Ross M.D., Elliot R.L. Thoracic Spine Compression Fracture in a Patient With Back Pain J Orthop Sports Phys Ther 2008;38(4)218.
This case study describes a 55 year old man who presented with immediate onset of thoracic spine pain while running. He had no specific findings on examination with the exception of a general decrease in mobility, as well as severe point tenderness at T9. His past medical history included discovery of T8 compression fracture several years earlier during an employment physical, as well as a family history of osteoporosis.
Imaging studies were performed, and indicated compression deformities at 4 levels of the thoracic spine, including T9. He underwent vertebroplasty with immediate abolition of his pain. On further testing it was found that he had osteoporosis, and medical treatment was initiated.
I can remember working with a similar patient, with nearly the exact same diagnosis – she was referred by a chiropractor with a diagnosis of thoracic disc derangement. She was in her 70’s, and had recently begun working out at a gym, when she noticed a “pop” in her back while using the deadlift machine. She had not had any radiographs, and on examination her motion was essentially normal, and repeated movements had no real effect on her symptoms. The only thing that reproduced her pain was direct palpation, as in this case study. She had denied any specific health complaints, but on further questioning revealed that she was osteopenic. She was referred back to the chiropractor for radiographs, and they confirmed the fracture. After laying off the gym for a few weeks, she was pain-free.
I frequently think of that patient and the importance of taking a thorough history and probing further when things don’t add up clinically. Unfortunately, with therapists often limited to 30 minute evaluations, taking a thorough health history is often not the first priority. In this case a thorough evaluation, including repeated movements, helped to rule out most mechanical causes, and further questioning helped to make the appropriate diagnosis.
On a side note, she sent a note to the chiropractor, thanking him for helping her to make the diagnosis – I never heard from her again.
Orthopedic Physical Therapy Research 