Wry Thorax

Wry thorax is also known as a thoracic facet joint sprain. This condition is characterised by damage to the connective tissue of one of the thoracic facet joints. Damage to these tissues commonly results from bending or twisting of the middle region of the back and may occur as a result of repetitive loading, prolonged positioning or with an acute traumatic movement.

In many cases patients notice a sudden onset of middle back pain with painfully restricted movements into the aggravating position. This sometimes severe restriction is characterised by a chemically driven inflammatory process as a result of the acute tissue damage. Most patients will therefore find their pain is worst when first moving in the morning.

Patients with a wry thorax will commonly have pain on one side of their back. This condition may also refer pain into their shoulder blade, upper arm, ribs or chest. Diagnosis of a wry thorax is made by a physiotherapist and can, though rarely, involve imaging to further assess the injured tissue.

Initial treatment of this condition may involve anti-inflammatory medication to reduce pain from the inflammatory process. Joint mobilisation and soft tissue massage is also utilised early to restore normal range of movement and aid in pain reduction and muscle spasm. Thoracic spine manipulation may be used to promote further mobility. Physiotherapists will also perform postural and lifting assessments to try and ascertain the cause of this injury and reduce its likelihood of representing in the future.