Thoracic Spine Case History and Quiz

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A 62-year-old female presents with an aching of the thoracic spine and thorocolumbar junction of a three month duration.  It is worse when she is on her feet for long periods of time, by the end of the day and at night time.  She finds she has catching pain at night time which affects her when getting up out of bed.   She did report a stumble recently but did not fall.  She does not have referred pain into her extremities.  She has received treatment before for her back 2 years ago with relief.  She is a retired seamstress.  Her daughter is planning a wedding in the near future and she is very busy with the planning.

Her pain is 5/10 after standing and 7/10 at night time.  It is worse by the end of the day and she is having difficulty sleeping as this pain is waking her. It is worse with coughing.

Medical history: She had a mastectomy for breast Cancer 8 years ago.  She has had gastric problems and has difficulty maintaining a reasonable weight.  She is an old smoker but quit two years ago.   She is having some trouble with anemia in the past few months and notes fatigue. Her walking program of 1 .5 miles has decreased and she feels she is spending more time lying down.

No Testing at this point as she is seeing you before she sees her MD.

Examination:

O/E: fair-haired thin lady who actively walks for exercise.  She is slightly kyphotic with a forward head posture.  Her gait is functional.

Posture: kyphotic and lordotic with scoliosis

ROM:
Painful and limited forward flexion of the trunk.
Minimal side flexion (B) for thoracic and lumbar spines
Extension is functional and primarily in the lumbar spine
U/E ROM is WNL with exception of shoulder elevation to 150 degrees bilaterally.
Cervical ROM presents with a capsular pattern but is asymptomatic
Rib excursions are WNL with mild aching along the lower right ribs with active deep breathing.

Neurological:
SLR and Femoral nerve tests are WNL
Slump test is mildly painful but negative for neurological signs
L/E myotomes are WNL
Reflexes are WNL, Normal plantar responses
No sensory loss
Overall she had a generalized weakness with difficulty with sit to stand transfers and supine to sit transfers on the bed and bed transfers on and off plinth are painful and difficult.
She has mild  tenderness on palpation at T7/8 with wasting around those segments.

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Rheumatoid Arthritis Quiz

Klippel, J. H., & SpringerLink (Online service). (2010). Pocket primer on the rheumatic diseases. Springer. https://doi.org/10.1007/978-1-84882-856-8

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Primer on the Rheumatic Diseases, 13th Edition