Physical therapist management of patients with thoracic spine pain calls for unique diagnostic considerations. While pain in the thoracic spine may be a common presentation, the thoracic spine is also the most common spinal region for fractures and metastatic lesions to occur. This session will review primary differential diagnostic considerations for thoracic spine pain before proceeding to examination and management. The session will review clinical examination and introduce manual therapy and exercise interventions for thoracic spine conditions. This session will highlight the importance of differential diagnosis and management of patients with thoracic spine conditions. A manual therapy and exercise-based approach will be presented that is both evidence-based and efficient, offering maximal value to the modern clinician. Importantly, participants will also be challenged to "think about their thinking" both during the session and afterward.