Pain in the thoracic spine

Introduction

The thoracic spine consists of 12 vertebrae and is located between the cervical and lumbar spine. Complaints in the area of the thoracic spine are usually described by those affected as dull or pressing pain, especially between the shoulder blades. Due to the articulated connection of the vertebrae in the thoracic region and the ribs, the pain can be motion-dependent, depending on the cause. The pain emanating from the thoracic spine can also radiate into the chest in a belt-shaped manner.

General causes

In comparison with other sections of the spine, the thoracic spine causes fewer complaints. Due to the stable rib-vertebral joints and involvement in the bony thorax, the thoracic spine is relatively restricted in its range of motion. As a result, the risk of herniated discs in the thoracic spine, for example, is reduced to less than 2%. Nevertheless, there are diseases that directly affect or involve the thoracic spine. In addition, sometimes adjacent organs, such as the heart, can also cause pain in the thoracic spine.

Diagnosis

In order for the attending physician to be able to reliably assign the pain to the thoracic spine, he must use various examinations and methods. At the beginning of each examination a detailed anamnesis (Greek anamnesis = reminder) should be taken. For this, the patient is asked in detail about his or her symptoms.

Especially in the thoracic spine, exact pain localization (e.g. vertebral body height, lateral, central, belt-shaped), pain quality (dull, stabbing, burning, pulling, etc. ), pain occurrence (e.g. respiration-dependent, movement-dependent, spontaneous, pressure-sensitive), pain duration (hours, days, weeks, etc. ), as well as any accompanying complaints such as neurological or other abnormalities (numbness of the arms, paralysis, incontinence, fever).

In this way an extraordinary number of conclusions can be drawn about the causes of pain in the thoracic spine! In the second step, the doctor examines the entire spine on the undressed upper body. He pays particular attention to symmetry and visible external changes or injuries.

For example, a crooked shoulder, a scoliosis in the area of the BWS can be an indication. On the other hand, if there are small, red blisters in the painful area, it is probably shingles. This generic term includes examinations of mobility or pain provocation tests.

Initially, the doctor can gradually palpate the thoracic spine to check whether there is sensitivity to knocking or pressure (as in the case of blockages or inflammation of the vertebral body). The condition of any hardened muscles can be determined by palpation. To assess mobility, the orthopedic surgeon often asks for rotational movements or prevention of the thoracic spine.

Painfulness during these exercises provides further, valuable information! To check the neurological status (e.g. limited in case of herniated disc of the BWS with involvement of the nerves) a strength test of the arms can be performed. Imaging techniques are the last step in the diagnosis of thoracic spine pain.

They are usually indicated if the pain persists for more than a week or if serious complications (e.g. paralysis of the arms) occur in the course of the disease. Depending on the problem, X-ray examinations, MRI images of the spinal column, CT images, myelographies or scintigraphy may be used. If an inflammatory or tumorous event is suspected, blood tests can be performed.

In individual cases, a thoracic spinal or intervertebral disc puncture can be prescribed. It should also be clarified whether there is a connection between back pain and internal organs. Sometimes heart attacks or pneumonia can trigger complaints of the thoracic spine.

The basic prerequisite for a successful therapy is a precise investigation of the cause. Because only when the pain-causing event has been clearly identified can targeted and individual treatment be provided. 1 Pain therapy If patients are affected by highly acute pain in the thoracic spine, pain-relieving medication is used in the vast majority of cases.

Otherwise, a “vicious circle” often threatens. Due to the massive complaints, we often unconsciously take a supposedly more bearable relieving position. As a consequence of this unnatural posture, the already tense muscles tense up all the more and cause further pain!As a rule, treatment begins with the group of “non-steroidal anti-inflammatory drugs”, or NSAIDs for short.

They have both analgesic and anti-inflammatory effects on the affected section of the thoracic spine. Among the known active ingredients are e.g. Ibuprofen or Diclofenac. However, caution is advised in case of prolonged administration!

Taken over a long period of time, they can cause dependency and numerous undesirable side effects. NSAIDs also inhibit the formation of the protective mucus layer of the stomach. If they are taken for months, the aggressive stomach acid starts to attack the surrounding walls.

In the worst case, chronic inflammation of the mucous membrane of the stomach (lat. gastritis) or gastric ulcers (lat. ulcer) can develop!

If painkillers are taken permanently, the kidneys and liver can be damaged. The basic principle is to keep the duration of intake as short as possible! Alternatively to the prescription of tablets, pain-relieving or anaesthetic ointments can be used.

They have the great advantage of not causing any serious side effects, as they only act locally. If patients suffer from long-lasting pain in the thoracic spine, if painkillers do not achieve success, or if there is a risk of long-term use, local anaesthetics can be an alternative. For this purpose, the doctor injects pain-relieving medication under the skin or into the muscles with a fine needle.

The injections are particularly promising when the pain is localized precisely at specific points (trigger points). Stubborn and therapy-resistant complaints (e.g. intercostal neuralagia) can be relieved by deeper injections directly at the bone or joint (thoracic facet infiltration, spinal nerve analgesia, costo-transverse blockade). It is hoped that this will directly eliminate the relevant pain sensors or nerve roots.

The intervention is performed while the patient is fully conscious, only the puncture site is anaesthetized. Usually the injection is performed with the patient sitting, back slightly bent forward. Under all circumstances a current X-ray image should be available!

Such procedures must be carefully considered, as complications such as infections or cardiovascular problems can occur. 2. heat application Often pain in the thoracic spine, muscular tensions are the cause. Heat applications promote the blood circulation in the affected muscle areas and thus relieve the spasms.

Numerous variants of the so-called “heat patches” are available on the market. By contact with the skin surface or oxygen from the ambient air, chemical processes are stimulated, which possess a pleasantly felt heat development of approximately 40 degrees. 3. physiotherapy In principle, physiotherapy is very useful in many cases!

Because in addition to muscular tensions, pain is often caused by small blockages in the rib or vertebral arch joints. The aim of therapy is to release these blockages and to relax the muscles. Very often there is a close connection between both phenomena.

The physiotherapist can use massage techniques, strengthening exercises or even taping. The overriding goals are mostly postural errors and incorrect movement patterns, which can be recognized and then corrected. Ideally, the patient is specifically instructed during the physiotherapy so that he can perform the exercises independently in everyday life.

4. operations Particularly severe cases, such as tumors of the thoracic spine, vertebral body infections or pronounced scoliosis, can make an operation indispensable. As a rule, however, the benefits and risks of such an operation should be carefully weighed against each other. Besides undesirable complications, they often do not achieve the desired success!