, trauma to the chest and back may cause scapula fracture, a painful condition that is very slow to recover.

Physiotherapy is very useful in treating the problems that occur in the scapulae. Massage and soft tissue stretch, joint mobilisation, manipulation and exercise are the modalities most commonly used to treat problems in this area.