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THORACIC DISC HERNIATION?

Exit forum ID Forum Discussion THORACIC DISC HERNIATION?

This topic contains 4 replies, has 2 voices, and was last updated by   Carl Nottoli, DC January 29, 2019 at 9:13 am.

Viewing 5 posts - 1 through 5 (of 5 total)
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  • #3978

    Christopher Stepien
    Participant
      • 51 YO Female
      • L: 3” under Left Lower scapula
      • Q: sharp, spasm (drops her to the ground)
      • I: 10/10 (dropped to knees 3x in 3 years)
        • 3/10 now
        • 1/10 minimum every day
      • P+: random movements
        • Worse as days goes
        • Breathing (sometimes)
          • Costo transverse joint or Disc inflammation with hypertonicity?
        • Thoracic rotation
        • SLPF “adjustment” (feels good, but sometimes feels like causes spasm)
          • Outright in mid back – clunk
          • ASK HER: How often does she do it?
          • [INSTABILITY?] Get flexion – extension views of spine?
        • Sometimes 10 mins after waking up
      • P-: Massage, rolfing

       

      Dx Hypothesis:

      1. Thoracic spine disc pathology

       

      2nd Order:

      • O: 3 YA (moving recycling bin – dropped to ground)
      • Severe tightness upper traps, ant pec, whole arms, whole upper and mid back
        • [Lower cervical disc derangement]
      • LD Hx: soccer, some fitness
      • Right Shoulder surgery

       

      Dx Hypothesis:

      1. Thoracic spine disc pathology
      2. Lower cervical disc pathology

      Questions:

      1. REVERSE ENGINEERING: No trauma? No high load? Is this possible? A thoracic disc herniation?
      2. IMAGING: Should get I get flexion/extension views of spine x-ray due to clunk OR get MRI of T-spine or both? Or are there tests I could include in her exam?
      #3983

      Carl Nottoli, DC
      Participant

        Where exactly does the clunk happen and how does she get it to come on?

        #3984

        Christopher Stepien
        Participant

          I haven’t done the exam yet, but I definitely heard it in mid-back and she goes to touch her toes and somehow flexes and extends locally in T spine to make it happen (or at least it seems).

          I’ll pin point this more in the exam.

          #3985

          Seth Schultz, DC
          Participant

            Along with thoracic disc pathology, given her age and history of damage to the spine Carl and I discussed the likelihood of insufficiency fracture in mid thoracic spine. Follow up MRI would give you a good read on the status of both the disc and any bony pathology present.

            #3986

            Carl Nottoli, DC
            Participant

              To piggy back on Seth’s comments, you could add passive and active extension of the T spine as well as spinous percussion while in the flexed position to gauge any local pain/inflammation.

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