Course Progress



Diagnosis and Management of the Thoracic Spine and Ribs

This IAOM-US course is appropriate for ATs, OTs, PT’s and PTA’s.  The IAOM-US teaches that the essential starting point for orthopedic care is accurate clinical diagnosis.  IAOM courses and resources present effective musculoskeletal techniques established by leaders in the field.  Scientific and clinical research provides the foundation for the entire program.

The region of the thoracic spine and ribs are not well understood in medical literature and in the clinical setting.


Psst!  Hi!  This list will automatically update as you update the progress on the various modules. If you click these objectives, nothing will happen. 

Pathoanatomy I
Pathoanatomy II
Pathoanatomy III
Clinical Exam I
Clinical Exam II
Interpretation and Pathology
Disc Management
Local Exam and Segmental Testing
Pathoanatomy - Ribs
Clinical Exam - Ribs
Case Study for Thoracic Pain
No valid payment method is enabled.


Links and References

Year Reference
2018 Heneghan NR, Smith R, Tyros I, Falla D, Rushton A (2018) Thoracic dysfunction in whiplash associated disorders: A systematic review. PLoS ONE 13(3): e0194235. https://doi. org/10.1371/journal.pone.0194235
2018 Hartstein AJ et al. Immediate Effects of Thoracic Spine Thrust Manipulation on Neurodynamic Mobility. J Manipulative Physiol Ther. 2018 Apr 15. pii: S0161-4754(16)30273-1. doi: 10.1016/j.jmpt.2017.10.006. [Epub ahead of print]
2018 Hou X et al. A systematic review of complications in thoracic spine surgery for ossification of ligamentum flavum. Spinal Cord. 2018 Apr;56(4):301-307. doi: 10.1038/s41393-017-0040-4. Epub 2017 Dec 28.
2017 Pecos-Martín et al. Immediate effects of thoracic spinal mobilisation on erector spinae muscle activity and pain in patients with thoracic spine pain: a preliminary randomised controlled trial. Physiotherapy 103 (2017) 90–97.
2017 Hidalgo B et al. The efficacy of manual therapy and exercise for treating non-specific neck pain: A systematic review. J Back Musculoskelet Rehabil. 2017 Nov 6;30(6):1149-1169. doi: 10.3233/BMR-169615.
2017 Xu N et al. A systematic review of complications in thoracic spine surgery for ossification of the posterior longitudinal ligament.  Eur Spine J. 2017 Jul;26(7):1803-1809. doi: 10.1007/s00586-015-4097-5. Epub 2015 Jul 16.
2017 Karas S and Pannone A. T4 Syndrome: A Scoping Review of the Literature. J Manipulative Physiol Ther 2017;40:118-125
2016 Hirai PM and Thompson OP. T4 syndrome e A distinct theoretical concept or elusive clinical entity? A case report. Journal of Bodywork & Movement Therapies (2016) 20, 722-727
2010 Jowsey P and Perry J. Sympathetic nervous system effects in the hands following a grade III postero-anterior rotatory mobilisation technique applied to T4: A randomised, placebo-controlled trial. Manual Therapy 15 (2010) 248–253
2016 Katzman WB et al. Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial. Osteoporos Int. 2016 Mar;27(3):899-903. doi: 10.1007/s00198-015-3478-2. Epub 2016 Jan 18
2016 Barret E et al. Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Man Ther. 2016 Dec;26:38-46. doi: 10.1016/j.math.2016.07.008. Epub 2016 Jul 21.
2016 Borkowski SL et al. Challenging the Conventional Standard for Thoracic Spine Range of Motion: A Systematic Review. JBJS Rev. 2016 Apr 5;4(4):e51-e511. doi: 10.2106/JBJS.RVW.O.00048.
2016 Joaquim AF et al. Thoracolumbar Injury Classification and Injury Severity Score System: A Literature Review of Its Safety.  Global Spine J. 2016 Feb;6(1):80-5. doi: 10.1055/s-0035-1554775. Epub 2015 Jun 5.
2015 Engel RM et al. Safety of thrust joint manipulation in the thoracic spine: a systematic review. J Man Manip Ther. 2015 Sep;23(4):173. doi: 10.1179/2042618615Y.0000000017.
2015 Louw A and Schmidt SG. Chronic pain and the thoracic spine. J Man Manip Ther. 2015 Jul;23(3):162-8.
2015 Pukenas BA. Normal Anatomy of the Spine: What You Need to Know. 2015 Wolters Kluwer, Inc
2015 Gunner CK. Thoracic Intradural Disc Herniation: Key Considerations in Operative Management. Acta Rheumatologica. 2015;2(1):1.
2015 Puentedura EJ and O’Grady WH. Safety of thrust joint manipulation in the thoracic spine: a systematic review. J Man Manip Ther. 2015 Jul;23(3):154-61.
2015 Manchikanti L et al. A Systematic Review and Best Evidence Synthesis of the Effectiveness of Therapeutic Facet Joint Interventions in Managing Chronic Spinal Pain. Pain Physician. 2015 Jul-Aug;18(4):E535-82.
2014 Chu J et al. Peripheral response to cervical or thoracic spinal manual therapy: an evidence-based review with meta analysis. J Man Manip Ther. 2014 Nov;22(4):220-9. doi: 10.1179/2042618613Y.0000000062.
2014 Roguski M et al. Pigmented villonodular synovitis of the thoracic spine. Journal of Clinical Neuroscience 21 (2014) 1679–1685.
2013 Suvarnnato T et al. The Effects of Thoracic Manipulation Versus Mobilization for Chronic Neck Pain: a Randomized Controlled Trial Pilot Study. J Phys Ther Sci. 2013 Jul; 25(7): 865–871.
2011 Cross KM et al. Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review. J Orthop Sports Phys Ther. 2011 Sep;41(9):633-42. doi: 10.2519/jospt.2011.3670. Epub 2011 Aug 31.
2008 Hadjipavlou AG et al. The pathophysiology of disc degeneration. J Bone Joint Surg [Br] 2008;90-B:1261-70
2006 Pytel P et al. Degenerative Spine Disease. Am J Clin Pathol 2006;125:193-202
2004 Arana E et al. Upper thoracic-spine disc degeneration in patients with cervical pain. Skeletal Radiol (2004) 33:29–33
2001 Fardon DF and Milette PC. Nomenclature and Classification of Lumbar Disc Pathology. SPINE Volume 26, Number 5, pp E93–E113
2000 McInerney J and Ball PA. The pathophysiology of thoracic disc disease. Neurosurg Focus 9 (4):E1, 2000.
1990 Abumi K, Panjabi M, Kramer K, Duranceau J, Oxland T, Crisco J. Biomechanical Evaluation of Lumbar Spinal Stability after Graded Facetectomies. 1990; 1142-1147
1993 Abumi et al. Adams MA. Biomechanics of the intervertebral disc, vertebra, and ligaments. In Szpalski M, Gunzburg R, Pope MH, eds. Lumbar Segmental Instability. Philadelphia: Lippincott Williams & Wilkins, 1999;3-13
2006 Adams MA, Pollintine P, Tobias JH, Wakley GK, Dolan P, Intervertebral disc degeneration can predispose to anterior vertebral fractures in the thoracolumbar spine. J Bone Miner Res. 2006 Sep;21(9):1409-16
1996 AizawaY. The courses and the segmental origins of the cutaneous branches of the thoracic dorsal rami. Kaibogaku ‘Zasshi. 1996;71:195-210
1974 Andriacchi T, Schultz A, Belytschko T, Galante J. A Model for Studies of Mechanical Interactions Between the Human Spine and Rib Cage. J. Biomechanics. 1974;7:497-507
1974 Andriachi T: A model for studies of mechanical interactions between the human spine and rib cage. J Biomech. 1974; 7:497-507
1985 Arce LA. Thoracic disc herniation. Surg Neurol. 1985; 23:356-361.
1999 Arendt-Nielsen L, Graven-Nielsen T, Svensson P. Assessment of muscle pain in humans—clinical and experimental aspects. In Muscle pain, myofascial pain and fibromyalgia: Recent advances (vol 7). Proceedings of the 4th world congress on myofascial pain and fibromyalgia, J Musculosk Pain. Vecchiet L (ed.). San Antonio: Haworth Press 1999: 25-41
1997 Aubin CE, Dansereau J, de Guise J, Labelle H. Rib Cage-Spine Coupling Patters Involved in Brace Treatment of Adolescent Idiopathic Scoliosis. Spine. 1997;22:629-635
1996 Bashline S, Bilott J, Ellis JP. Meningovertebral Ligaments and Their Putative Significance in Low Back Pain. Journal of Manipulative and Physiological Therapeutics. 1996;19;9:592-596
1993 Benhamou CL. Pseudovisceral pain referred from costovertebral arthropathies. Spine. 1993;18:790795
1990 Bonica JJ (ed). The management of Pain. Philadelphia: Lea & Febiger, 1990
1997 Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine: Terminology and surgical staging. Spine. 1997; 22(9):1036-44.
1997 Broc GG, NR Crawford, VKH Sonntag, CA Dickman. Biomechanical Effects of Transthoracic Microdiscectomy. Spine. 1997;22:605-612
1997 Byl, et al. Postural imbalance and vibratory sensitivity in patients with idiopathic scoliosis: implications for treatment. J Orthop Sports Phys Ther. 1997; 26,2:60-68
1995 Carson J. J Neurol Neurosurg Psychiatry.1971;34:68-77. Arce CA. Neurol Clinics. 1985;3:383-392 Cervero F. Mechanisms of visceral pain: Past and present. In Gebhart GF (ed) Visceral Pain, Progress in Pain Research and Management. Seattle: IASP Press; 1995: 61-69
1995 Chiu KY. Cord compression caused by multiple disc herniations and intraspinal cyst in Scheuermann’s disease. Spine. 1995; 20:1075-1079.
1997 Christiansen E, IL Kanstrup. Increased Risk of Stress-Fractures of the Ribs in Elite Rowers. Scandinavian Journal of Medicine & Science in Sports, 1997, Vol 7, Iss 1, pp 49-52
1999 Cortet B, Houvenagel E, Puisieux F et al. Spinal curvatures and quality of life in women with vertebral fractures secondary to osteoporosis. Spine. 1999; 24(18):1921.
1998 Dellestable F, Gaucher A. Clay-shoveler’s fracture. Stress fracture of the lower cervical and upper thoracic spinous processes. Rev Rhum Engl Ed 1998 Oct;65 (10):575-82
1974 Domisse GF. The blood supply of the spinal cord. J Bone Joint Surg. 1974;56:225-295
1994 Dreyfuss P, Tibiletti C, Dreyer S. Thoracic Zygapophyseal Joint Pain Patterns. Spine. 1994:19;7:807-811
1969 Dwyer AF, Newton NC, Sherwood AA. An anterior approach to scoliosis. A preliminary report. Clin Orthop. 1969;62:192-202
1994 Ebenbichler, et al. [Scoliosis and its conservative treatment possibilities.] Wien Med Wochenschr. 1994; 144,24:593-604
1997 Ebraheim NA, Jabaly G, Xu RA, Yeasting RA. Anatomic Relations of the Thoracic Pedicle to the Adjacent Neural Structures. Spine. 1997;22;14:1553-1557
1997 Ebraheim NA, Xu R, Ahmad M, Yeasting RA. Projection of the Thoracic Pedicle and Its Morphometric Analysis. Spine. 1997;22;3:233-238
1997 Ebraheim NA, Xu R, Ahmad M, Yeasting RA. The Quantitative Anatomy of the Thoracic Facet and the Posterior Projection of Its Inferior Facet. Spine. 1997;22;16:1811-1818
1997 Edmondston SJ, KP Singer, RE Day, RI Price, PD Breidahl. Ex-Vivo Estimation of Thoracolumbar Vertebral Body Compressive Strength – The Relative Contributions of Bone Densitometry and Vertebral Morphometry. Osteoporosis International, 1997, Vol 7, Iss 2, pp 142-148
1999 Edmonston SH, Allison GT, Althorpe BM, McConnell DR, Samual KK. Comparison of ribcage and posteroanterior thoracic spine stiffness: An investigation of the normal response. Man Ther 1999; 4:157-62.
1997 Errico TJ, Stecker S, Kostuik JP.Thoracic pain syndromes. In: Frymoyer JW, ed. The adult spine: principles and practice. Philadelphia: Lippincott-Raven; 1997:1623-1637.
1998 Fahey et al. The pathogenesis of Schmorl’s nodes in relatin to acute trauma. Spine. 1998; 23,21:2272- 2275
1988 Failé T. Het T4-syndroom. Nederlands Tijdschrift voor Manuele Therapie. 1988. 7,2:38-40.
1992 Fontijne WP, de Klerk LW, Braakman R et al. CT scan prediction of neurological deficit in thoracolumbar burst fractures. J Bone Joint Surg Br. 1992; 74(5):683-5
1999 Foreman RD. Mechanisms of cardiac pain. Annual Review of Physiology. 1999;61:143-167
1992 Franson RC, Saal JC, Saal JA. Human disc phospholipase A2 is inflammatory. Spine, 1992; 17 (suppl): 129-132
1993 Fraser DM. T-3 Revisited. Journal of Orthopaedic Medicine. 1993. 15,1: 3-4.
1997 Fujimura Y, Nishi Y, Nakamura M, Toyama Y, Suzuki N. Long-Term Follow-Up Study of Anterior Decompression and Fusion for Thoracic Myelopathy Resulting from Ossification of the Posterior Longitudinal Ligament. Spine. 1997;22;3:305-311
1990 Galletti R, Obletter G, Giamberardino MA, et al. Pain in osteoarthritis of the knee. Adv Pain Res Ther 1990; 13: 183-191
2006 Geelhoed MA, McGaugh J, Brewer PA, Murphy D. A new model to facilitate palpation of the level of the transverse processes of the thoracic spine. J Orthop Sports Phys Ther. 2006. Nov;36(11):876-81.
1999 Giamberardino MA. Visceral hyperalgesia. In Proceedings of the 9th World Congress on Pain. Seattle: IASP Press; 1999: In Press.
2000 Goh S et al. Influence of age and gender on thoracic vertebral body shape and disc degeneration: An MR investigation of 169 cases. J Anat 2000;197:647-57
1999 Goodear M, Styles C. Stress Fractures of the Thoracic Spine Transverse Processes in a Water Skier. Clinical Nuclear Medicine. 1999;24;4:285-286
1967 Gregersen GG, Lucas DB. An In Vivo Study of the Axial Rotation of the Human Thoracolumbar Spine. Journal of Bone and Joint Surgery. 1967;49-A;2:247-262
1984 Grieve GP. De bewegingen van de borstwervelkolom. Hoofdstuk 8. 103-120 Grieve GP. The spinal column (Dutch edition). Lochem. The Netherlands: Uitgeversmaatschap de Tijdstroom; 1984:27.
1994 Hamanishi C, Kawabata T, Yosii T, Tanaka S. Schmorl’s Nodes on magnetic resonance imaging: Their incidence and clinical relevance. Spine 1994; 19: 450-453.
1975 Heinz GJ, Zavala DC. Slipping rib syndrome. Diagnosis using the “hooking maneuver”. JAMA 1975; 86:75- 8
1993 Hoheisel U, Duranti R, Galletti R, et al. Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain? Nurosci Lett 1993; 153: 9-12.
2001 Holmes JF et al. Epidemiology of thoracolumbar spine injury in blunt trauma. Academic Emergency Medicine. 2001; 8:866-72.
2000 Hopf. [Criteria for treatment of idiopathic scoliosis between 40 degrees and 50 degrees. Surgical versus conservative therapy.] Orthopaede. 2000. 29,6:500-506.
1994 Jiang H, Raso JV, Moreau MJ, Russell G, Hill DL, Bagnall KM. Quantitative Morphology of the Lateral Ligaments of the Spine. Spine. 1994;19;23:2676-2682
1998 Karlson, K.A. Am. J. Sports.Med. Rib Sress Factures in Elite Rowers. A Case Series and Proposed Mechanism. 1998; 26: 516-519.
2001 Katz, Durrani. Factors that influence oucome in bracing large curves in patients with adoliescent idiopathic scoliosis. Spine. 2001; 26,21:2354-2361.
1997 Kawahara F, Noguchi M, Yamamichi N, Konishi F, Yagasaki R, Minami M, Earashi M, Kinoshita K, Taniya T, Miyazaki I. Ectopic Breast Cancer: Two Case Reports and Review of the Japanese Literature. Breast Cancer 1997; 4:43-48.
2000 Kenny AM, Prestwood KM. Osteoporosis, pathogenesis, diagnosis, and treatment in older adults. Rheum Dis Clin North Am. 2000; 26(3):569-91.
1998 Kumazawa T. Primitivism and plasticity of pain-Implication of polymodal receptors. Neurosci Res 1998; 32: 9-31.
2002 Langrana N, Harten RD, Lin DC, Reiter MF, Lee CK. Acute thoracolumbar burst fractures: A new view of loading mechanisms. Spine. 2002; 27(5):498-508
1998 LeBlanc et al. morphologic discrimination among healthy subjects and patients with progressive and nonprogressive adolescent idiopathic scoliosis. Spine. 1998; 23,10:1109-1116
1993 Lee D. Biomechanics of the Thorax: A Clinical Model of in Vivo Function. The Journal of Manual and Manipulative Therapy. 1993;1;1:13-21
2000 Lee HM, Kim HS, Kim DJ, Suk KS, Park JO, Kim NH. Reliability of magnetic resonance imaging in detecting posterior ligament complex injury in thoracolumbar spinal fractures. Spine. 2000; 25(16):2079- 84.
2001 Lenke, et al. Multisurgeon assessment of surgical decision-making in adolescent idiopathic scoliosis: curve classification, operative approach, and fusion levels. Spine. 2001; 26,21:2347-2353
1999 Leong et al. Kinematics of the chest cage and spine during breathing in healthy individuals and in patients with adolescent idiopathic scoliosis. Spine. 1999; 24,13:1310
1967 Loebl WY. Measurement of spine and range of spinal movement. Ann Phys Med.1967;9:103
1952 Logue V. Thoracic intervertebral disc prolapse with spinal cord compression. J Neurol Neurosurg Phsychiatry. 1952; 15:227-241.
1996 Lord, MJ, Ha, K.I., and Song, K.S. Stress Fractures of the Ribs in Golfers. Am. J. Sports. Med. 1996; 24: 118-122.
1997 Lucas ML, Berg EE. Unilateral Thoracic Facet Dislocation. Clinical Orthopaedics and Related Research. 1997;335:162-165
1996 Maat G, Matricali B, van Persijn van Meerten E. Postnatal Development and Structure of the Neurocentral Junction. Its Relevance for Spinal Surgery. Spine. 1996;21;6;661-666
1997 Maitland GD. Vertebral Manipulation. 4th edition. Butterworth: London. 1997.
1997 Mannion AF, Dumas GA, Cooper RG, Espinosa FJ, Faris MW, Stevenson JM. Muscle Fibre Size and Type Distribution in Thoracic and Lumbar Regions of Erector Spinae in Healthy Subjects without Low Back Pain: Normal Values and Sex Differences. J. Anat. 1997;190:505-513
2000 McGuckin N. The T4 Syndrome. In: Modern Manual Therapy. Eds. Grieve. Mcinerney J, Ball P. The pathophysiology of thoracic disc disease. Neurosurg Focus. 2000; 9,4:1-8
1998 Mclain RF, JG Pickar. Mechanoreceptor Endings in Human Thoracic and Lumbar Facet Joints. Spine, 1998, Vol 23, Iss 2, pp 168-173
2001 Mellion LR, Ladeira C. The herniated thoracic disc: A review of literature. J Man Manip Ther 2001; 9:154- 63.
2000 Menck JY, Requejo SM, Kulig K. Thoracic spine dysfunction in upper extremity complex regional pain syndrome type I. J Orthop Sports Phys Ther 2000; 30:401-9
1994 Mense S. Referral of muscle pain. Am Pain Soc J. 1994; 3: 1-9 Meyer RA, Campbell JN, & Raja SN. Peripheral neural mechanisms of nociception. In Wall PD, Melzack R (Eds) Textbook of Pain (CD-ROM), 1997. Record 260
1990 Nakayama H et al. An 80-year old patient with thoracic disc herniation. Spine 1990; 15:1234-5.
1962 Nathan A, Schwartz A. Inverted pattern of development of thoracic vertebral osteophytes in situs inversus and in other instances of right descending aorta. Radiol Clin. 1962;31:150
2002 Nikkolasihto A, S Lahde. Stress-Fracture of the 2nd-Rib as a Cause of Back-Pain. Rofo – Fortschritte auf dem Gebiet der Rontgenstrahlen und der O’Conner PA, Eustace S, O’Byrne J. Spinal cord injury following osteoporotic vertebral fracture: Case report. Spine. 2002; 27(18):E413-15
1996 Oda I, Abumi K, Lu D, Shono Y, Kaneda K. Biomechanical role of the Posterior Elements, Costovertebral Joints, and Rib Cage in the Stability of the Thoracic Spine. Spine. 1996;21;12:1423-1429
Oostendorp RAB, van Eupen AAJM, Elvers JWH. Aspects of sympathetic nervous system regulation in patients with cervicogenic vertigo: 20 years of experience. IFOMPT Proceedings, 5th International Conference. Vail, CO 1992, 132
2006 Ozturk C et al. Far lateral thoracic disc herniation presenting with flank pain. Spine. 2006;6(2):201-3.
1976 Panjabi MM, Brand Jr, RA, White III AA. Mechanical Properties of the Human Thoracic Spine. The Journal of Bone and Joint Surgery. 1976;58-A;5;642-652
1976 Panjabi MM, Brand RA Jr., White AA III. Three-Dimensional Flexibility and Stiffness Properties of the Human Thoracic Spine. J. Biomechanics. 1976;9:185-192
1981 Panjabi MM, Hausfeld JN, White III AA. A Biomechanical Study of the Ligamentous Stability of the Thoracic Spine in Man. Aeta orthop. Scand. 1981;52:315-326
1990 White AA, Hirsch C. The significance of the vertebral posterior elements in the mechanics of the thoracic spine. Clin Orthop. 1971;81:2-14 Philadelphia: Lippincott: 1990.
1999 Procacci P, Maresca M. Referred pain from somatic and visceral structures. Curr Rev Pain 1999; 3:96-99.
1986 Procacci P, Zoppi M, Maresca M. Clinical approach to visceral sensation. In Cervero F, Morrison JFB (eds). Visceral Sensation. Progress in Brain Research. Amsterdam: Elsevier, 1986: 21-28
1997 Rang HP, Beavan S, & Dray A. Nociceptive Peripheral Neurons: Cellular Properties. In Wall PD, Melzack R (Eds) Textbook of Pain (CD-ROM), 1997. Record 713
1997 Resnick DK, Weller SJ, Benzel EC. Biomechanics of the Thoracolumbar Spine. Management of the Thoracolumbar Stability. 1997;8;4:455-469
1987 Ross JS. Thoracic disc herniation. MR Imaging Radiology. 1987; 165:511-151.
1984 Sato A, Swenson RS.Sympathetic nervous system resonse to mechanical stress of the spinal column of rats. J Man Phys Ther 1984; 7:141-7
1996 Schellhas KP, Smith MD, Gundry CR, Pollei SR. Cervical discogenic pain. Prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers. Spine. 1996;21:300-312.
1994 Schellhas KP, Pollei SR, Dorwart RH. Thoracic Discography-A Safe and Reliable Technique. Spine. 1994;19;18:2103-2109
1994 Schellhas KP. Thoracic discography: a safe and reliable technique. Spine. 1994; 19:2103-2109
1973 Schultz AB, Belytschko TB, Andriacchi TP, Galante JO. Analog studies of forces in the human spine. Mechanical properties and motion segment behavior. J Biomech. 1973;6:373-383
1974 Schultz AB, Hirsch C. Mechanical Analysis of Techniques for Improved Correction of Idiopathic Scoliosis. Clinical Orthopaedics and Related Research. 1974;100:66-73
1997 Shenoi RM, Duong TT, Brega KE, Gaido LB. Ossification of the Ligamentum Flavum Causing Thoracic Myelopathy-A case report. American Journal of Physical Medicine and Rehabilitation. 1997;76;1:68-72
2007 Sizer PS, Brismée, JM, Cook CE. Coupling Behavior of the Thoracic Spine: a Systematic Review of the Literature. J Manipulative Physiol Ther 2007;30:390-399
2007 Sizer PS Jr, Brismée JM, Cook C. Medical screening for red flags in the diagnosis and management of musculoskeletal spine pain. Pain Pract. 2007 Mar;7(1):53-71.
1998 Stillerman C et al. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. J Neurosurg. 1998; 88:623-633.
2002 Sundaresan N, Rothman, A, Manhart K, Kelliher K. Surgery for solitary metastases of the spine: Rationale and results of treatment. Spine. 2002; 27(16):1802-6
1999 Takeuchi T et al. Biomechanical role of the intervertebral disc and costovertebral joint in stability of the thoracic spine. A canine model study. Spine 1999; 24:1414-20.
1996 Tatsui H, Onomura T, Morishita S et al. Survival rates of patients with metastatic spinal cancer after scintigraphic detection of abnormal radioactive accumulation. Spine. 1996; 21(18):2143-8.
2001 Toh E, Yerby SA< Bay Bk, McLain RF, Benson DR. Mochida J. The effect of anterior osteophytes and flexural position on thoracic trabecular strain. Spine 2001; 26:22-6
1999 Van Oostenbrugge RJ, Herpers MJ, de Kruijk JR. Spinal cord Compression Caused by Unusual Location and Extension of Ossified Ligamenta Flava in a Caucasian Male. Spine. 1999;24;5:486-488
1998 Vecchiet L, Pizzigallo E, Iezzi S, et al. Differentiation of sensitivity in different tissues and its clinical significance. J Musculoskeletal Pain 1998; 6:33-45
1999 Vecchiet L, Vecchiet J, Giamberardino MA. Referred muscle pain: Clinical and pathophysiologic aspects. Cur Rev Pain 1999; 3:489-98.
2001 Villemure et al. Progression of vertebral and spinal three-dimensional deformities in adolescent idiopathic scoliosis. Spine. 2001; 26,20:2244-2250
2000 Viti JA, Paris SV. The use of upper thoracic manipulation in a patient with headache. J Man Manip Ther 2000; 8:25-8.
1998 Wall EJ et al. Endoscopic discetomy increases thoracic spine flexibility as effectively as open discectomy. Spine 1998; 23:9-16.
1998 Wall EJ, Bylski-Austrow DI, Shelton FS, Crawford AH, Kolata RJ, Baum DS. Endoscopic Discectomy Increases Thoracic Spine Flexibility as Effectively as Open Discectomy. 1998;23;1:9-16
1999 Wenger, Frick. Scheuermann kyphosis. Spine. 1999; 24,24:2630
1995 Whitcomb DC et al. Chronic abdominal pain caused by thnoracic disc herniation. AM J Gastroenterol. 1995;90:835-7.
1990 White AA, Panjabi MM. Clinical Biomechanics of the Spine. Sec. Ed. Philadelphia: JB Lippincott;1990:117
1971 White III AA, Hirsch C. The Significance of the Vertebral Posterior Elements in the Mechanics of the Thoracic Spine. Clinical Orthopaedics and Related Research. 1971;81:2-14
1997 Wood KB, Blair JM, Aepple DM, Schendel MJ, Garvey TA, Gundry CR, Heithoff KB. The Natural History of Asymptomatic Thoracic Disc Herniations. Spine. 1997;22;5:525-530
1995 Wood KB, Garvey TA, Gundry C, Heithoff KB. Magnetic Resonance Imaging of the Thoracic Spine. The Journal of Bone and Joint Surgery. 1995;77-A;11:1631-1638
1997 Wright JM, E Matayoshi, AP Goldstein. Bursal Osteochondromatosis Overlying an Osteochondroma of a Rib – A Case-Report. Journal of Bone and Joint Surgery – American Volume, 1997, Vol 79A, Iss 7, pp 1085-1088.
2001 Xiong Y, Lachmann E, Marini S, Nagler W. Thoracic disk herniation presenting as abdominal and pelvic pain: A case report. Arch Phys Medi Rehab 2001; 82:1142-4
2006 Young BA, Gill H, Wainner RS, Flynn TW. Thoracic Costotransverse Joint Pain Patterns in Asymptomatic Subjects. Journal Manual Manipulative Therapy; 2006; 185.
1996 Yuh WT, Quets JP, Lee HJ, Simonson TM, Micalsom LS, Nguyen PT, Sato Y, Mayr NA, Berbaum KS. Anatomic distribution of metastases in the vertebral body and modes of hematogenous spread. Spine. 1996; 21:2243-50.