- It is believed to be a result of a herniation of a disk
through the endplate into the vertebral body (Sinaki
and Mokri, 2000).
•Five percent of the population demonstrates radi-
ographic evidence of this disease without symptoms. - Radiographic evidence comprises ( 1 ) anterior wedg-
ing, ( 2 ) endplate irregularity, ( 3 ) Schmorl’s nodes, and
( 4 ) apophyseal ring fracture (Sinaki and Mokri, 2000). - Conservative management is directed at correction of
postural issues, strengthening core musculature with
occasional use of a spinal orthosis in those refractory
to conservative management.
FACET JOINT SYNDROME
•With facet joint syndrome, pain is generally localized
to the spine, with only occasional radicular features.
- The pain is typically exacerbated by extension, and
improves with activity. - Isolated facet arthropathy is a rare finding (Errico,
Stecker, and Kostuik, 1997). - Manipulative therapy should be the initial treatment
for this condition in conjunction with a comprehen-
sive exercise program with attention toward postural
biomechanics. - Additional treatment may include relative rest, weight
control, analgesics/NSAIDs, flexion-based exercise
therapies, lumbosacral support, facet injections, and
radiofrequency neurotomy in refractory episodes.
COSTOVERTEBRAL JOINT PAIN
- Costovertebral joint pain is a result of osteoarthritic
changes and most commonly involves the ribs that are
single articulations with the vertebral bodies (ribs 1,
11, and 12) and the ribs that are the longest (ribs 6–8).
•Pain is often unilateral, and may be described as achy,
burning, or radiating.
•Palpation of the costovertebral junction may repro-
duce pain as can manipulation of the rib. - The diagnosis may be confirmed with an injection of
a local anesthetic.
•Treatment may include a corticosteroid injection or sur-
gical excision of the affected joint in refractory cases.
THORACIC COMPRESSION FRACTURES
- Compression fractures are usually the result of a com-
pressive flexion movement or trauma. - The fractures are generally seen with osteoporosis,
trauma (usually associated with a burst fracture),
metastatic disease, multiple myeloma or hyper-
parathyroid disease (Sinaki and Mokri, 2000).- The most common areas prone to fractures are the mid
and lower thoracic, and upper lumbar vertebral bodies. - On physical examination there is often tenderness
when the affected vertebral body is percussed. - The diagnosis can be established by radiographs,
MRI, CT scan, and/or bone scan.
•Treatment may include relative rest, pain medications,
therapy utilizing an extension-based program, a brace
with a three-point contact system. - In the young female athlete with a compression frac-
ture, evidence for the female athlete triad of amenor-
rhea, osteoporosis, and anorexia needs to be a part of
the evaluation.
NEOPLASM- Neoplasms in the thoracic spine may be categorized
as primary and metastatic. - Primary neoplasms are rare compared to metastasis.
- Common sources for the metastasis may include
breast, lung, kidney, thyroid, prostate, malignant
melanoma, myeloma, lymphoma, colon, and bladder
(Errico, Stecker, and Kostuik, 1997). - The hallmark of this disease process is considered to
be complaints of localized back pain, particularly noc-
turnal pain that can disrupt sleep. - Early there may be sensory changes and loss of bowel
and bladder function along with other myelopathic
symptoms. - Often there may be a mixed picture of radiculopathy,
myelopathy, and long tract signs. - The diagnosis can often be established through the
use of MRI. - Radiation may be the treatment of choice, and at times
high dose dexamethasone may be necessary when
there is cord compression present (Sinaki and Mokri,
2000). - Chemotherapy, hormonal therapy and surgical
decompression and/or corpectomy may be considered
when appropriate. - Additional treatment with appropriate pain medica-
tion management and spinal support or bracing should
also be addressed.
DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS- Diffuse idiopathic skeletal hyperostosis (DISH) is a
nondeforming ossification process that can involve
any level of the spine, but most commonly affects the
thoracic spine.
254 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE