Abstract
BACKGROUND: Segmental and somatic dysfunction in the thoracic section can lead to various clinical symptoms. It is necessary to distinguish three variants. CLINICAL PICTURE: 1. Local pain Potentially life-threatening differential diagnoses have to be considered, and when in doubt chest pain emergency diagnostics must be initiated. 2. Vertebro-visceral reflex The main segmental roots of the sympathetic trunk are in thoracic segments, this results in a high-grade linking to thoracic and abdominal organs. "Non-specific" thoracic and abdominal symptoms can be caused by segmental and somatic dysfunction in thoracic segments. 3. Viscero-vertebral reflex Visceral nociception is transmitted via vegetative fibers to thoracic segments. Here, painful dysfunction can occur, which might be the first sign of severe structural disease like neoplasia or ulcer in thoracic or abdominal organs. DIFFERENTIAL DIAGNOSTICS: Differential diagnostics is challenging, and manual medicine can contribute substantially. Biomechanical and neurophysiologic particularities must be known.