Clinical Anatomy and Mgmt of Back Pain [Vol 2 - Thoracic Spine]

307 Pages·1997·73.962 MB·English

by  L. Giles, K. Singer

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permissitoonr eproduacen yp arotf t .hpiusb licats.hioounl bde addressed
tot ilt:p ublishers
British Ubrary Cataloguing in PubllcationD ata
Giles,L .G .F.
Clinicaaln aromanyd man agemenr oft horascpiinec pain
1.S pine- Disease2s. B ackache- Trearmen3t .T horacic
vertebrae -Diseases
I. itleT. H. Singer, (KeKvi.n P.P )
617.5'64
Ubrary ofC ongressC ataloguining Publication Data
Thec liniacnaalt oym andm anagemento ft horaciscp inpea in/[editbeyd]
L.G.GEil esa ndK .P.S inger.
p. cm.
Includbeisb liographirceafle renacnedsin dex.
ISBN0 75064 7892
1.Th oracic vertebra-ePa thophysiolog2y..B ackache.3 .S pin-e Disease-sT reatment.
I. GilesG,. F L. SingeKr.,P (KeviP.n)
[DNLM: 1.T horaciVce rtebra-ep hysiopathologyB. ack2Pa .in -diagnosis.B ack3 .
Pain - therapy. 4.Th oraciVce rtebra-ea naromayn dh istoloWEg y7.2 5C 641]
RD533.C56 99-056627
617.5'-6d4c 21
ISBN0 75064 7892
Composiotni byG enesis TypesettinLags,e rQ uayR,o chestKeern,t
Printeadn db OlUlind GreaB[r ilabiny T heB athP resAsv,o n
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Contents
Lisotf c ontributors vii 10 Cervicothoraancdit ch oracolumbar
Foreword ix spinalp ains yndromes 157
Preface xi ].-Myai gne
Acknowledgement xiii
11 The htoracic psine andt he' tirneedc k
SectiIo nI ntroduction syndrome' 171
H.F. Farfan
Introducttiheo ne:n igmoaft het horacic
spine 3
K.P Singera ndS .] .E dmondston 12 Radioloogfyt h e thoracsipci ne 177
I.WM cCaU
Secti/Io n Anatomy,P atholoagyn d
Biomechanics 15
SectiIVo n Managemenotf T horacic
2 Anatomy oft he thoracsipci ne 17 SpinPea in 203
K.P Sniger andS .G oh
13 Medicaaln di nvasimvaen agemenotf
3 Ligamenotfst heh umanv ertebral thorcaicsp ina.l pain 205
column 34 R.] .S tolkaenrd G.] .G roen
R.V. Putza ndM . Mi.iUer-Gerbl
14S urgictarle atmeonftd iseasaensd
4 Biomechaniocfts h et horacsipci naen d traumoaf t het horacsipci ne 223
ribcage 45 G.F. inFdlya and ESi.s enstein
IA.. F. Stokes
15C hiropracmtainca gemenotf t horacic
5 Patholoogyf t het horacsipci ne 63 spnie paino fm echanicaolr igin 244
K.P Singer D.] .L awrencaen dB .B akkum
6 Developmenatnaolm alioefst he 16O steopathci managemenotf t horacic
thoracriecg ion 83 spinpea in 257
].S aadaS,.S onga ndW H.B reidahl T. McCluneC,. W alkearn dK .B urton
7 Pathoa.natomcihcaarla cteriosftt ihces 17P hysiothermaanpayg emento ft horacic
thoracolumjbunacrt oinalr egino 100 spinpea in 268
K.P Singer andA .M almivaara D.G .L ee
8 Thoracniecu raaln atomy 114 18 Diagnosoifst horacsipci npea inan d
G.] .G roena nd ]R.S. t olker contraindicattois poinnasl m obilization
andm anipulatoin 283
SectiIoIIn DiagnosoifsT horacSipci ne L.G .F. Giles
Pain 143
9 Diagnosiso ft horacipca ins yndromes 145
].H .B land Index 299
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Contributors
B.B akkum DC,P hD L.G .F .G ilesM Sc,D C(C),P hD
NationCaoll leogfeC hiropracLtomicb,ard ,I L DirectSopri,n aPali nU nit,T ownsvilGleen eral
60148U,S A HospitTaolw, nsvi4l8le1 0Q,u eenslaAnuds,t ralia
J.H .B landMD
ProfesosfoM re dicin-eRh eumatologEym,e ritus S.Go h BSC(Hons)PT,
Unievrsityo fV ermonCto Uegoef M edicine, Centrfeo rM usculoskelSettuadli eUsni,v ersity
Rheumatologayn dC linicIammlu nologUyn itG,i ven DepartmeonftS urgerTyhe,U niverSoiftyW estern
MedicalB uUdingR,o om D-302,B urlingtVoenr,m ont AustralRioay,aP ler ht HospitPaelr,t 6h0 00W,e stern
05405U,S A Austarlai
W. H.B reidahl BSc,MB BS,F RACR
G.J .G roen MD, PhD
ConsultRaandti ologDiespta,r tmeonftI maging
ServiceRso,y aPl ertHhos pita,lP erthW,e stern Associate ProCfeenstsrfoeor r,P erioperative
Australia MedicinAene,s thesiolaongydP ainC liniUcn,i versity
MedicaCle ntrUet rechPtO,. B ox 855003,5 08G A
K.B urton PhD,D O, MErgS Utercht,T heN etherlands
SpinaRle searUcnh itUn,i versoiftH yu ddersfield,
30Q ueenS treeHtu,d dersfieHlOdI 3DH,U K
D.J .La wrence DC
NationalC olkge ofC hiropratcCi,L ombard,I L
S.E dmondstoPhDn, MT,PT
60148U,S A
Centrfeo rM usculoskelSettuadli eUsn,i vresity
DepartmeonftS urgery,T heU niversoiftW ye stern
AustraRloiyaaP,le rtHho spital,P ert6h0 00W,e stern
D. Lee MT,P T
Australia
DeltOar thopaedPihcys iotherapy Clin.ic,
# 302- 84251 20tSht reeDte,l tBaC,, V 4C 6R2,
S.E isenstePihnD ,F RCS
Canada
ConsultantO rthopedaicS urgeoCne,n trfeo rS pinal
Studi,eR soberJto neasn dA gnesH untH ospital,
GobowenO, swestrShyr,o pshire,U K J.-MYa.i gneM D
Hotel-Dieu oHspita,lR ehabilitDaetpiaornt ment,
H.F .F arfaMDn PlacNeot re Dame,7 5004Pa ris,F rance
(deceased)
G.F .F indlBaScy,M B,C hB,F RCS A.M almivaaMrDa, PhD
Consultant NeuroWsaulrtgoeCno enn,t rfeo r FinniIsnhs titouftO ec cupatoinalH ealth,
Neuroloagyn dN eurosurgNHerSy T,r usLto,w er Departmetno fO ccupatioMneadli cine,
LaneF,a zakerJey, LiUvKe rpool, Topeliuksen4k1aA t,u0 0250H elsink,iF inland
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viiCio ntbruit ors
I.M cCalFl RCR K.P .S ingerP hD, PT
ConsultaRnatd iologDiespta,r tmeonftR adiology, Centrfeo rM usculoskelSettuadli eUsn,i versity
TheR oberJto neasn dA gnesH untO rthopaedic Dep:u1:meonft TheU niversoift\Vye ,stern
InstitUOlscw,e stry, AustralRioay,a l HospitPaelr,t 6h0 00\'Vc,,t ern
Australia
T.M cCluneD O
S.S ongB Sc( Hons)M,B BS,F RACR
SpinaRle searcUhn itU.n iversoiftyH lIddersfit"'lrl,
30Q ueenS treeHtu,d dersfiHeDl1d3 DH,U K MHI DepartmeonftI magi.nSge rvicHeosv,a l
PertHho spital, WesterAnu stra6l0i0a 0
M. Miiller-GerPblhD
Ludwig-Maximmilians-UMniiivnecrhseint,a t I.A .F .S tokePshD
AnatomiscAnhset al!P,e ttenkofe1r1s,0t -r 80336 DepartmeonftO rthopaedaincrlsR ehabilit:uion.
MiincliGeenr,m any UniversoiftVye rmomB,u rlingVtTo n0,5 405I,S A
R.Pu tz MD, PhD R.J .S tolkeMrD , PhD
Ludwig-MaximrniIians-Universitat Miinchen,D epartmeonftA nesthesiolCoagtyh,ar iHnoas pital,
Anatom.isA<nhset aiPle,t tenkofer,s 0t-r 80356 5602 EindhoveTnh,e Nethe:rbncls
Miinchen(,; ermany
C.Wa lker nsc( Hons)B,S c( Ost)
J.S aadaF RCR SpinalR esearcUhn itU,n iversoiftH yu ddersfield,
ConsultaRnatd iologNiosrtf,o Hloks pitNaolr,w ichUK, 30Q ueenS treeHtu,d dersfieHlOdt 3 DH,U K
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Foreword
Havingb een personalalnyd heaviliyn volvefdo r assembleadn excelleinntte rnationtaela m from
nearl2y5 y earins clinicaanldl aboratosryt udioefs diverbsuet r elevadnits ciplitnoa edsd resnso rmaaln d
thes pineh,a vinagt tendendu merousc onferencesp athologisctarlu ctuarnedf unctiino na ddititoont he
andm eetingcso ncernewdi thb ackp ain,a ndh aving diagnosainsd managemenotf pain involvitnhge
reada multitude of publicatidoenasl inwgi tht he thoracriecg ioTnh.e t eama ndt heierd itoarrse t ob e
vertebcraoll umnt,h ep erceptitohna tI g aineeda rly congratulatefdo rh avinags semblae dc omprehensive
after takinugp my intereisntt hes pinew,a s that but readablaec counto f existiknnogw ledge,f or
comparewdi tht hel umbara ndc ervicaslp inet he havinagc hievesdu bstantuinaiflo rmitoyf s tylea,n d
thoracsipci nhea sr eceivmeudc h lesast tentiMoyn . forh aving raiseda range of new conceptTsh.e
perceptihoans c ontinuteodb e sustainoevde rt hat resultbinogo kp resenat vsa luabsloeur ceo fi nforma­
manyy earMs.y own explanatfioortn h er easonwsh y tionf orp rofessionals iinnvt ohlevin evde stigation
thet horacsipci nhea sn ota ttracttheeds amel eveolf andc linicmaanla gemento f backp aina,s wella s
clinicaanldl aboratory investaisgt ahteic oenrv ical providinbga sics cientiwsittsh a richs ourceo f
andl umbarre gioinsst hatth et horaCrieCg ioinsl ess existiknnogw ledgea sw ella sp rovidinag s ubstantial
oftent hes ourceo fc omplainotfsb ackp aint,h atth e stimluusf orn ew lineosf i nvestigation.
presencoef t her ibsi mposessu bstantidalilfyf erent Ia m grateful toh avet hiosp portunittyob ea blet o
biomechaniinfclaule nceasn dt hersee emst ob el ess expresmsy personaglr atitutdoe t hea uthorasn d
patholoing yt harte gioonf t hes pine. editofrosr f tllianng i mportannitc hei nt hes pinal
Taking accounotf t hirse latlivaeco kf p asitn terestl iteratuarned I c onfidentlpyr edictth aatn yonew ho
in thet horacsipci naen dt here freshainndgt horough hasa ni ntereisnbt a ck pain iatcnsad u sewsi lrle ach
approachd isplaybeyd D r Gileasn dP rofessSoirn ger a similcaorn clusion.
too therre gionosft hes pinael reacdoyv ereind this
three-volusmeer ieIs, h avel ookedf orwarwdi th ProfessBoarr riVee rnon-RobeMrDt,s PhD
particulkaerelnay n ticipattoit ohne iorf ferionng t he DirectoIrn,s titouftM ee dicaaln dV eterinaSrcyi ence
thoracsipci neI.am notd isappointaesdt hey have AdelaidNeo,v ember19 99
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Preface
Ouri ntentiino cno mpilitnhgi nse w texste rieisst o asa llc liniciwahnos s eeka comprehensirveev ieowf
providaen i nternatipoenraslp ectoinv et her ationalt horacsipci ne paIintn h.e b elietfh atq ualiirlyl ustra­
approactho managinmge chanicsapli napla inW.e tionsf acilittahtee m essagec,a refuls electioofn
presenat comprehensirveev iewa nd analysoifs materiaanld d etailceadp tiohnasv eb eenp reparetdo
clinicraellleyv ainntf ormatfiroonm t heb asiscc iences complementth et extAn. importanste conodb jective
leadintgo diagnosainsd treatmeonft mechanical ist oe ncouraggree atecro mmunicatiobne tween the
spinadli sorders. c1.inical schools iinnt thiesr seusbtjeedc tth,r ough
Thisv olumeh ighlightthse valueo f a team whicha stronger scibeansitsif fiocre valuatiaonnd
approacihn a ppreciattihnecg o mplexiryo ft horacic managemenotf t horacsipci npea inw ilelm erge.
spinep aina nd a rangeo f treatmeanptp roaches. Thet exits o rganizesdo t hati tca nb ea pproached
Thoraciscp inpea inp oseas specicahla llentgoet he ins everwaaly sa,c corditnogt hen eedso ft her eader.
clinicwihaon m,u sta ppreciatthee v arieoryf syn­ SectioIni ntroductehser easonibnegh intdh itse xt,
dromesa nd referrpaalt ternwsh ich can min1ic describitnhge e nigmao f thoracsipci nep aint,h e
disordearts d istansti tesC.o ntemporaryc ontribu­known epidemioloogyf t hep roblema,n di tsm any
tionfsr omt hefi eldso f anatomyp,a thoglyo,b io­ complexitfioerts h ec liniciSaenc.t ioInIp resentthse
mechanicnse,u roanatomcyl,i nimceald iicne, pain clinicaaln atomyp,a thologya nd biomechaniocfs
contr,or ladioloogryt,h opaedincesu,r osurgecrhyir,o ­ thet horacriecg ioann dc ontainssp ecicahla pteorns
practioCs,t eopatahnyd physiotheraaprye a llp re­ the adjoinicnegr vicorhoraancdi ct horacolumbar
sentedin thisv olumeE.a chs ectiownr,i ttebny junctiornealg ionTsh.i ss ectioanl sop resenat sv ery
experiencaecda demiccl iniciapnrso,v ideas s um­ detaileodv ervieowf t horacniecu roanatotmoyp ro­
mary of pertinemnatt eriatlh.a tw illl eadt o an videa basifso ru nderstanditnhge d iagnostcihca l­
improveudn derstandoifn tgh ec auseosf thoracic lengaew aititnhge c linician.
spinpea ine,m phasizipnrgi marimleyc hanicsaolu r­ The cliniciwahno wishesa quicko vervieowf
ces. Manageampepnrto achaerse o utlinebda,s edo n clinicaals sessmecnotn cepts shcoounlsdu lSte ction
routine assessment taencdh nsiuqpupeosr tebdy IIIDi,a gnosoifsT horaciScp ineP ainT.h isi ncludes
clinicraela soninsgt rategiTehsi.s t extd oes not diagnostiimca gingp rocedureasn d medicala nd
attemptot endorsae singlteh erapbyu,t r athetro surgicaaplp roachetso thoraciscp inep ain, and
highlitghhetc ommon approactho m echanictarle at­separatceh apterosn thea ssessmeanntd manage­
ment thatm ay be providebdy medicals,u rgical,m ent strategies prboyv icdheidr opractoosrtse,o ­
chiropracotsitce,o patahnyd physiotherparpayc ti­pathasn dp hysiotherapAi ssptesc.i cahla ptebry the
tionerNse.w erin vasivpea inc ontroslt rategairees lateH arryF FarfaMnD describheiss r emindetro
alsoou tlinteodi nforcml inicioafns su cho ptionfso r clinicitaone sx aminteh ew hole perwshoenn assess­
them anagemenotf chronic thoracic pain.i ngt horacpiaci n.
Ourg oails t op resetnt hiisnf ormatiionna manner SectioIVn p resenat msu ltidiSCiplainpaprryo actho
whichw illb enefitb oth the undergraduaatned them anagemenotf thoracsipci nep aina,n d con­
postgradusattued enotfm echanictahle ra,pa ysw ell cludewsi tha comprehensicvhea ptesru mmarizing
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