{"id":8342,"date":"2024-01-01T20:07:52","date_gmt":"2024-01-01T20:07:52","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/clinical-reasoning-and-pathologies-of-the-thoracic-spine-it\/"},"modified":"2024-11-27T18:28:31","modified_gmt":"2024-11-27T18:28:31","slug":"clinical-reasoning-and-pathologies-of-the-thoracic-spine-it","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/it\/clinical-reasoning-and-pathologies-of-the-thoracic-spine-it\/","title":{"rendered":"Ragionamento clinico e patologie della colonna vertebrale toracica"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\"><b>Redazione originale <\/b>&#8211; <a title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\">Jess Bell<\/a> sulla base del corso di <a class=\"external text\" href=\"https:\/\/members.physio-pedia.com\/course_tutor\/tanya-bell-jenje\/\" rel=\"nofollow\">Tanya Bell-Jenje<\/a><br \/>\n<b>Contributori principali<\/b> &#8211; <a class=\"mw-userlink\" title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\"><bdi>Jess Bell<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Lucinda hampton\" href=\"\/User:Lucinda_hampton\"><bdi>Lucinda hampton<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Kim Jackson\" href=\"\/User:Kim_Jackson\"><bdi>Kim Jackson<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Rucha Gadgil\" href=\"\/User:Rucha_Gadgil\"><bdi>Rucha Gadgil<\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Olajumoke Ogunleye\" href=\"\/User:Olajumoke_Ogunleye\"><bdi>Olajumoke Ogunleye<\/bdi><\/a> e <a class=\"mw-userlink\" title=\"User:Carin Hunter\" href=\"\/User:Carin_Hunter\"><bdi>Carin Hunter<\/bdi><\/a><\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display: none;\" role=\"button\" type=\"checkbox\"><\/p>\n<div class=\"toctitle\" dir=\"ltr\" lang=\"en\">\n<h2 id=\"mw-toc-heading\">Contenuti<\/h2>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Introduction\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Introduzione<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-2\"><a href=\"#Muscles_of_the_Thorax\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">Muscoli del torace<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-3\"><a href=\"#Intercostals\"><span class=\"tocnumber\">2.1<\/span> <span class=\"toctext\">Intercostali<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-4\"><a href=\"#Iliocostalis\"><span class=\"tocnumber\">2.2<\/span> <span class=\"toctext\">Ileocostale<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Pectoralis_Major\"><span class=\"tocnumber\">2.3<\/span> <span class=\"toctext\">Grande pettorale<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-6\"><a href=\"#Rhomboid_Major_and_Minor\"><span class=\"tocnumber\">2.4<\/span> <span class=\"toctext\">Grande e piccolo romboide<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-7\"><a href=\"#Serratus_Anterior\"><span class=\"tocnumber\">2.5<\/span> <span class=\"toctext\">Dentato anteriore<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-8\"><a href=\"#External_Oblique_vs_Serratus_Anterior\"><span class=\"tocnumber\">2.5.1<\/span> <span class=\"toctext\">Obliquo esterno vs Dentato anteriore<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-9\"><a href=\"#The_Diaphragm\"><span class=\"tocnumber\">2.6<\/span> <span class=\"toctext\">Il diaframma<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-10\"><a href=\"#The_Effect_of_Diaphragmatic_Bracing_on_the_Thoracic_Spine\"><span class=\"tocnumber\">2.6.1<\/span> <span class=\"toctext\">L&#8217;effetto del bracing diaframmatico sulla colonna vertebrale toracica<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-11\"><a href=\"#Pathologies\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">Patologie<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-12\"><a href=\"#Spinal_Masqueraders\"><span class=\"tocnumber\">3.1<\/span> <span class=\"toctext\">Mascheratori spinali<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-13\"><a href=\"#Thoracic_Outlet_Syndrome\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">Sindrome dello stretto toracico<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-14\"><a href=\"#Stress_Fracture_of_the_Ribs\"><span class=\"tocnumber\">4.1<\/span> <span class=\"toctext\">Frattura da stress delle costole<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-15\"><a href=\"#Manubriosternal_Joint_Pain\"><span class=\"tocnumber\">4.2<\/span> <span class=\"toctext\">Dolore all&#8217;articolazione manubrio-sternale<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-16\"><a href=\"#Costochondritis\"><span class=\"tocnumber\">4.3<\/span> <span class=\"toctext\">Costocondrite<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-17\"><a href=\"#Cervical_Facet_Pain\"><span class=\"tocnumber\">4.4<\/span> <span class=\"toctext\">Dolore alle faccette cervicali<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-18\"><a href=\"#Thoracic_Disc_Pathology\"><span class=\"tocnumber\">4.5<\/span> <span class=\"toctext\">Patologia del disco toracico<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-19\"><a href=\"#Summary\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">Sintesi<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-20\"><a href=\"#References\"><span class=\"tocnumber\">6<\/span> <span class=\"toctext\">Citazioni<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span id=\"Introduction\" class=\"mw-headline\">Introduzione<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Introduction\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Introduction\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=1\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La <a title=\"Thoracic Anatomy\" href=\"\/Thoracic_Anatomy\">colonna vertebrale toracica<\/a> \u00e8 un\u2019area complessa che \u00e8 stata ampiamente trascurata dalla ricerca.<sup id=\"cite_ref-:13_1-0\" class=\"reference\"><a href=\"#cite_note-:13-1\">(1)<\/a><\/sup> Sebbene solo il 13% dei soggetti riferisca ogni anno di avere un dolore toracico specifico,<sup id=\"cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\">(2)<\/a><\/sup> \u00e8 ormai risaputo che il torace pu\u00f2 essere un fattore contribuente silenzioso di altre patologie distali e prossimali.<sup id=\"cite_ref-:13_1-1\" class=\"reference\"><a href=\"#cite_note-:13-1\">(1)<\/a><\/sup> Inoltre, diverse patologie non meccaniche possono <a title=\"Mascheratori spinali\" href=\"\/Spinal_Masqueraders\">mascherarsi<\/a> da dolore toracico muscolo-scheletrico. Tutte queste condizioni devono essere prese in considerazione nella valutazione dei pazienti con dolore toracico.<\/p>\n<h2><span id=\"Muscles_of_the_Thorax\" class=\"mw-headline\">Muscoli del torace<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Muscoli del torace\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=2\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modificare la sezione: Muscoli del torace\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=2\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Nel torace sono presenti 112 inserzioni muscolari. In questa pagina vengono illustrati alcuni dei muscoli che possono interessare il torace. Ulteriori informazioni sulla muscolatura della colonna vertebrale toracica sono disponibili <a title=\"Muscoli principali della colonna vertebrale toracica\" href=\"\/Thoracic_Spine_Major_Muscles\">qui<\/a>.<\/p>\n<h3><span id=\"Intercostals\" class=\"mw-headline\">Intercostali<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Intercostali\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=3\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modificare la sezione: Intercostali\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=3\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<div class=\"thumb tright\"><a class=\"image\" href=\"\/File:WhatsApp_Image_2020-04-10_at_3.26.18_PM.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/5\/55\/WhatsApp_Image_2020-04-10_at_3.26.18_PM.jpg\/300px-WhatsApp_Image_2020-04-10_at_3.26.18_PM.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/5\/55\/WhatsApp_Image_2020-04-10_at_3.26.18_PM.jpg\/450px-WhatsApp_Image_2020-04-10_at_3.26.18_PM.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/5\/55\/WhatsApp_Image_2020-04-10_at_3.26.18_PM.jpg 2x\" alt=\"Immagine WhatsApp 2020-04-10 at 3.26.18 PM.jpg\" width=\"300\" height=\"308\" data-file-width=\"477\" data-file-height=\"489\"><\/a><\/div>\n<p>Esistono 11 coppie di muscoli <a title=\"Stiramento del muscolo intercostale\" href=\"\/Intercostal_Muscle_Strain\">intercostali<\/a>. Ogni muscolo ha tre strati disposti da superficiale a profondo:<sup id=\"cite_ref-:0_3-0\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<ul>\n<li>Esterno<\/li>\n<li>Interno<\/li>\n<li>Il pi\u00f9 interno<\/li>\n<\/ul>\n<p>I nervi intercostali provengono per lo pi\u00f9 dai rami anteriori dei <a title=\"Nervi spinali toracici\" href=\"\/Thoracic_Spinal_Nerves\">nervi spinali da T1 a T11.<\/a><sup id=\"cite_ref-:0_3-1\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup> Insieme all&#8217;arteria e alla vena intercostali, questi nervi corrono tra gli strati intermedi e profondi dei muscoli intercostali. I nervi intercostali da T7 a T11 lasciano la parete toracica ed entrano nella parete addominale per innervare il peritoneo addominale.<sup id=\"cite_ref-:1_4-0\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup> Innervano:<sup id=\"cite_ref-:1_4-1\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Ribs\" href=\"\/Ribs\">Costole<\/a> e cartilagini costali<\/li>\n<li>Muscoli intercostali (tutti gli strati)<\/li>\n<li>Pleura parietale, che riveste la superficie interna della cavit\u00e0 toracica, compresi il <a title=\"Il diaframma: anatomia e diagnosi differenziale\" href=\"\/Diaphragm_Anatomy_and_Differential_Diagnosis\">diaframma<\/a>, il pericardio e l&#8217;<a title=\"Aorta\" href=\"\/Aorta\">aorta<\/a> toracica<\/li>\n<\/ul>\n<p>Per via di questa innervazione condivisa, le malattie della parete o della cavit\u00e0 toracica potrebbero mascherarsi da dolore <a title=\"Dermatomi\" href=\"\/Dermatomes\">dermatomerico<\/a> derivante dalla colonna vertebrale toracica.<sup id=\"cite_ref-:1_4-2\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup> Pertanto, \u00e8 essenziale valutare costantemente il paziente per individuare eventuali <a title=\"Un\u2019introduzione alle bandiere rosse nelle patologie gravi\" href=\"\/An_Introduction_to_Red_Flags_in_Serious_Pathology\">bandiere rosse<\/a>. Una scarsa risposta del paziente al trattamento pu\u00f2 indicare una patologia pi\u00f9 grave ed \u00e8 considerata un\u2019importante bandiera rossa.<sup id=\"cite_ref-:1_4-3\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><sup id=\"cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\">(5)<\/a><\/sup><\/p>\n<h3><span id=\"Iliocostalis\" class=\"mw-headline\">Ileocostale<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modifica la sezione: Iliocostalis\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=4\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modifica la sezione: Iliocostalis\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=4\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<div class=\"thumb tright\"><a class=\"image\" href=\"\/File:250px-Iliostalis.png\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.physio-pedia.com\/images\/2\/21\/250px-Iliostalis.png\" alt=\"250px-Iliostalis.png\" width=\"250\" height=\"472\" data-file-width=\"250\" data-file-height=\"472\"><\/a><\/div>\n<p>L&#8217;Ileocostale \u00e8 il pi\u00f9 laterale dei muscoli erettori spinali. \u00c8 suddiviso in tre parti:<sup id=\"cite_ref-:2_6-0\" class=\"reference\"><a href=\"#cite_note-:2-6\">(6)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Iliocostalis Cervicis\" href=\"\/Iliocostalis_Cervicis\">Ileocostale del collo<\/a><\/li>\n<li><a title=\"Iliocostalis Thoracis\" href=\"\/Iliocostalis_Thoracis\">Ileocostale del dorso<\/a><\/li>\n<li><a title=\"Iliocostalis Lumborum\" href=\"\/Iliocostalis_Lumborum\">Ileocostale dei lombi<\/a><\/li>\n<\/ul>\n<p>L&#8217;Ileocostale dei lombi origina dalla cresta iliaca e si inserisce sui processi trasversi lombari da L1 a L4, sull&#8217;angolo delle costole dalla 4a alla 12esima costola e sulla fascia toracolombare. L&#8217;ileocostale del collo e del dorso ha inserzioni sulle sei costole superiori fino ai processi trasversi di C4.<sup id=\"cite_ref-:2_6-1\" class=\"reference\"><a href=\"#cite_note-:2-6\">(6)<\/a><\/sup> L&#8217;ileocostale, quindi, collega la disfunzione lombopelvica con quella toracica. L&#8217;ipertonicit\u00e0 di questo muscolo pu\u00f2 potenzialmente avere un impatto sugli <a class=\"mw-redirect\" title=\"Il torace semplificato\" href=\"\/The_Thorax_Simplified\">anelli toracici<\/a>.<sup id=\"cite_ref-:1_4-4\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<h3><span id=\"Pectoralis_Major\" class=\"mw-headline\">Grande pettorale<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modifica della sezione: Pettorale maggiore\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=5\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modifica della sezione: Pettorale maggiore\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=5\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Il <a title=\"Pectoralis major\" href=\"\/Pectoralis_major\">grande pettorale<\/a> costituisce la parte voluminosa dei muscoli del torace. Si tratta di un muscolo spesso e a forma di ventaglio che origina da:<sup id=\"cite_ref-:3_7-0\" class=\"reference\"><a href=\"#cite_note-:3-7\">(7)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Sternum\" href=\"\/Sternum\">Sterno<\/a> anteriore (fino al processo xifoideo)<\/li>\n<li><a class=\"mw-redirect\" title=\"Clavicola\" href=\"\/Clavicula\">Clavicola<\/a><\/li>\n<li>6a costola (estremit\u00e0 sternale)<\/li>\n<li>Le 6 cartilagini costali superiori<\/li>\n<li>Aponeurosi dell&#8217;<a title=\"External Abdominal Oblique\" href=\"\/External_Abdominal_Oblique\">obliquo esterno<\/a><\/li>\n<\/ul>\n<p>Si inserisce sul labbro laterale del solco bicipitale dell&#8217;<a title=\"Omero\" href=\"\/Humerus\">omero<\/a>.<sup id=\"cite_ref-:3_7-1\" class=\"reference\"><a href=\"#cite_note-:3-7\">(7)<\/a><\/sup> Ha anche <a title=\"Upper Extremity Myofascial Chains\" href=\"\/Upper_Extremity_Myofascial_Chains\">legami fasciali<\/a> con il <a title=\"Latissimus Dorsi Muscle\" href=\"\/Latissimus_Dorsi_Muscle\">grande dorsale<\/a>.<sup id=\"cite_ref-:1_4-5\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><sup id=\"cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\">(8)<\/a><\/sup><\/p>\n<p>L&#8217;iperattivit\u00e0 del grande pettorale \u00e8 associata alla <a title=\"Thoracic Hyperkyphosis\" href=\"\/Thoracic_Hyperkyphosis\">cifosi toracica<\/a> e alla traslazione anteriore dell&#8217;omero.<sup id=\"cite_ref-:1_4-6\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup> Le clavicole orizzontali sono un segno clinico di iperattivit\u00e0 di questo muscolo.<sup id=\"cite_ref-:1_4-7\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup> Lo stretching del pettorale pu\u00f2 contribuire a ridurre la cifosi, nonch\u00e9 la posizione con anteposizione del capo\/la posizione arrotondata delle spalle e l&#8217;<a title=\"Upper-Crossed Syndrome\" href=\"\/Upper-Crossed_Syndrome\">upper crossed syndrome<\/a>.<sup id=\"cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\">(9)<\/a><\/sup><sup id=\"cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\">(10)<\/a><\/sup><\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 402px;\"><a class=\"image\" href=\"\/File:Thoracic_and_scapula_motor_control_exercise.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/1\/18\/Thoracic_and_scapula_motor_control_exercise.jpg\/400px-Thoracic_and_scapula_motor_control_exercise.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/1\/18\/Thoracic_and_scapula_motor_control_exercise.jpg\/600px-Thoracic_and_scapula_motor_control_exercise.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/1\/18\/Thoracic_and_scapula_motor_control_exercise.jpg 2x\" alt=\"\" width=\"400\" height=\"269\" data-file-width=\"713\" data-file-height=\"479\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>La Figura 1 Esercizio per ridurre la cifosi toracica.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>L&#8217;esercizio illustrato nella Figura 1 pu\u00f2 essere utilizzato per migliorare il controllo motorio di torace e scapola. Pu\u00f2 inoltre ridurre la cifosi toracica aumentando l&#8217;attivit\u00e0 delle fibre medie e inferiori del trapezio e riducendo l&#8217;iperattivit\u00e0 delle fibre superiori del trapezio.<sup id=\"cite_ref-:1_4-8\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<p>NB: \u00e8 importante migliorare l&#8217;attivazione del trapezio inferiore nei pazienti che presentano una cifosi toracica accentuata. Durante gli esercizi si dovrebbe dare l&#8217;indicazione &#8220;in basso e in fuori&#8221; piuttosto che &#8220;in basso e in dentro&#8221;.<sup id=\"cite_ref-:1_4-9\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<p>Si veda anche <a title=\"Scapular Dyskinesia\" href=\"\/Scapular_Dyskinesia\">Discinesia scapolare<\/a>.<\/p>\n<h3><span id=\"Rhomboid_Major_and_Minor\" class=\"mw-headline\">Grande e piccolo romboide<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Romboide Maggiore e Minore\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=6\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modificare la sezione: Romboide Maggiore e Minore\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=6\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>I <a title=\"Rhomboids\" href=\"\/Rhomboids\">romboidi<\/a> sono costituiti da due muscoli:<sup id=\"cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\">(11)<\/a><\/sup><\/p>\n<ul>\n<li>Grande romboide\n<ul>\n<li>Un muscolo quadrangolare<\/li>\n<li>Inferiore al piccolo romboide<\/li>\n<li>Origina dai processi spinosi da T1 a T4<\/li>\n<li>Si inserisce sul margine mediale della scapola al di sotto della radice dell\u2019angolo inferiore<sup id=\"cite_ref-:1_4-10\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/li>\n<\/ul>\n<\/li>\n<li>Piccolo romboide\n<ul>\n<li>Un muscolo cilindrico<\/li>\n<li>Origina dal <a title=\"Ligamentum nuchae\" href=\"\/Ligamentum_nuchae\">legamento nucale<\/a> e dalle vertebre C7 e T1<\/li>\n<li>Si inserisce sul margine mediale alla radice della spina della scapola<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>L&#8217;iperattivit\u00e0 di questi muscoli porta a:<sup id=\"cite_ref-:1_4-11\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li>Colonna vertebrale toracica invertita (nota anche come colonna vertebrale toracica lordotica), con forze di compressione sulle faccette<\/li>\n<li>Rotazione verso il basso della scapola, che carica la colonna cervicale<\/li>\n<li>Irritazione durale<\/li>\n<\/ul>\n<h3><span id=\"Serratus_Anterior\" class=\"mw-headline\">Dentato anteriore<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modifica della sezione: Serrato anteriore\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=7\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modifica della sezione: Serrato anteriore\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=7\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 402px;\"><a class=\"image\" href=\"\/File:Hug_an_aunt_stretch.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/b\/bd\/Hug_an_aunt_stretch.jpg\/400px-Hug_an_aunt_stretch.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/b\/bd\/Hug_an_aunt_stretch.jpg\/600px-Hug_an_aunt_stretch.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/b\/bd\/Hug_an_aunt_stretch.jpg\/800px-Hug_an_aunt_stretch.jpg 2x\" alt=\"\" width=\"400\" height=\"225\" data-file-width=\"1600\" data-file-height=\"900\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Figura 2. Esercizio per l&#8217;attivazione del dentato anteriore &#8220;Hug an aunt&#8221;.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>Il <a title=\"Serratus Anterior\" href=\"\/Serratus_Anterior\">dentato anteriore<\/a> \u00e8 un muscolo a forma di ventaglio. Si trova in profondit\u00e0 rispetto alla scapola e ai muscoli pettorali:<sup id=\"cite_ref-:4_12-0\" class=\"reference\"><a href=\"#cite_note-:4-12\">(12)<\/a><\/sup><\/p>\n<ul>\n<li>Origina dalle superfici supero-laterali delle 8 o 9 costole superiori<\/li>\n<li>Corre all&#8217;indietro e si inserisce lungo l&#8217;angolo superiore, il bordo mediale e l&#8217;angolo inferiore della scapola<\/li>\n<\/ul>\n<p>Questo muscolo \u00e8 un potente protrattore (abduttore). \u00c8 inoltre coinvolto nella rotazione verso l&#8217;alto (che consente l&#8217;attivit\u00e0 sopra la testa), nell&#8217;inclinazione posteriore e nella rotazione esterna della scapola. Mantiene la scapola piatta contro la gabbia toracica e pu\u00f2 mobilizzare la colonna vertebrale toracica in cifosi.<sup id=\"cite_ref-:1_4-12\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><sup id=\"cite_ref-:4_12-1\" class=\"reference\"><a href=\"#cite_note-:4-12\">(12)<\/a><\/sup><\/p>\n<p>Gli esercizi illustrati nella Figura 2 sono utili per:<sup id=\"cite_ref-:1_4-13\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li>Colonna vertebrale toracica invertita (si veda sopra)<\/li>\n<li>Possibile dolore durale<\/li>\n<li>Mirate alle varie digitazioni del dentato anteriore<\/li>\n<\/ul>\n<h4><span id=\"External_Oblique_vs_Serratus_Anterior\" class=\"mw-headline\">Obliquo esterno vs Dentato anteriore<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Obliquo esterno vs Serrato anteriore\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=8\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modificare la sezione: Obliquo esterno vs Serrato anteriore\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=8\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>L&#8217;obliquo esterno, l&#8217;obliquo interno e il trasverso dell&#8217;addome sono i tre muscoli della parete addominale antero-laterale. L&#8217;obliquo esterno \u00e8 il pi\u00f9 grande, il pi\u00f9 spesso e il pi\u00f9 superficiale di questi muscoli:<sup id=\"cite_ref-:1_4-14\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><sup id=\"cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\">(13)<\/a><\/sup><\/p>\n<ul>\n<li>Si inserisce sulle 6 o 7 costole inferiori (e, quindi, pu\u00f2 influenzare l&#8217;attivit\u00e0 del diaframma)<sup id=\"cite_ref-:1_4-15\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/li>\n<li>Corre obliquamente da superiore-laterale a inferiore-mediale<\/li>\n<li>Si inserisce sulla cresta iliaca<\/li>\n<\/ul>\n<p>L&#8217;obliquo esterno e il dentato anteriore si interdigitano dalla 5a alla 9a costola.<sup id=\"cite_ref-:1_4-16\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup> L&#8217;azione opposta di questi muscoli (ad esempio, durante il canottaggio o la tosse) crea una reazione di stress, che \u00e8 una delle principali cause delle fratture da stress.<sup id=\"cite_ref-:7_14-0\" class=\"reference\"><a href=\"#cite_note-:7-14\">(14)<\/a><\/sup><\/p>\n<h3><span id=\"The_Diaphragm\" class=\"mw-headline\">Il diaframma<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modifica della sezione: Il Diaframma\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=9\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modifica della sezione: Il Diaframma\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=9\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Il <a title=\"Il diaframma: anatomia e diagnosi differenziale\" href=\"\/Diaphragm_Anatomy_and_Differential_Diagnosis\">diaframma<\/a> \u00e8 un muscolo della respirazione a forma di cupola, innervato dal <a title=\"Phrenic Nerve\" href=\"\/Phrenic_Nerve\">nervo frenico<\/a> (C3-5). Il diaframma ha tre parti, che hanno origine da:<sup id=\"cite_ref-:5_15-0\" class=\"reference\"><a href=\"#cite_note-:5-15\">(15)<\/a><\/sup><\/p>\n<ul>\n<li>Processo Xifoideo<\/li>\n<li>Le 6 cartilagini costali inferiori del torace lateralmente attraverso le digitazioni che incrociano quelle del trasverso dell&#8217;addome<sup id=\"cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\">(16)<\/a><\/sup><\/li>\n<li>Le prime due <a title=\"Vertebre lombari\" href=\"\/Lumbar_Vertebrae\">vertebre lombari<\/a> posteriormente<\/li>\n<\/ul>\n<p>Esso confluisce in un tendine centrale che forma la cresta della cupola. Il segmento periferico si inserisce sulla parete toracica e sulla cavit\u00e0 addominale.<sup id=\"cite_ref-:5_15-1\" class=\"reference\"><a href=\"#cite_note-:5-15\">(15)<\/a><\/sup><\/p>\n<p>Il diaframma \u00e8 collegato tramite la fascia a:<sup id=\"cite_ref-:1_4-17\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li>Sistema <a title=\"Aorta\" href=\"\/Aorta\">aortico<\/a><\/li>\n<li><a title=\"Vena Cava\" href=\"\/Vena_Cava\">Vena cava<\/a> inferiore<\/li>\n<li>Fegato<\/li>\n<li><a title=\"Psoas Major\" href=\"\/Psoas_Major\">Muscoli dello psoas<\/a><\/li>\n<li><a title=\"Quadratus Lumborum\" href=\"\/Quadratus_Lumborum\">Quadrato dei lombi<\/a><\/li>\n<li><a title=\"Transversus Abdominis\" href=\"\/Transversus_Abdominis\">Trasverso dell&#8217;addome<\/a><\/li>\n<li><a title=\"Pelvic Floor Anatomy\" href=\"\/Pelvic_Floor_Anatomy\">Pavimento pelvico<\/a><\/li>\n<li>Sistema cardiaco (pleura e pericardio)<\/li>\n<li>Fascia profonda e mediana del collo<\/li>\n<li><a title=\"Osso occipitale\" href=\"\/Occipital_Bone\">Occipite<\/a><\/li>\n<li>Dura<\/li>\n<li>Legamenti frenico-esofagei<\/li>\n<li>Reni<\/li>\n<\/ul>\n<p>Il diaframma e gli intercostali sono gli unici muscoli che sono attivi durante l&#8217;inspirazione tranquilla.<sup id=\"cite_ref-:6_17-0\" class=\"reference\"><a href=\"#cite_note-:6-17\">(17)<\/a><\/sup> Durante l&#8217;espirazione tranquilla, il diaframma, la gabbia toracica e la parete toracica si rilassano e tornano alla loro posizione originale, espellendo l&#8217;aria dai polmoni.<sup id=\"cite_ref-:5_15-2\" class=\"reference\"><a href=\"#cite_note-:5-15\">(15)<\/a><\/sup><\/p>\n<p>Il diaframma \u00e8 quindi essenziale per una fisiologia respiratoria ottimale. Inoltre, influisce anche su molti altri sistemi, tra cui il sistema nervoso, il sistema muscolare e posturale, nonch\u00e9 il sistema linfatico.<sup id=\"cite_ref-:1_4-18\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><sup id=\"cite_ref-:6_17-1\" class=\"reference\"><a href=\"#cite_note-:6-17\">(17)<\/a><\/sup><\/p>\n<h4><span id=\"The_Effect_of_Diaphragmatic_Bracing_on_the_Thoracic_Spine\" class=\"mw-headline\">L&#8217;effetto del bracing diaframmatico sulla colonna vertebrale toracica<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: L'effetto del rinforzo diaframmatico sulla colonna vertebrale toracica\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=10\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modificare la sezione: L'effetto del rinforzo diaframmatico sulla colonna vertebrale toracica\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=10\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Il bracing diaframmatico in situazioni di basso carico pu\u00f2 verificarsi in:<sup id=\"cite_ref-:1_4-19\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Chronic Low Back Pain\" href=\"\/Chronic_Low_Back_Pain\">Lombalgia cronica<\/a><sup id=\"cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\">(18)<\/a><\/sup><\/li>\n<li><a title=\"Post-traumatic Stress Disorder\" href=\"\/Post-traumatic_Stress_Disorder\">Disturbo da stress post-traumatico<\/a><\/li>\n<li><a title=\"Panic Disorder\" href=\"\/Panic_Disorder\">Attacchi di panico<\/a><\/li>\n<li><a title=\"Coronavirus Disease (COVID-19)\" href=\"\/Coronavirus_Disease_(COVID-19)\">COVID-19<\/a><\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 402px;\"><a class=\"image\" href=\"\/File:90-90_Bridge_with_ball_and_balloon.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/a\/a0\/90-90_Bridge_with_ball_and_balloon.jpg\/400px-90-90_Bridge_with_ball_and_balloon.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/a\/a0\/90-90_Bridge_with_ball_and_balloon.jpg\/600px-90-90_Bridge_with_ball_and_balloon.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/a\/a0\/90-90_Bridge_with_ball_and_balloon.jpg\/800px-90-90_Bridge_with_ball_and_balloon.jpg 2x\" alt=\"\" width=\"400\" height=\"225\" data-file-width=\"968\" data-file-height=\"544\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Figura 3. Ponte 90\/90 con palla e palloncino.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>I pazienti che adottano questa strategia di bracing potrebbero presentare dolore a schiena, torace, collo e costole. Il bracing fissa la parete toracica e riduce la mobilit\u00e0 toracica. Pu\u00f2 portare a:<sup id=\"cite_ref-:1_4-20\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li>Ipocapnia (cio\u00e8 diminuzione dei livelli di anidride carbonica)<\/li>\n<li>Aumento della frequenza <a title=\"Valutazione respiratoria\" href=\"\/Respiratory_Assessment\">respiratoria<\/a><\/li>\n<li>Respirazione apicale<\/li>\n<li>Frequenza respiratoria irregolare<\/li>\n<\/ul>\n<p>Normalmente, le costole dalla 1a alla 7a ruotano posteriormente durante l&#8217;inspirazione completa e anteriormente durante l&#8217;espirazione completa.<sup id=\"cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\">(19)<\/a><\/sup><sup id=\"cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\">(20)<\/a><\/sup> \u00c8 importante insegnare ai pazienti una <a title=\"La gestione dei disturbi dello schema respiratorio\" href=\"\/The_Management_of_Breathing_Pattern_Disorders\">respirazione corretta<\/a>, poich\u00e9 una meccanica respiratoria ottimale favorisce il movimento sincrono delle costole.<\/p>\n<p>Il ponte 90\/90 con palla e palloncino (si veda Figura 3) \u00e8 stato creato per migliorare la funzione e la respirazione, per migliorare la postura e la stabilit\u00e0 e per ridurre il dolore.<sup id=\"cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\">(21)<\/a><\/sup><\/p>\n<h2><span id=\"Pathologies\" class=\"mw-headline\">Patologie<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Pathologies\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=11\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Pathologies\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=11\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<h3><span id=\"Spinal_Masqueraders\" class=\"mw-headline\">Mascheratori spinali<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modifica della sezione: Mascheratori spinali\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=12\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modifica della sezione: Mascheratori spinali\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=12\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>In alcuni casi, il dolore toracico potrebbe avere origini non meccaniche. Le condizioni viscerali o sistemiche che si presentano come dolore toracico sono note come mascheratori spinali. Esempi di mascheratori spinali toracici sono:<sup id=\"cite_ref-:1_4-21\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Pneumothorax\" href=\"\/Pneumothorax\">Pneumothorax<\/a><\/li>\n<li>Dolore pleuritico<\/li>\n<li><a title=\"Coronary Artery Disease (CAD)\" href=\"\/Coronary_Artery_Disease_(CAD)\">Malattia coronarica<\/a><\/li>\n<li>Dolore esofageo<\/li>\n<li>Tumori (ad esempio, polmone)<\/li>\n<li>Condizioni del fegato e della milza<\/li>\n<li><a title=\"Herpes Zoster\" href=\"\/Herpes_Zoster\">Herpes zoster<\/a><\/li>\n<li><a title=\"Panoramica sulle spondiloartropatie\" href=\"\/Overview_of_Spondyloarthropathies\">Artrite sieronegativa<\/a><\/li>\n<li><a title=\"Ankylosing Spondylitis (Axial Spondyloarthritis)\" href=\"\/Ankylosing_Spondylitis_(Axial_Spondyloarthritis)\">Spondilite anchilosante<\/a><\/li>\n<li><a title=\"Polmonite\" href=\"\/Pneumonia\">Polmonite<\/a><\/li>\n<li><a title=\"Linfoma\" href=\"\/Lymphoma\">Linfoma<\/a> maligno<\/li>\n<li><a title=\"Cancro gastrico\" href=\"\/Gastric_Cancer\">Ulcere allo stomaco<\/a><\/li>\n<\/ul>\n<h2><span id=\"Thoracic_Outlet_Syndrome\" class=\"mw-headline\">Sindrome dello stretto toracico<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Sindrome dell'uscita toracica\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=13\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modificare la sezione: Sindrome dell'uscita toracica\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=13\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La <a title=\"Sindrome dell'uscita toracica (TOS)\" href=\"\/Thoracic_Outlet_Syndrome_(TOS)\">sindrome dello stretto toracico (TOS)<\/a> \u00e8 un gruppo di disturbi che causano la compressione di nervi, arterie o vene mentre escono dallo stretto toracico. La TOS si verifica tipicamente in tre punti:<sup id=\"cite_ref-:1_4-22\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li>Triangolo scaleno<\/li>\n<li>Spazio costo-clavicolare<\/li>\n<li>Spazio retropettorale<\/li>\n<\/ul>\n<p>Una cifosi posturale\/toracica, delle bretelline del reggiseno strette, un succlavio iperattivo e la presenza di una costola cervicale possono restringere lo spazio costo-clavicolare e creare sintomi neurovascolari.<sup id=\"cite_ref-:1_4-23\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup> Le strutture solitamente interessate dalla TOS sono le seguenti:<sup id=\"cite_ref-:8_22-0\" class=\"reference\"><a href=\"#cite_note-:8-22\">(22)<\/a><\/sup><\/p>\n<ul>\n<li>Arteria e vena succlavie<\/li>\n<li>Arteria e vena ascellari<\/li>\n<li>Plesso brachiale<\/li>\n<\/ul>\n<p>Esistono tre tipi di TOS:<sup id=\"cite_ref-:8_22-1\" class=\"reference\"><a href=\"#cite_note-:8-22\">(22)<\/a><\/sup><sup id=\"cite_ref-:9_23-0\" class=\"reference\"><a href=\"#cite_note-:9-23\">(23)<\/a><\/sup><\/p>\n<ol>\n<li>Neurogena (ad esempio, plesso brachiale)\n<ul>\n<li>Il tipo pi\u00f9 comune (circa il 95% dei casi)<sup id=\"cite_ref-:10_24-0\" class=\"reference\"><a href=\"#cite_note-:10-24\">(24)<\/a><\/sup>)<\/li>\n<li>I sintomi includono:\n<ul>\n<li>Dolore<\/li>\n<li>Debolezza<\/li>\n<li>Pesantezza del braccio<\/li>\n<li>Paraestesia<\/li>\n<\/ul>\n<\/li>\n<li>I sintomi neurogeni tendono a peggiorare con le attivit\u00e0 sopra la testa o quando il braccio del paziente \u00e8 a penzoloni sul fianco<\/li>\n<\/ul>\n<\/li>\n<li>Venosa (ad esempio, vena succlavia) &#8211; nota anche come sindrome di Paget-von Schroetter<sup id=\"cite_ref-:10_24-1\" class=\"reference\"><a href=\"#cite_note-:10-24\">(24)<\/a><\/sup>\n<ul>\n<li>I sintomi includono:\n<ul>\n<li>Gonfiore<\/li>\n<li>Dolore<\/li>\n<li>Decolorazione bluastra<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Arteriosa (ad esempio, arteria succlavia)\n<ul>\n<li>Tipo meno comune<\/li>\n<li>I sintomi includono:\n<ul>\n<li>Dolore<\/li>\n<li>Freddezza<\/li>\n<li>Pallore del braccio<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p>La TOS spesso non viene individuata dai clinici: il tempo medio per la diagnosi \u00e8 di 60 mesi. La TOS potrebbe essere scambiata per tunnel carpale, compressione delle radici nervose cervicali, problemi psicosociali, sindrome del dolore regionale complesso, fibromialgia, sclerosi multipla, etc.<sup id=\"cite_ref-:1_4-24\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<p>La TOS pu\u00f2 essere diagnosticata utilizzando i seguenti test e indagini:<sup id=\"cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\">(25)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Test di Adsons\" href=\"\/Adsons_Test\">Test di Adson<\/a><\/li>\n<li><a title=\"Stress test di Roos\" href=\"\/Roos_Stress_Test\">Elevated Arm Stress Test<\/a> (test di Roos)\n<ul>\n<li>\u00c8 stato riscontrato che l&#8217;utilizzo dei test di Adson e di Roos come cluster determina una maggiore specificit\u00e0 rispetto all&#8217;utilizzo di questi test da soli<sup id=\"cite_ref-:10_24-2\" class=\"reference\"><a href=\"#cite_note-:10-24\">(24)<\/a><\/sup><\/li>\n<\/ul>\n<\/li>\n<li><a title=\"Test di tensione dell'arto superiore (ULTT)\" href=\"\/Upper_Limb_Tension_Tests_(ULTTs)\">Test di tensione dell&#8217;arto superiore<\/a><\/li>\n<li>Studio della conduzione nervosa (spesso negativo)<\/li>\n<li>Risonanza magnetica in elevazione<\/li>\n<li>Ecografia Doppler \/ duplex<\/li>\n<li>I blocchi scaleni possono essere utilizzati come strumento diagnostico<sup id=\"cite_ref-:9_23-1\" class=\"reference\"><a href=\"#cite_note-:9-23\">(23)<\/a><\/sup><\/li>\n<li>Come parte dei test sensitivi quantitativi, il test della percezione della temperatura utilizzando stimoli freddi e caldi mostra una buona affidabilit\u00e0 per quanto riguarda la degenerazione delle fibre nervose piccole<sup id=\"cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\">(26)<\/a><\/sup><\/li>\n<\/ul>\n<h3><span id=\"Stress_Fracture_of_the_Ribs\" class=\"mw-headline\">Frattura da stress delle costole<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Frattura da stress delle costole\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=14\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modificare la sezione: Frattura da stress delle costole\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=14\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Le fratture da stress delle costole sono tipicamente associate a sport che hanno:<sup id=\"cite_ref-:1_4-25\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li>Elevata entiit\u00e0 di sforzo (ad esempio, sollevamento pesi)<\/li>\n<li>Ripetizioni ad alto carico (ad esempio, golf, canottaggio, lancio, overtraining)<\/li>\n<\/ul>\n<p>Tendono a verificarsi quando le azioni opposte del dentato anteriore e dell&#8217;obliquo esterno generano forze di trazione e, di conseguenza, una reazione di stress (si veda sopra).<sup id=\"cite_ref-:7_14-1\" class=\"reference\"><a href=\"#cite_note-:7-14\">(14)<\/a><\/sup><\/p>\n<p><a title=\"Frattura da stress costale nei canottieri\" href=\"\/Rib_stress_fracture_in_rowers\">Canottaggio<\/a>:<\/p>\n<ul>\n<li>L&#8217;incidenza delle fratture da stress delle costole nel canottaggio \u00e8 compresa tra il 6 e il 12%:<sup id=\"cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\">(27)<\/a><\/sup>\n<ul>\n<li>Si verifica pi\u00f9 spesso nelle costole dalla 5a alla 9a costola<\/li>\n<li>Tipicamente antero-laterali, ma possono essere anche postero-laterali<sup id=\"cite_ref-:7_14-2\" class=\"reference\"><a href=\"#cite_note-:7-14\">(14)<\/a><\/sup><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Golf:<sup id=\"cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\">(28)<\/a><\/sup><\/p>\n<ul>\n<li>Il pi\u00f9 delle volte si verificano sul lato di battura (cio\u00e8 il lato non dominante) e interessano le costole postero-laterali<\/li>\n<li>Le costole pi\u00f9 spesso interessate sono dalla 4a alla 6a costola<\/li>\n<\/ul>\n<p>Le fratture da stress delle costole vengono diagnosticate in base all&#8217;anamnesi e alle scansioni ossee, alla TAC o alla risonanza magnetica.<sup id=\"cite_ref-:1_4-26\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup> I pazienti solitamente necessitano di un&#8217;interruzione dell&#8217;attivit\u00e0 sportiva da 3 a 9 settimane.<sup id=\"cite_ref-:1_4-27\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><sup id=\"cite_ref-:11_29-0\" class=\"reference\"><a href=\"#cite_note-:11-29\">(29)<\/a><\/sup><sup id=\"cite_ref-30\" class=\"reference\"><a href=\"#cite_note-30\">(30)<\/a><\/sup> I pazienti tendono a presentare:<sup id=\"cite_ref-:11_29-1\" class=\"reference\"><a href=\"#cite_note-:11-29\">(29)<\/a><\/sup><\/p>\n<ul>\n<li>Storia di improvviso peggioramento del dolore<\/li>\n<li>Dolore con la respirazione profonda, la tosse, gli starnuti, girandosi nel letto<\/li>\n<li>Impossibilit\u00e0 di dormire sul lato interessato<\/li>\n<li>Dolore importante, specifico, palpabile all&#8217;esame<\/li>\n<li>Test di compressione della costola positivo<\/li>\n<li>Alterazione della meccanica respiratoria<\/li>\n<li>Dolore con le flessioni e con il test del muscolo dentato anteriore<\/li>\n<li>Dolore con il sit-up, anche con un focus sull&#8217;obliquo<\/li>\n<\/ul>\n<h3><span id=\"Manubriosternal_Joint_Pain\" class=\"mw-headline\">Dolore all&#8217;articolazione manubrio-sternale<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Dolore all'articolazione manubrio-sternale\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=15\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modificare la sezione: Dolore all'articolazione manubrio-sternale\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=15\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Il dolore all&#8217;articolazione manubrio-sternale si verifica spesso in seguito a una lesione da accelerazione\/decelerazione<sup id=\"cite_ref-31\" class=\"reference\"><a href=\"#cite_note-31\">(31)<\/a><\/sup> (ad esempio, lancio, servizio). La sclerosi di questa articolazione si riscontra anche in vari tipi di artrite, tra cui:<sup id=\"cite_ref-:1_4-28\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Ankylosing Spondylitis (Axial Spondyloarthritis)\" href=\"\/Ankylosing_Spondylitis_(Axial_Spondyloarthritis)\">Spondiloartrite assiale \/ spondilite anchilosante<\/a><\/li>\n<li><a title=\"Artrite reattiva\" href=\"\/Reactive_Arthritis\">Artrite reattiva \/ Reiters<\/a><\/li>\n<li><a title=\"Artrite psoriasica\" href=\"\/Psoriatic_Arthritis\">Artrite psoriasica<\/a><\/li>\n<li><a title=\"Rheumatoid Arthritis\" href=\"\/Rheumatoid_Arthritis\">Artrite reumatoide<\/a><\/li>\n<\/ul>\n<h3><span id=\"Costochondritis\" class=\"mw-headline\">Costocondrite<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Costocondrite\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=16\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Modificare la sezione: Costocondrite\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=16\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>La <a title=\"Costocondrite\" href=\"\/Costochondritis\">costocondrite<\/a> \u00e8 un&#8217;infiammazione delle articolazioni costo-condrali o condro-sternali. \u00c8 pi\u00f9 frequente negli adulti di et\u00e0 superiore ai 40 anni. Nel 90% dei pazienti \u00e8 interessata pi\u00f9 di una costola. Le costole pi\u00f9 frequentemente interessate sono dalla 2a alla 5a costola.<sup id=\"cite_ref-:12_32-0\" class=\"reference\"><a href=\"#cite_note-:12-32\">(32)<\/a><\/sup><\/p>\n<ul>\n<li>Dolore localizzato da lieve a grave, ma che potrebbe irradiarsi alla spalla, al collo e alle braccia<sup id=\"cite_ref-:1_4-29\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/li>\n<li>\u00c8 importante escludere l&#8217;artrite sieronegativa, la polmonite, i disturbi cardiovascolari e le patologie maligne<sup id=\"cite_ref-:1_4-30\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/li>\n<li>Viene trattata con FANS e pu\u00f2 richiedere settimane o mesi per risolversi<sup id=\"cite_ref-:12_32-1\" class=\"reference\"><a href=\"#cite_note-:12-32\">(32)<\/a><\/sup><\/li>\n<\/ul>\n<p>La costocondrite pu\u00f2 essere confusa con la sindrome di <a title=\"Tietzes\" href=\"\/Tietzes\">Tietze<\/a>, ma questa condizione \u00e8 caratterizzata dall&#8217;ingrossamento di una sola cartilagine costale. Solitamente sono interessate la 2a o 3a costola ed \u00e8 pi\u00f9 comune nei pazienti pi\u00f9 giovani.<sup id=\"cite_ref-:12_32-2\" class=\"reference\"><a href=\"#cite_note-:12-32\">(32)<\/a><\/sup><\/p>\n<h3><span id=\"Cervical_Facet_Pain\" class=\"mw-headline\">Dolore alle faccette cervicali<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Dolore alla faccetta cervicale\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=17\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modificare la sezione: Dolore alla faccetta cervicale\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=17\">modifica fonte<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>\u00c8 ormai assodato che i dischi cervicali e le articolazioni delle faccette cervicali trasmettono il dolore alla parte superiore del torace.<sup id=\"cite_ref-:1_4-31\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<h3><span id=\"Thoracic_Disc_Pathology\" class=\"mw-headline\">Patologia del disco toracico<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Modificare la sezione: Patologia del disco toracico\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=18\">modifica<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Modificare la sezione: Patologia del disco toracico\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=18\">fonte edit<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>La <a title=\"Sindrome del disco toracico\" href=\"\/Thoracic_Disc_Syndrome\">patologia del disco toracico<\/a> \u00e8 rara e i soggetti sono spesso asintomatici. Uno dei motivi per cui \u00e8 cos\u00ec rara \u00e8 per via dello spessore del disco toracico, che \u00e8 pi\u00f9 sottile rispetto alle altre regioni. Il rapporto tra il disco toracico e il corpo vertebrale \u00e8 di 1:5 (contro 2:5 nella colonna cervicale e 1:3 nella colonna lombare).<sup id=\"cite_ref-:1_4-32\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Dermatomes_for_Thoracic_Spine_Course.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/9\/9a\/Dermatomes_for_Thoracic_Spine_Course.jpg\/300px-Dermatomes_for_Thoracic_Spine_Course.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/9\/9a\/Dermatomes_for_Thoracic_Spine_Course.jpg\/450px-Dermatomes_for_Thoracic_Spine_Course.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/9\/9a\/Dermatomes_for_Thoracic_Spine_Course.jpg\/600px-Dermatomes_for_Thoracic_Spine_Course.jpg 2x\" alt=\"\" width=\"300\" height=\"250\" data-file-width=\"1800\" data-file-height=\"1500\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Figura 4. Dermatomeri spinali.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>Nel 75% dei casi, la patologia del disco toracico si verifica a livello di T8 o sotto, con un picco intorno a T11 o T12.<sup id=\"cite_ref-33\" class=\"reference\"><a href=\"#cite_note-33\">(33)<\/a><\/sup> Solo l&#8217;1% dei prolassi con <a title=\"Mielopatia\" href=\"\/Myelopathy\">mielopatia<\/a> grave si verifica nella colonna vertebrale toracica.<sup id=\"cite_ref-:1_4-33\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<p>Esistono due tipi di patologia discale:<sup id=\"cite_ref-:1_4-34\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li>Dolore toracico centrale (mielopatico):\n<ul>\n<li>Paralisi delle gambe e compressione del midollo spinale<\/li>\n<li>Compromissione della vescica e dell&#8217;intestino<\/li>\n<\/ul>\n<\/li>\n<li>Dolore dermatomerico unilaterale (radicolare)\n<ul>\n<li>Compressione della radice nervosa<sup id=\"cite_ref-:1_4-35\" class=\"reference\"><a href=\"#cite_note-:1-4\">(4)<\/a><\/sup><\/li>\n<li>Il dolore segue la via dermatomerica intercostale (si veda Figura 4)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2><span id=\"Summary\" class=\"mw-headline\">Sintesi<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Summary\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=19\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Summary\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=19\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li>\u00c8 utile ripristinare la colonna vertebrale toracica neutra<\/li>\n<li>Il dentato anteriore \u00e8 fondamentale per ripristinare una cifosi toracica ottimale da una posizione invertita disfunzionale<\/li>\n<li>L&#8217;insegnamento di una respirazione corretta \u00e8 importante, poich\u00e9 una buona meccanica respiratoria richiede un movimento sincrono delle costole<\/li>\n<li>Poich\u00e9 esistono molti mascheratori spinali toracici, le bandiere rosse dovrebbero essere valutate constantemente:\n<ul>\n<li>Un&#8217;importante bandiera rossa da considerare \u00e8 una scarsa risposta al trattamento<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2><span id=\"References\" class=\"mw-headline\">Citazioni<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: References\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;veaction=edit&amp;section=20\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: References\" href=\"\/index.php?title=Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine&amp;action=edit&amp;section=20\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-:13-1\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:13_1-0\">1.0<\/a><\/sup> <sup><a href=\"#cite_ref-:13_1-1\">1.1<\/a><\/sup><\/span> <span class=\"reference-text\">Bell-Jenje T. The Thorax Simplified &#8211; Anatomy, Biomechanics and Regional Interdependence Course. Plus , 2021.<\/span><\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-2\">\u2191<\/a><\/span> <span class=\"reference-text\">Leboeuf-Yde C, Nielsen J, Kyvik KO, Fejer R, Hartvigsen J. <a class=\"external text\" href=\"https:\/\/link.springer.com\/article\/10.1186\/1471-2474-10-39\" rel=\"nofollow\">Pain in the lumbar, thoracic or cervical regions: do age and gender matter? A population-based study of 34,902 Danish twins 20\u201371 years of age<\/a>. <i>BMC Musculoskelet Disord<\/i>. 2009;10(39).<\/span><\/li>\n<li id=\"cite_note-:0-3\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:0_3-0\">3.0<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-1\">3.1<\/a><\/sup><\/span> <span class=\"reference-text\">Tang A, Bordoni B. Anatomy, Thorax, Muscles. (Updated 2021 Jul 26). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: <a class=\"external free\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538321\/\" rel=\"nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538321\/<\/a><\/span><\/li>\n<li id=\"cite_note-:1-4\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:1_4-0\">4.00<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-1\">4.01<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-2\">4.02<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-3\">4.03<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-4\">4.04<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-5\">4.05<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-6\">4.06<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-7\">4.07<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-8\">4.08<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-9\">4.09<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-10\">4.10<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-11\">4.11<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-12\">4.12<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-13\">4.13<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-14\">4.14<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-15\">4.15<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-16\">4.16<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-17\">4.17<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-18\">4.18<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-19\">4.19<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-20\">4.20<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-21\">4.21<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-22\">4.22<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-23\">4.23<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-24\">4.24<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-25\">4.25<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-26\">4.26<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-27\">4.27<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-28\">4.28<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-29\">4.29<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-30\">4.30<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-31\">4.31<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-32\">4.32<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-33\">4.33<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-34\">4.34<\/a><\/sup> <sup><a href=\"#cite_ref-:1_4-35\">4.35<\/a><\/sup><\/span> <span class=\"reference-text\">Bell-Jenje T. Assessment and Treatment of the Thoracic Spine Course. Plus , 2021.<\/span><\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-5\">\u2191<\/a><\/span> <span class=\"reference-text\">Finucane LM, Downie A, Mercer C, Greenhalgh SM, Boissonnault WG, Pool-Goudzwaard AL et al. <a class=\"external text\" href=\"https:\/\/www.jospt.org\/doi\/10.2519\/jospt.2020.9971?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed\" rel=\"nofollow\">International framework for red flags for potential serious spinal pathologies<\/a>. J Orthop Sports Phys Ther. 2020;50(7):350-72. <\/span><\/li>\n<li id=\"cite_note-:2-6\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:2_6-0\">6.0<\/a><\/sup> <sup><a href=\"#cite_ref-:2_6-1\">6.1<\/a><\/sup><\/span> <span class=\"reference-text\">Henson B, Kadiyala B, Edens MA. Anatomy, Back, Muscles. (Updated 2021 Aug 10). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: <a class=\"external free\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537074\/\" rel=\"nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537074\/<\/a><\/span><\/li>\n<li id=\"cite_note-:3-7\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:3_7-0\">7.0<\/a><\/sup> <sup><a href=\"#cite_ref-:3_7-1\">7.1<\/a><\/sup><\/span> <span class=\"reference-text\">Solari F, Burns B. Anatomy, Thorax, Pectoralis Major Major. (Updated 2021 Jul 26). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK525991\/<\/span><\/li>\n<li id=\"cite_note-8\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-8\">\u2191<\/a><\/span> <span class=\"reference-text\">Pandya R. Upper Extremity Myofascial Chains Course. Plus , 2021.<\/span><\/li>\n<li id=\"cite_note-9\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-9\">\u2191<\/a><\/span> <span class=\"reference-text\">Roddey TS, Olson SL, Grant SE. The effect of pectoralis muscle stretching on the resting position of the scapula in persons with varying degrees of forward head\/rounded shoulder posture, Journal of Manual &amp; Manipulative Therapy. 2002;10(3):124-8.<\/span><\/li>\n<li id=\"cite_note-10\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-10\">\u2191<\/a><\/span> <span class=\"reference-text\">Kim MK, Lee JC, Yoo KT. The effects of shoulder stabilization exercises and pectoralis minor stretching on balance and maximal shoulder muscle strength of healthy young adults with round shoulder posture. J Phys Ther Sci. 2018;30(3):373-80.<\/span><\/li>\n<li id=\"cite_note-11\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-11\">\u2191<\/a><\/span> <span class=\"reference-text\">Farrell C, Kiel J. Anatomy, Back, Rhomboid Muscles. (Updated 2021 Jul 26). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: <a class=\"external free\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK534856\/\" rel=\"nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK534856\/<\/a> <\/span><\/li>\n<li id=\"cite_note-:4-12\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:4_12-0\">12.0<\/a><\/sup> <sup><a href=\"#cite_ref-:4_12-1\">12.1<\/a><\/sup><\/span> <span class=\"reference-text\">Lung K, St Lucia K, Lui F. Anatomy, Thorax, Serratus Anterior Muscles. (Updated 2020 Nov 14). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: <a class=\"external free\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK531457\/\" rel=\"nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK531457\/<\/a> <\/span><\/li>\n<li id=\"cite_note-13\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-13\">\u2191<\/a><\/span> <span class=\"reference-text\">Seeras K, Qasawa RN, Ju R, et al. Anatomy, Abdomen and Pelvis, Anterolateral Abdominal Wall. (Updated 2021 Jul 26). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: <a class=\"external free\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK525975\/\" rel=\"nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK525975\/<\/a> <\/span><\/li>\n<li id=\"cite_note-:7-14\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:7_14-0\">14.0<\/a><\/sup> <sup><a href=\"#cite_ref-:7_14-1\">14.1<\/a><\/sup> <sup><a href=\"#cite_ref-:7_14-2\">14.2<\/a><\/sup><\/span> <span class=\"reference-text\">Karlson KA. Rib stress fractures in elite rowers. A case series and proposed mechanism. Am J Sports Med. 1998;26(4):516-9. <\/span><\/li>\n<li id=\"cite_note-:5-15\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:5_15-0\">15.0<\/a><\/sup> <sup><a href=\"#cite_ref-:5_15-1\">15.1<\/a><\/sup> <sup><a href=\"#cite_ref-:5_15-2\">15.2<\/a><\/sup><\/span> <span class=\"reference-text\">Bains KNS, Kashyap S, Lappin SL. Anatomy, Thorax, Diaphragm. (Updated 2020 Apr 21). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: <a class=\"external free\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519558\/\" rel=\"nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519558\/<\/a> <\/span><\/li>\n<li id=\"cite_note-16\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-16\">\u2191<\/a><\/span> <span class=\"reference-text\">Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidiscip Healthc. 2013 Jul 25;6:281-91. doi: 10.2147\/JMDH.S45443. PMID: 23940419; PMCID: PMC3731110. <a class=\"external free\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3731110\/\" rel=\"nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3731110\/<\/a> <\/span><\/li>\n<li id=\"cite_note-:6-17\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:6_17-0\">17.0<\/a><\/sup> <sup><a href=\"#cite_ref-:6_17-1\">17.1<\/a><\/sup><\/span> <span class=\"reference-text\">Clifton-Smith T. How We Breathe Course. Plus , 2020.<\/span><\/li>\n<li id=\"cite_note-18\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-18\">\u2191<\/a><\/span> <span class=\"reference-text\">Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):352-62. doi: 10.2519\/jospt.2012.3830. Epub 2011 Dec 21. PMID: 22236541. <a class=\"external free\" href=\"https:\/\/www.jospt.org\/doi\/full\/10.2519\/jospt.2012.3830\" rel=\"nofollow\">https:\/\/www.jospt.org\/doi\/full\/10.2519\/jospt.2012.3830<\/a> <\/span><\/li>\n<li id=\"cite_note-19\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-19\">\u2191<\/a><\/span> <span class=\"reference-text\">Beyer B, Sholukha V, Dugailly PM, Rooze M, Moiseev F, Feipel V et al. In vivo thorax 3D modelling from costovertebral joint complex kinematics. Clin Biomech (Bristol, Avon). 2014;29(4):434-8. <\/span><\/li>\n<li id=\"cite_note-20\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-20\">\u2191<\/a><\/span> <span class=\"reference-text\">Lee DG. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4534848\/\" rel=\"nofollow\">Biomechanics of the thorax &#8211; research evidence and clinical expertise<\/a>. J Man Manip Ther. 2015;23(3):128-38.<\/span><\/li>\n<li id=\"cite_note-21\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-21\">\u2191<\/a><\/span> <span class=\"reference-text\">Boyle KL, Olinick J, Lewis C. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2971640\/\" rel=\"nofollow\">The value of blowing up a balloon<\/a>. N Am J Sports Phys Ther. 2010;5(3):179-88. <\/span><\/li>\n<li id=\"cite_note-:8-22\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:8_22-0\">22.0<\/a><\/sup> <sup><a href=\"#cite_ref-:8_22-1\">22.1<\/a><\/sup><\/span> <span class=\"reference-text\">Li N, Dierks G, Vervaeke HE, Jumonville A, Kaye AD, Myrcik D et al. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7957681\/\" rel=\"nofollow\">Thoracic outlet syndrome: a narrative review<\/a>. J Clin Med. 2021;10(5):962. <\/span><\/li>\n<li id=\"cite_note-:9-23\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:9_23-0\">23.0<\/a><\/sup> <sup><a href=\"#cite_ref-:9_23-1\">23.1<\/a><\/sup><\/span> <span class=\"reference-text\">Illig KA, Donahue D, Duncan A, Freischlag J, Gelabert H, Johansen K et al. <a class=\"external text\" href=\"https:\/\/www.jvascsurg.org\/article\/S0741-5214(16)30191-4\/fulltext\" rel=\"nofollow\">Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome<\/a>. J Vasc Surg. 2016;64(3):e23-35. <\/span><\/li>\n<li id=\"cite_note-:10-24\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:10_24-0\">24.0<\/a><\/sup> <sup><a href=\"#cite_ref-:10_24-1\">24.1<\/a><\/sup> <sup><a href=\"#cite_ref-:10_24-2\">24.2<\/a><\/sup><\/span> <span class=\"reference-text\">Jones MR, Prabhakar A, Viswanath O, Urits I, Green JB, Kendrick JB et al. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6514035\/\" rel=\"nofollow\">Thoracic outlet syndrome: a comprehensive review of pathophysiology, diagnosis, and treatment<\/a>. Pain Ther. 2019;8(1):5-18.<\/span><\/li>\n<li id=\"cite_note-25\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-25\">\u2191<\/a><\/span> <span class=\"reference-text\">Povlsen S, Povlsen B. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5872004\/\" rel=\"nofollow\">Diagnosing thoracic outlet syndrome: current approaches and future directions<\/a>. Diagnostics (Basel). 2018;8(1):21. <\/span><\/li>\n<li id=\"cite_note-26\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-26\">\u2191<\/a><\/span> <span class=\"reference-text\">Ridehalgh C, Sandy-Hindmarch OP, Schmid AB. <a class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/325948713_Validity_of_Clinical_Small_Fiber_Sensory_Testing_to_Detect_Small_Nerve_Fiber_Degeneration\" rel=\"nofollow\">Validity of clinical small-fiber sensory testing to detect small-nerve fiber degeneration<\/a>. J Orthop Sports Phys Ther. 2018;48(10):767-74.<\/span><\/li>\n<li id=\"cite_note-27\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-27\">\u2191<\/a><\/span> <span class=\"reference-text\">Warden SJ, Gutschlag FR, Wajswelner H, Crossley KM. <a class=\"external text\" href=\"https:\/\/www.researchgate.net\/publication\/11070935_Aetiology_of_Rib_Stress_Fractures_in_Rowers\" rel=\"nofollow\">Aetiology of rib stress fractures in rowers<\/a>. 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Available from: <a class=\"external free\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470388\/\" rel=\"nofollow\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470388\/<\/a><\/span> <\/li>\n<\/ol>\n<\/div>\n<p><!-- NewPP limit report Cached time: 20231206065650 Cache expiry: 0 Reduced expiry: true Complications: (show\u2010toc) CPU time usage: 0.180 seconds Real time usage: 0.198 seconds Preprocessor visited node count: 780\/1000000 Post\u2010expand include size: 82\/2097152 bytes Template argument size: 0\/2097152 bytes Highest expansion depth: 3\/100 Expensive parser function count: 0\/100 Unstrip recursion depth: 0\/20 Unstrip post\u2010expand size: 8425\/5000000 bytes --><br \/>\n<!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 9.874 1 Special:Contributors\/Clinical_Reasoning_and_Pathologies_of_the_Thoracic_Spine 100.00% 9.874 1 -total --><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Redazione originale &#8211; Jess Bell sulla base del corso di Tanya Bell-Jenje Contributori principali &#8211; Jess Bell, Lucinda hampton, Kim Jackson, Rucha Gadgil, Olajumoke Ogunleye e Carin Hunter Contenuti 1 Introduzione 2 Muscoli del torace 2.1 Intercostali 2.2 Ileocostale 2.3 Grande pettorale 2.4 Grande e piccolo romboide 2.5 Dentato anteriore 2.5.1 Obliquo esterno vs Dentato [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-8342","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/8342","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/comments?post=8342"}],"version-history":[{"count":4,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/8342\/revisions"}],"predecessor-version":[{"id":11384,"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/pages\/8342\/revisions\/11384"}],"wp:attachment":[{"href":"https:\/\/langs.physio-pedia.com\/it\/wp-json\/wp\/v2\/media?parent=8342"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}