- SlidesAnkylosing Spondylitis / Axial SpondyloarthritisGradual spinal stiffness and pain over three months in someone under about forty, worse in the morning and after rest and eased by movement, often with alternating buttock pain and systemic features. It is the reverse of the mechanical pattern — and the reason this page matters is that physiotherapists see these patients years before rheumatology does.
- SlidesCardiac / Pulmonary Referred Pain (Visceral Mimic)Central or left chest ache, sometimes into the neck, jaw, arm or back, with a poor link to movement or posture and associated breathlessness, sweating, nausea or dizziness. The whole page in one line: not movement-provoked = not musculoskeletal until proven otherwise. Your job here is recognition, vitals, documentation and referral — not diagnosis, and not treatment.
- SlidesCostochondritis / Tietze's SyndromeSharp anterior chest pain at the costosternal or costochondral junctions, worse with deep breathing, coughing and trunk rotation, and reproducible on palpation. Most of it settles. The whole clinical skill is in the screening you do before you say that — because reproducible tenderness lowers the probability of something serious without excluding it, and the published mimics include tumour, tuberculosis and infection.
- SlidesCostovertebral (CVJ) / Costotransverse (CTJ) Joint DysfunctionLocal thoracic pain that catches sharply with a breath, a cough or a sneeze and wraps along the rib, usually after a sudden rotation or an awkward lift. It overlaps so heavily with the PIV joint pattern that the management barely differs — and the thing usually left out is that these joints are a described site of involvement in axial spondyloarthritis.
- SlidesRib Contusion / Stress InjurySharp, localised rib pain after trauma or repetitive loading, hurting on deep breath, cough, laugh and rotation. The orthopaedic injury is usually the easy part — the complication is respiratory, and the two common teachings that need attention are 'eased by bracing' and '4–6 weeks'.
- SlidesScheuermann's DiseaseAn adolescent with a visible, stiff thoracic kyphosis that doesn't straighten on extension, a mid-thoracic ache that's worse sitting and better lying flat, and often more distress about how it looks than about the pain. Two common teachings need correcting: neurological examination is mandatory here, and it is not reliably self-limiting after skeletal maturity.
- SlidesThoracic Discogenic PainThoracic pain that may wrap around the chest or abdomen in a band, worse with flexion, loading, coughing and sneezing, and eased by unloading. Two things matter more than the diagnosis: a thoracic disc on a scan is usually incidental, and the failure mode of this pattern is the spinal cord.
- SlidesThoracic Facet (PIV) Joint DysfunctionLocalised, sharp thoracic pain provoked by extension and ipsilateral rotation, often after an awkward movement or a sustained posture, sometimes wrapping round the rib cage as a pseudo-visceral referral. It responds well and it is the most common thing you'll see in this region — provided you have cleared the chest first and are honest that no test names the joint.
- SlidesThoracic Outlet Syndrome (TOS)Pain and paraesthesia through the neck, shoulder, arm and hand, worse with overhead work and carrying, sometimes with a heavy, swollen or cold hand. It is a diagnosis of exclusion — the provocation tests are poorly specific — and the job on the floor is to clear the cervical spine and the distal entrapments first, and to recognise the two vascular versions that need medical review before any rehab.
This is a learning tool. It does not diagnose patients and does not replace your clinical educator.
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