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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.

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    Christopher Stepien
      • 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


      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?

      Carl Nottoli, DC

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


        Christopher Stepien

          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.


          Seth Schultz, DC

            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.


            Carl Nottoli, DC

              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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