Problem No. 1

1. i) Thoracic paravertebral muscles

2. Thoracic joints

3. Intervertebral

4. Facet

5. Costo-vertebral

6. Costo – transverse

7. Thoracic Intervertebral disc

8. Thoracic vertebra

9. Thoracic nerve roots

10. Rib

11. Supraspinous, posterior longitudinal and interspinous ligaments

12. ii) Cumulative micro-trauma from repetitive high intensity asymmetrical stress on the structures listed above

13. iii) T6 or T7

14. iv) May predispose to bony pathology e.g. stress fracture

15. v) Rib stress fracture

16. vi) Increased mid-thoracic kyphosis and scoliosis concave to the left due to prolonged right side-flexion in a rower whose oar is on the right.

17. vii) Associated irritation of the adjacent thoracic sympathetic ganglion

Problem No. 2

1. i) Pars Interarticularis/Pedicle L3-5

2. Left L3-S1 facet joints

3. Paraspinal muscles – Quadratus lumborum and Psoas

4. Intervertebral disc

5. ii) Cumulative micro-trauma from repeated end range, high force lumbar extension coupled with left side-flexion and rotation

6. iii) Pars Interarticularis/Pedicle L3-5 stress fracture

7. Left L3-S1 facet joint injury

8. Intervertebral disc

9. iv) No pain with lumbar flexion

10. No pain with sitting/coughing/sneezing

11. Only painful with throwing

12. No radiating pain

13. No neurological symptoms

14. v) Pain only with throwing and extension

15. Pain eases with a short rest from aggravating activity but resumes soon after

16. vi) Pain with or without ROM limitation with lumbar extension

17. Positive Stork test (combined extension, side-flexion and rotation)

18. Tenderness over the L4 articular pillar

19. Negative neurological and neural tension tests

20. vii) Fast bowling in cricket

21. Pitching in baseball

22. Golf swing

23. Tennis serve

24. viii) MRI – to exclude acute bony stress (marrow oedema, periostitis +/− fracture line in pars interarticularis or pedicle), to exclude joint and disc pathology, to exclude ligamentous or muscular pathology

25. CT to stage any suspected bony lesion