Pain in the thoracic region of the spine is a common complaint, which can be as disabling as cervical and lumbar pain (Edmonston & Singer 1997). There are reports in the literature of presentations involving acute cervical ‘locked facet joints’ as well as acute lumbar ‘locked facet joints’ (Maitland 1978; Exelby 2001). Although there are a multitude of conditions that can arise from the thoracic spine and ribs (Grieve 1994), the acute locked thoracic facet joint is not widely described.
The cervical and lumbar presentations have im- plicated intra-articular meniscoids within the synovial joints (Bogduk & Engel 1984; Bogduk & Jull 1984; Mercer & Bogduk 1993). These problems are frequently associated with acute deformity. The torticollis in the cervical spine and the kyphosis and scoliosis in the lumbar spine are typical examples (McKenzie 1990). McKenzie (1990) also comments that sudden locking or the appearance of deformity does not occur in the thoracic spine due to reduced mobility compared with the cervical and lumbar regions. The presence of the rib cage has been stated as the major cause for enhancing stability of the thoracic spine (Edmonston & Singer 1997).
There is work in the literature describing the presence of menisci in the lumbar and cervical zygapophyseal joints (Bogduk & Engel 1984; Mercer & Bogduk 1993), but little reviewing the presence of menisci in the thoracic spine. Singer et al. (1990) investigated meniscoid structures in the thoraco- lumbar junction (T10-L2). However, the structure and biomechanical function of meniscoids in this region may be different from the upper-mid thoracic region.
Stuart John Horton, DipPhty, PGDipManipPhty, Cred MDT,
Manipulative Physiotherapist, Clinical Tutor, School of Physiotherapy, University of Otago, PO Box 56, Dunedin, New Zealand. Tel.: 64 3 479 5757; Fax: 64 3 479 5161; E-mail: email@example.com
Another source of acute thoracic pain may be the intervertebral disc where painful though minor disc lesions amounting to a localized joint derangement may occur (Grieve 1988). Thoracic disc prolapse can occur but is thought to be infrequent in comparison with the incidence in the cervical and lumbar regions (McKenzie 1990).
There are a wide variety of manual therapy procedures available to the physiotherapist to treat benign thoracic pain. It is claimed that more often than not these problems respond to mobilization or manipulation procedures. Sustained natural apophy- seal glides (SNAGs) are described by Mulligan (1999) as useful techniques for treatment of the spinal column. However, the understanding of how or why the procedures are able to benefit patients has not been widely researched. The following case report describes a patient with acute thoracic pain and deformity, who responded dramatically to a SNAG, as well as a discussion on the possible mechanism of how the technique may have worked.