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CASE REPORTS
JOURNAL ARTICLE
Thoracic disc herniation: a diagnostic challenge.
Manual Therapy 2000 August
An unusual case of lower thoracic disc herniation combined with shoulder pain is presented in this case report, A literature search showed that shoulder pain associated with a lower thoracic disc herniation has not yet been reported. An acromioplasty for chronic impingement syndrome was performed to relieve the patient's shoulder symptoms. An unsatisfactory outcome plus a progressive but incomplete paraplegia, prompted further investigation and this revealed a low thoracic herniation. The nucleotomy which followed afterwards lead to a rapid improvement of both the shoulder symptoms and the incomplete paraplegia. This case report shows that chronic shoulder pain may be caused or exacerbated by a thoracic disc herniation in the low thoracic spine. Therefore, prior to performing surgery for peripheral joint symptomatology, the possibility of a central sensitising trigger should be excluded by physical examination of neural tissue dynamics as well as any other necessary confirmatory investigations.
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