What is thoracic facet joint disorder?

Posterior thoracic joint disorder, also known as posterior thoracic joint misalignment, occurs from time to time in clinical practice. The posterior joints of the thoracic vertebrae are facet joints. Since the posterior facet joints of the thoracic vertebrae are in an approximately coronal position and are supported by ribs on both sides, the stability of the thoracic vertebrae is stronger than that of the cervical and lumbar vertebrae. The chance of posterior joint misalignment is lower than that of the cervical and lumbar vertebrae. few. However, when sudden external force, improper position change, or twisting makes the posterior joint unable to bear the shared tensile and compressive stress, it may cause acute misalignment of the posterior thoracic joints. [Clinical Symptoms] During normal physiological breathing movements of the human body, the range of motion of the posterior joints of the thoracic spine is very small. However, joint dislocation can also be caused by squeezing or improper twisting, coughing, sneezing, etc. Typical patients can often hear a "chuck" sound when the posterior thoracic joints are suddenly dislocated. In mild cases, joint strain may occur, showing obvious local pain and discomfort in the dislocated segment; in severe cases, it may cause ligament tears and posterior joint dislocation. , manifested as "fork in the air", pain in the neck, shoulders and back due to traction, pain and discomfort in the ribs, chest tightness, chest compression and blockage, difficulty turning over at night, and sensory and motor dysfunction of the tissues in the corresponding areas controlled by the spinal nerves. [Signs] Patients with acute posterior thoracic joint disorder have a painful face and difficulty in tilting and turning their head and neck. They often maintain a fixed position (mostly anteversion) and cannot rotate at will; there is tenderness and percussion pain in the spinous process of the damaged thoracic segment. and paravertebral tenderness, the pain is even worse when taking a deep breath, the spinous process deviates from the central axis of the spine, the posterior process is bulged or sunken, etc. Tenderness, painful nodules or cord-like objects can be seen in the paravertebral soft tissue of the damaged segment. [Diagnosis] 1. There is a history of trauma or long-term bad posture. 2. Clinical symptoms and signs: See the “Clinical Symptoms” and “Signs” section above for details. 3. Palpation: There is obvious tenderness, percussion pain or deviation in the thoracic spinous process of the dislocated segment. The paraspinous soft tissue may have varying ranges and degrees of tension or even spasm, and you can often feel cord-like objects and pain when pressed. 4. Plain X-ray: Because the dislocation of posterior thoracic vertebrae joints is a subtle change in anatomical position, it is often difficult to show on X-ray. However, X-ray examination can exclude thoracic tuberculosis, tumors, fractures, rheumatoid and other diseases. Introduction to methods for treating thoracic facet joint disorders

This post received 6 flowers. Thoracic facet joint disorder is a frequently-occurring clinical disease. From a physiological point of view: the 12 thoracic vertebrae, as part of the spine, constitute an important part of the mechanical pillar of the human body; the spinal cord passes through the thoracic spinal canal, and many nerves with different functions pass by the thoracic vertebrae. Due to the large number of thoracic facet joints, the symptoms and signs caused by the disorder are relatively complex. The specific manifestations are related to many factors such as the level and number of the dislocated thoracic vertebrae, the different involved tissues, the varying degrees of tissue involvement, and the duration of the disease. , therefore, there are large differences: such as muscle strain, intercostal neuralgia, thoracic and abdominal organ dysfunction, and head and neck symptoms. From a morphological and structural point of view: the thoracic vertebrae participate in forming the thorax. By virtue of the joint capsule, surrounding ligaments, muscles and other soft tissues, they are closely combined with the ribs to form a relatively stable state and are not easily damaged. Therefore, clinical thoracic vertebrae facet joint disorders are caused Diseases are often misdiagnosed as cardiovascular system diseases, respiratory system diseases, digestive system diseases, nervous system diseases, etc. Drug treatment has little effect. Even if it is effective, it often relapses when the drug is stopped, seriously affecting the patient's work, study and life. Life.

After several years of clinical exploration and learning from experienced teachers, the author has a rough understanding of the treatment of thoracic facet joint disorders, and has summarized effective methods for treating thoracic facet joint disorders. The ten techniques are introduced below.

1 Technique Introduction

111 Stamping Method Take the rotational transfer of the fifth thoracic vertebra to the left and the sixth thoracic vertebra to the right as an example. The patient lies prone, the doctor stands on the left side, presses the heel of his left palm on the right side of the spinous process of the fifth thoracic vertebra, and presses the heel of his right palm on the left side of the spinous process of the sixth thoracic vertebra, and then instructs the patient to take a deep breath, and when the exhalation is almost complete, The doctor used both hands to apply an inch of force at the same time. At this time, a crisp snapping sound of the joint can often be heard, indicating that the joint is reset. Then check the adjacent upper and lower joints. If there is still misalignment, perform the procedure again according to the law. This method can be used as a general method to correct thoracic facet joint disorders, and is especially suitable for patients with facet joint disorders accompanied by slight anterior and posterior spondylolisthesis of the thoracic spine.

112 Rotary stamping method This method is a derivative of the stamping method. The difference is that the hands rotate clockwise during stamping. In this way, the combined force formed by the punching force and the rotational force is more labor-saving than the punching method for simple rotational dislocation of the thoracic spine.

113 Single Palm Vibration Method The mechanism of this method is the same as that of the stamping method and the rotary stamping method, but when performing the technique, both hands are replaced with one hand. Take the left rotational shift of the fifth thoracic vertebra as an example. The patient lies prone, and the doctor stands on the left side, with his right palm against the spinous process of the fifth thoracic vertebra, and instructs the patient to take a deep breath. When the exhalation is almost over, press the heel of the right palm to the right with an inch force. Hearing a popping sound of the joint indicates that the joint has been reset. . The single palm vibration method is more suitable for disorders of the upper and middle thoracic facet joints.

The 114 Knee Top Chest Expansion and Pulling Method is also known as the "thoracic vertebra resistance reduction method". There are three specific methods for the operation: The patient sits astride the chair facing the back of the chair, crosses his hands upwards and holds them behind his head, and the doctor presses his knees against the deviated spinous process.

Method A: The doctor moves his hands forward from the patient's armpits, then goes back and up, grabs the patient's forearm, and slowly pulls the patient's forearm back while applying a slight force on the knee. If a popping sound is heard in the joint, it indicates joint reset. Method B: The doctor holds the tip of the patient's elbow with both hands and slowly pulls it back. When the movement reaches the maximum, it flickers slightly. Hearing a popping sound from the joint indicates that the joint has been reset. Method C: This method was used when I was not very proficient in the first two methods. I found that the slightly fatter patients could not tolerate using method A, and method B sometimes caused patients to feel shoulder pain if performed carelessly, so I used method B. Be flexible. The doctor stretches out his hands from the patient's armpits, then hooks the patient's shoulders upwards with both hands, and slowly pulls the patient back. At the same time, the knee joint slightly presses forward against the deviated spinous process. When the movement reaches the maximum, you can hear the sound with a little more force. Joint snapping sound. This method is more suitable for facet joint disorders in the upper and middle thoracic spine.

115 Shoulder Pulling Method Take the left deviation of the spinous process of the third thoracic vertebra as an example. The patient lies prone, and the doctor stands on the side of the patient's head, pressing the right side of the spinous process of the third thoracic vertebra with the hypothenar of his left hand. At the same time, he pulls the patient's right shoulder upward and to the left with his right hand. Hearing a popping sound indicates joint reduction. This method is more suitable for facet joint disorders in the upper and middle thoracic spine.

116 Finger Pushing Method Take the right deviation of the spinous process of the eleventh thoracic vertebra as an example. The patient lies prone, and the doctor stands on the right side of the patient. He places his thumbs on top of each other against the deviated spinous process, and gradually pushes it to the left. Hearing a snapping sound indicates that the joint has been reset. The finger pushing method is suitable for patients with joint disorders at the junction of the cervicothoracic and thoracolumbar vertebrae, as well as patients who are thin and have loose joint capsules.

117 Hammering Method Take the right shift of the spinous process of the second thoracic vertebra as an example. The patient lies prone, and the doctor stands on the right side. He squeezes the outer spinous process with his left thumb and punches it with his right hand. Hearing a snapping sound indicates joint reset. Be careful not to use sudden force during operation, and it is prohibited for patients with osteoporosis or diseases that cause osteoporosis. This method is suitable for facet joint disorders in the upper and middle thoracic spine.

118 Overlapping hands compression method: The patient lies prone, the doctor stands on the left side, overlaps his hands on the spinous process of the middle thoracic vertebrae, instructs the patient to take a deep breath, and when he is about to exhale, press hard and hear the joints A popping sound indicates joint reset. This method is suitable for new injuries caused by whiplash injuries to the spine. Some people call the snapping sound of the joints when the reduction is successful "firecrackers".

119 Sitting Rotation Pushing Method Take the right shift of the spinous process of the twelfth thoracic vertebra as an example. The patient sits, and the assistant fixes the patient's legs. The doctor sits on the right side and passes his right hand from the patient's right armpit upwards to hook the patient's neck. He uses his left thumb to hold the deviated spinous process. The patient relaxes and the doctor leads the patient with his right hand. Swing the upper body from upright to the lower right. When the force is transmitted to the twelfth thoracic vertebra, push it with your right thumb, and you can hear the snapping sound of the joint returning. This method is more suitable for facet joint disorders in the lower thoracic spine.

1110 Pull-out and traction method Compared with the previous nine methods, this method is more difficult to operate and has higher requirements for doctors. Take the deviation of the first thoracic fasciculus as an example. The patient lies on his back, and the doctor sits on the bedside. He supports the patient's neck with his right hand and relaxes the patient's neck muscles with his thumb and index finger. He supports the patient's jaw with his left hand and slowly pulls it. When it reaches the first thoracic vertebra, he makes a traction movement with an inch of force and hears A slight joint snapping sound indicates reset. This method requires a lot of proficiency to operate successfully. This method is suitable for upper thoracic facet joint disorders.

2 Examples of medical records

Sun ××, female, 33 years old, came to the clinic in May 2003. He reported back pain for more than 1 week, which worsened for 3 days. After examination, it was found that the facet joints of his thoracic spine were disordered and his spinous process was deflected to the left. There were no other special symptoms. So local relaxation techniques were applied, and then the pressing method was used for reduction. Four clear joint popping sounds were heard, and the patient told him that "it feels much more relaxed." Considering that this was the first treatment, he could not use too many restorative techniques, so he ordered He went home and applied hot compress, and continued treatment on the second day. The patient came early the next day and was overjoyed. He said that he had been suffering from this disease for 13 years and had never expected such a curative effect. After careful medical history, the patient told him that he fell from a car 13 years ago and was hospitalized. When he was discharged, he was told that the shape of his spine could not be corrected. Afterwards, the disease would occur every one month or whenever the weather suddenly changed. Even after being hospitalized and taking medicine, the disease could not be eradicated. When the spine was checked again, it was found that the entire spine was curved to one side. Only then did it become clear that it was a whiplash injury on one side. Therefore, the stamping method was still used, and after one week of treatment, all the disordered small joints were corrected. Considering the long medical history, he was instructed to apply hot compress for half an hour every day, and to treat it every 3 days to consolidate the curative effect for 1 month.

3 Discussion

Regarding the etiology and pathogenesis of thoracic facet joint disorders, there have long been two different views: one is that it is caused by bone lesions, such as bone hyperplasia, etc. Spasm and edema of surrounding muscles, nerves, and blood vessels, followed by pain and small joint dislocation. This is what is commonly known as the "skeletal theory" [1]; the other is that the muscles, nerves, blood vessels and other soft tissues are adversely stimulated to produce spasm and edema, which leads to the destruction of the stress-bearing structure of the thoracic spine and imbalance of the spine, thus producing small joints. Bone hyperplasia secondary to the disorder. This is what is commonly known as the "muscular theory" [2].

Judging from clinical observation and the etiology and pathogenesis of bone hyperplasia, this disease is mostly caused by long-term improper sitting posture, cold, excessive fatigue, external force injury, etc., which leads to spasm of the soft tissue around the thoracic spine, squeezing the surrounding nerves and blood< /p>

Tube, blood circulation is blocked, resulting in diffuse pain, and then the stability of the spine is destroyed and the balance is lost, resulting in scoliosis, and then facet joint disorder or even thoracic spondylolisthesis, which is a facet joint disorder. If it is not effectively corrected, the congestion and edema of the surrounding tissue cannot be dissipated and absorbed well. Over time, it will lead to bone hyperplasia, disordered thoracic facet joint protrusions and bone hyperplasia.

The excess irritates the surrounding soft tissue, causing further soft tissue spasm, congestion, and edema, squeezing the surrounding blood vessels and nerves, resulting in more severe pain and other symptoms, thus forming a vicious cycle. When performing manual reduction, relaxation techniques are first used to dilate capillaries, accelerate local blood circulation, increase tissue oxygen supply, promote the excretion of metabolic wastes such as nitrogen, carbon dioxide, etc., and increase morphine-like substances in the patient's blood to relieve soft tissue spasm, relieve pain. In this way, the cause of the disease is eliminated from the soft tissue aspect and the further development of the vicious cycle is cut off; then, the facet joint disorder is corrected through restorative manipulation, its adverse stimulation to the surrounding soft tissue is eliminated, and the mechanical balance of the spine is restored. With the correction of misaligned facet joints, some patients' clinical symptoms can be quickly eliminated. In this way, the cause of the disease is eliminated from the bony structure and the development of the vicious cycle is cut off.

Through clinical treatment observation, we have the following understanding: (1) Before using each technique, the local area must be fully relaxed. This will not only be conducive to the one-time success of the technique, but also maximize the effectiveness of the technique. Avoid unnecessary injury or pain to patients. (2) After performing the complete complex manipulation, you must use tendon-regulating manipulation to restore the local anatomical position to facilitate the smooth 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 power that doctors can send and receive freely. Because it can be sent and received within an inch, it is called "inch strength". (4) When introducing the techniques, the segmentation of the spine is only vaguely summarized as the upper, middle and lower segments without precise positioning. This is because in actual operations, due to different habits or different proficiency of each doctor, some techniques are different. The difference in operation is only subtle, but the corrected thoracic spine is quite different, so strict positioning is not required. (5) In the article, the author mentioned joint reduction many times but did not mention successful reduction. This is because due to the different scales of doctors, or the different levels of skills, sometimes the reduction cannot be completed successfully at one time, and some slight dislocations will still be left, which requires The operation was performed again to correct it, so it was just said to be reset. (6) For patients with thoracic facet joint disorder for a long time, multiple reductions should be performed to achieve success. Complete reduction should not be forced at one time to avoid causing new injuries. (7) For patients with poor physical constitution, relatively loose joint capsule, or long-term disease course, after completing the complex manipulation method, you can appropriately point and press the Zusanli point to speed up recovery and consolidate the curative effect. (8) The above techniques have good effects on simple thoracic facet joint disorders and their complicated symptoms. If used properly, symptoms can often be relieved quickly. However, in clinical practice, it is necessary to carefully examine and distinguish it from other diseases. Particular attention should be paid to the elderly, frail, osteoporosis and other patients. Manual treatment should be prohibited for tumor patients. (9) As for the snapping sound during small joint reduction, it can be used as an indication for joint reduction, but it is not the only indication. Therefore, it cannot be forced, let alone pursue the snapping sound one-sidedly and use violence to avoid causing new injuries.