What is called thoracic vertebral small joint disorder

Posterior thoracic joint disorder, also known as posterior thoracic joint misalignment, occurs from time to time in the clinic. The posterior joints of the thoracic spine are articular synovial joints. Because the articular surfaces of the posterior articular synovium of the thoracic spine are similar to the coronal position, and there are ribs on both sides to support them, the stability of the thoracic spine is stronger than that of the cervical spine and the lumbar spine, and the chances of the posterior joints misaligning are less than those of the cervical spine and the lumbar spine. However, when sudden external pulling, improper position change, twisting, so that the posterior joints can not withstand the shared tensile and compressive stress, it may cause acute posterior joints of the thoracic spine misalignment lesions. ［Clinical symptoms: In the normal physiological respiratory movement of the thoracic spine, the range of motion of the posterior joints is very small, but in the case of extrusion or inappropriate sprain and contusion, even coughing and sneezing can also cause joint dislocation. Typical patients in the onset of the posterior thoracic spine joints in the sudden dislocation of the "snorting" sound, light joint strain, the performance of the dislocation of the joints of the local pain and discomfort; heavy ligament tear, the posterior joints are dislocated, the performance of the "fork in the air", the neck, shoulder and back as pain, the neck, shoulder and back. In severe cases, it may cause ligament tearing, posterior joint dislocation, pain in neck, shoulder and back, pain and discomfort in ribs, chest tightness, chest pressure and blockage, difficulty in turning over at night, and sensory and motor dysfunction in the corresponding spinal innervated area. ［Signs and symptoms] Patients with acute posterior thoracic spondylolisthesis have a painful face, difficulty in tilting the head and neck, turning the side, and often remain in a fixed position (most often in anterior tilting position), unable to rotate at will; damaged thoracic vertebral segment spinous processes have compression pain, tenderness and paravertebral compression pain, and the pain is worse with deep inhalation; the spinous processes are deviated from the spinal column central axis; the posterior processes are elevated or concave, and so on. The soft tissues of the paraspinal region of the damaged segment can be seen to have tenderness, painful nodules or striae on palpation. [Diagnosis: 1. History of trauma or long-term poor posture. 2. 2. Clinical symptoms and signs: see "Clinical Symptoms" and "Signs" above. 3. Palpation: obvious pressure pain, percussion pain or distortion of the thoracic spinous process of the misaligned segment. The soft tissues next to the spinous process may have different range and degree of tension or even spasm, which can be felt as strips and cords and painful when pressed. 4. X-ray film: Because the subluxation of the posterior thoracic spine is a subtle change in anatomical position, it is often not easy to show on X-ray film. However, X-ray examination can exclude thoracic spine tuberculosis, tumor, fracture, rheumatoid and other diseases. Treatment of thoracic spondylolisthesis is the introduction of maneuver This post received 6 flowers Thoracic spondylolisthesis is a clinical disease. Physiologically, 12 thoracic vertebrae, as part of the spinal column, form an important part of the body's mechanical pillars; the spinal cord passes through the spinal canal of the thoracic vertebrae, and many nerves with different functions pass through the side of the thoracic vertebrae. Due to the large number of small joints in the thoracic vertebrae, the symptoms and signs caused by the disorders are complicated, and the specific manifestations are related to the level of the misaligned thoracic vertebrae, the number of different tissues, the different degree of tissue involvement, and the duration of the disease, so there are big differences: such as muscular strains, intercostal neuralgia, thoracic and abdominal organs dysfunction, and head and neck symptoms, and so on. From the perspective of morphology and structure: thoracic spine is involved in the formation of thoracic silhouette, by virtue of the joint capsule, peripheral ligaments and muscles and other soft tissues closely integrated with the ribs *** with the formation of a more stable state, not easy to be damaged, so in the clinic, thoracic spine due to small joint disorders often misdiagnosed as cardiovascular diseases, respiratory diseases, digestive diseases, neurological disorders, and so on, the effect of drug therapy is very little, and even if it is effective, often stop the drug and have another attack. Even if the treatment is effective, it is often stopped that the attack again, seriously affecting the patient's work, study and life. The author after several years of clinical exploration, and to the experienced teacher to learn, the small joint disorder of the thoracic spine correction and treatment of a little rough understanding, and summarized the treatment of small joint disorder of the thoracic spine effective ten kinds of manipulation, is now introduced as follows.1 Manipulation Introduction 111 Punching method Take the fifth thoracic vertebrae to the left, the sixth thoracic vertebrae to the right rotational displacement as an example. The patient lies down, the doctor stands on the left side, presses the heel of the left hand on the right side of the spinous process of the fifth thoracic vertebra, and the heel of the right hand on the left side of the spinous process of the sixth thoracic vertebra, and then the patient is asked to breathe y, and when the exhalation is about to be completed, the doctor uses both hands to apply a one-inch force to the pressure at the same time. At this time, you can often hear a crisp joint popping sound, suggesting that the joint is reset. Then check the neighboring upper and lower joints, if there is still misalignment, then according to the law again. This method can be used as a generalized technique for correcting disorders of the small joints of the thoracic spine, especially for those with small joint disorders and slight anterior and posterior slips of the thoracic spine.112 Rotational Stamping This method is a derivative of the stamping method, with the difference being that the hands rotate in a clockwise direction during the stamping process. The combined force of the stamping and rotational forces is more efficient than stamping for simple rotational dislocations of the thoracic spine.113 Single Palm Vibration This method is based on the same mechanism as the stamping and rotational stamping methods, but is performed with one hand instead of two. Take the fifth thoracic vertebra as an example of a leftward rotational displacement. The patient lies prone, the doctor stands on the left side, the right palm against the spinous process of the fifth thoracic vertebra, the patient is asked to take a deep breath, and when the exhalation is about to be completed, the heel of the right palm is pressed to the right with an inch of force, and the sound of the joints popping is indicative of the reset of the joints. The single palm vibration method is more suitable for upper and middle thoracic small joint disorders.114 The knee-on-top thoracic trigger method is also known as the "thoracic spine confrontation reset method". There are three methods of operation: the patient sits on the chair facing the backrest of the backrest chair, crosses the arms behind the head, and the doctor pushes the knees against the distorted spinous processes.A method: the doctor takes both hands from the patient's armpits to the front, and then wraps them around the back to the upper back, grasps the patient's forearms, and pulls the patient's forearms backward slowly, and at the same time, exerts a little force on the knees, and a popping sound of the joints is heard, then it suggests that the joints are reset.B method: the doctor holds the elbow tip of the patient's hands and pulls them backward slowly, and when they move, it suggests that the joints are reset. Method B: The doctor holds the tip of the patient's elbow with both hands and slowly pulls it backward, and when the activity reaches its maximum limit, it flickers slightly, and when the sound of the joint popping is heard, the joint is prompted to be reset.Method C: This method is a modification of the previous two methods that I mastered when I was not quite proficient in them, and I found that patients who were slightly fatter couldn't tolerate it if I used Method A. Method B can make the patient feel pain in the shoulder when the patient is not careful with its operation, so I changed my mind. The doctor's hands from the patient's armpits, and then both hands hooked up the patient's shoulders, slowly pulling back, while the knee joints slightly forward against the crooked spinous processes, to be the maximum activity, a little force can be heard when the joints popping sound. This method is more suitable for small joint disorders of the upper middle thoracic vertebrae.115 Shoulder pulling method Take the left deviation of the spinous process of the third thoracic vertebrae as an example. The patient is lying down, the doctor stands on the side of the patient's head, presses the right side of the third thoracic spinous process with the small fishbone of the left hand, and at the same time pulls the patient's right shoulder with the right hand to the upper left, and the sound of popping is heard, which suggests that the joint is reset. This method is more suitable for disorders of the small joints of the upper and middle thoracic vertebrae.116 Finger-push method Take the right deviation of the spinous process of the eleventh thoracic vertebra as an example. The patient lies down, the doctor stands on the patient's right side, and the thumbs of both hands overlap against the distorted spinous process, gradually increase the force and push to the left, and when the sound of joint popping is heard, it suggests that the joint is reset. This method is suitable for patients with cervicothoracic and thoracolumbar joint disorders, as well as those who are thin and weak with laxity of the joint capsule.117 Punching method Take the rightward displacement of the spinous process of the second thoracic vertebra as an example. The patient is lying down, the doctor stands on the right side, the left thumb squeezes the spinous process and strikes it with the right fist, and the sound of the joint popping will indicate that the joint is reset. Be careful not to use sudden violence during the operation, and it is forbidden for patients with osteoporosis or diseases that lead to osteoporosis. This method is suitable for the upper and middle thoracic spine small joint disorder.118 The patient is lying down, the doctor stands on the left side, the hands overlap on the middle thoracic spine, and ask the patient to take a deep breath, and when the exhalation will be finished, press with the inch force, and when the sound of the joint popping is heard, the joint will be hinted to be reset. This method is suitable for new spinal whiplash injuries, and the sound of the joints popping when the reset is successful is called "firecrackers".119 Seated rotational push method Take the rightward displacement of the spinous process of the twelfth thoracic vertebra as an example. The patient sits, the assistant fixes the patient's legs, the doctor sits on the right side with the right hand from the patient's right armpit through the patient's neck upward with the hand hooked, with the left thumb against the skewed spinous process, the patient relaxes, the doctor with the right hand to drive the patient's upper body from the upright to the right downward swing, to wait for the force to the twelfth thoracic vertebrae with the right hand thumb to push it, you can hear the joints reset popping sound. This method is more suitable for small joint disorders of the lower thoracic vertebrae.1110 Pulling, stretching and traction method Compared with the previous nine methods, this method is more difficult to operate and requires a higher level of skill from the doctor. Take the first thoracic vertebra as an example. The patient lies supine, the doctor sits at the head of the bed, holds the patient's neck with the right hand and relaxes the patient's neck muscles with the thumb and forefinger; the patient's left hand holds the patient's lower jaw and slowly pulls it, and when it reaches the first thoracic vertebrae, the doctor makes a pulling movement with an inch of force, and when a slight sound of the joints popping is heard, the patient is prompted to reset the joints. This method requires great skill to operate successfully. This method is suitable for small joint disorder of the upper thoracic vertebrae.2 Case example: Sun x x, female, 33 years old, came to the clinic in May 2003, reporting back pain for more than 1 week. She reported back pain for more than 1 week, which had been aggravated for 3 days. On examination, it was found that the thoracic facet joints were disorganized and the spinous processes were deviated to the left, but there were no other special symptoms. We applied a local relaxation maneuver, and then repositioned the spine with a stamping method. When we heard four crisp joint pops, the patient told us that he felt much more relaxed. Considering that this was the first treatment, we could not use too many repositioning maneuvers, so we instructed the patient to go home and apply a hot compress, and continue treatment on the second day. The next day, the patient came early and was overjoyed, saying that he had been suffering from this disease for 13 years and had never expected such an effect. Upon careful questioning of the patient's medical history, he told us that he had fallen from a car 13 years ago and was hospitalized, but when he was discharged from the hospital, he was told that the shape of his spine could not be corrected. After that, the patient was told that the shape of the spine could not be corrected. After that, the patient was hospitalized for one month or when there was a sudden change in the weather, and he was hospitalized for medication, but he could not get rid of the problem, so when he checked his spine again, he found that the whole spine was curved to the side, and he realized that it was an injury caused by a whiplash. So, she continued to use the stamping method, and after 1 week of treatment, all the disordered small joints were corrected. Considering the long history of the disease, he was instructed to apply hot compresses for half an hour every day, and to treat once every 3 days to consolidate the effect for 1 month.3 Discussion On the etiology of the disorder of the small joints of the thoracic spine, there have been two different views for a long time: one is that due to the bone lesions, such as osteophytes, resulting in spasm and edema of the surrounding muscles, nerves and blood vessels, and then the pain and small joints are dislocated. This is what is customarily referred to as the "osseous theory" [ 1 ]; the other view is that the muscles, nerves, blood vessels and other soft tissues are subjected to adverse stimuli resulting in spasm, edema, resulting in thoracic vertebrae force structure disruption, spinal imbalance, resulting in small joint disorders secondary to osteomalacia. This is what is customarily referred to as the "myogenic theory" [ 2 ]. From clinical observation and combined with the etiology of osteophytes, this disease is mostly due to long-term sitting posture, or due to cold, or excessive fatigue, external injuries, etc., resulting in spasm of the soft tissues around the thoracic vertebrae, extrusion of the surrounding neurovascularity, so that the blood circulation is impeded, resulting in diffuse pain, and then spinal stability is destroyed, loss of balance, resulting in scoliosis, and then small joint disorders and even Thoracic spondylolisthesis, this small joint disorder is not effectively corrected, the surrounding tissue congestion and edema can not be well dissipated, absorption, over time will lead to osteophytes, the disorder of the small joints of the thoracic spine protruding part of the osteophytes produced by the bone to stimulate the surrounding soft tissues, causing further spasm of the soft tissues, congestion, edema, extrusion of the surrounding blood vessels, nerves, resulting in more severe pain and other symptoms, thus forming a vicious circle. This creates a vicious circle. The implementation of manipulation of reset, first of all through the relaxation of the manipulation, so that the capillary expansion, accelerate the local blood circulation, increase the amount of oxygen supply to the tissues, promote the excretion of metabolic wastes, such as nitrogen, carbon dioxide, etc. and elevate the patient's blood morphine-like substances in order to lift the spasticity of the soft tissues to alleviate pain. In this way, the cause of the disease is removed from the soft tissues, and the further development of the vicious circle is cut off; then, the small joint disorders are corrected through the revision manipulation, and the undesirable stimulation to the surrounding soft tissues is eliminated, so as to restore the mechanical balance of the spine. With the correction of misaligned small joints, some patients' clinical symptoms can be rapidly eliminated. In this way, the cause of the disease is eliminated from the bony structure, and the development of the vicious circle is cut off. Through clinical observation, we have the following experience: (1) All the manipulations should be fully relaxed before use, which is not only conducive to the success of the manipulation in one time, but also to avoid unnecessary injury or pain to the patients. (2) After doing the whole complex of manipulation, we should use tendon management to restore the anatomical position of the local area so as to facilitate the flow of qi and blood, which is conducive to the recovery of the disease. (3) The "inch strength" mentioned many times in the article is a kind of explosive force that the doctor can send and receive freely, because it is sent and received between one inch, so it is called "inch strength". (4) When introducing the techniques, the segmentation of the spine is only summarized by vague upper, middle and lower segments without precise positioning, because in practice, due to the different habits or different degrees of proficiency of each doctor, the difference between the operation of some techniques is only subtle, but the correction of the thoracic vertebrae is much more different, and therefore not strictly positioned. (5) In the article, the author mentioned joint reset several times but did not say successful reset, because due to the doctor's grasp of different degrees, or the depth of the power of different, sometimes can not be completely reset successfully, there will still be some slight misalignment, and need to be corrected again, and therefore only said reset. (6) For patients who have been suffering from disorders of the small joints of the thoracic vertebrae for a long time, they should be reset several times before being successful, and should not be forced to be reset completely at one time, in order not to cause new injuries. (7) For patients with poor physical condition, laxity of the joint capsule, or patients with a long history of the disease, appropriate points and presses on the foot-sanli point can be used to accelerate the recovery and consolidate the effect of the treatment after the complete restoration of the manipulation. (8) The above techniques are effective in treating simple thoracic small joint disorders and their complications. If used appropriately, the symptoms can be relieved quickly. However, it should be carefully examined in the clinic and differentiated from other diseases, especially for patients who are old and frail, osteoporosis and so on, and it should be prohibited for patients with tumors. (9) The popping sound when resetting the small joints can be used as an indication of joint resetting, but it is not the only indication, therefore, it cannot be forced, and it is not possible to pursue the popping sound and use violence, so as not to cause new injuries.