Pain of the thoracic spine
Since the thoracic spine is relatively immobile in comparison to the cervical and lumbar spine, pain is rather rare here. Nevertheless, pain of a different localization can radiate here and thus simulate a disturbance in the area of the thoracic spine. In the field of manual medicine (chirotherapy), pain in the spinal column is often referred to as “blockage”.
This is a temporary restriction of mobility within the spinal column, but without a specific organic change. Therefore, no demonstrable cause for such a functional restriction can be found. Therefore, the concept of blocking is not undisputed among medical professionals.
Blockages often lead to subsequent muscle tension which in turn leads to pain. Therapeutically, in manual therapy, a deblocking by means of special hand movements is possible. In orthodox medicine, treatment with physiotherapy, heat and painkillers is usually indicated for this type of thoracic spine pain.
Another possible cause of thoracic spine pain is degenerative changes, i.e. typical signs of wear and tear that are more pronounced in some people and less so in others. However, they occur very rarely in the area of the thoracic spine. Intercostal neuralgia, which is also called intercostal neuralgia, can cause belt-like pain in the thoracic spine with radiation along the ribs.
The reason for the pain is irritation of the nerves that run along below each rib. The pain is often accompanied by a loss of sensitivity in the area of the affected nerves. Treatment is usually with painkillers.
Other typical illnesses that directly affect the spinal column and can lead to pain are scoliosis, a congenital malformation of the spinal column, or ankylosing spondylitis, a rheumatic disease that often occurs at a younger age. Also typical is the herniated disc of the BWS which manifests itself more often between the age of 40 and 50 years. The latter two diseases, however, affect the cervical or lumbar spine or the sacral part of the spinal apparatus much more frequently.
There are other non-orthopedic but very important differential diagnoses that should be considered when acute pain in the thoracic spine begins: In a pneumothorax, a defect in the pleura (pleura) mistakenly allows air to enter the pleural space. In the most spectacular case, this can happen, for example, through a stabbing. But such a defect can also originate from inside the body, which is more common in young, tall men.
If air gets into the pleural gap, there is no negative pressure here. This causes the lung on the affected side to contract and is hardly available for breathing. This can quickly develop into a life-threatening condition, especially if it is a special form of pneumothorax, the tension pneumothorax.
In this case, however, air no longer reaches the pleural gap, so that one side of the thorax becomes increasingly inflated and important structures such as the trachea and heart are displaced. In addition to chest pain, shortness of breath, accelerated breathing (tachypnea) and a coughing sensation can occur. A tension pneumothorax can be accompanied by accelerated heartbeat (tachycardia) and falling blood pressure.
An X-ray is the diagnostic tool of choice. In the case of pain in the area of the thoracic spine, a heart attack should also be ruled out if necessary. Typically, the pain radiates from the left side of the chest into the left arm, but there are many other possible pain localizations such as the right arm, lower jaw, upper abdomen and back.
An ECG and a determination of the cardiac enzymes by means of a blood sample are important diagnostic tools here. Furthermore, disturbances in the area of the gall bladder in the sense of gallstones (chole(cysto)lithiasis) or inflammation of the gall bladder (cholecystitis) can cause pain in the area of the shoulder and upper back. In rare cases, pain from an inflammation of the pancreas (pancreatitis) can also radiate into the upper back.
A fracture of the thoracic spine can have various causes. Such injuries are common in older patients, especially women suffering from osteoporosis. The bones here become much more fragile and fragile due to degradation processes so that a fracture in osteoporosis often occurs without actual trauma.
Here the pain symptoms are sometimes much less acute than in fractures caused by the use of force. In some cases, such so-called osteoporotic sintered fractures are incidental findings on an x-ray of the spine. A classic example of a vertebral fracture caused by trauma is the head jump into too shallow water.
In this case, however, the cervical spine is more frequently affected than the thoracic spine. Other accidents, such as falls during sports or traffic accidents, can also be the cause of spinal fractures. Fractures resulting from such trauma are usually accompanied by significant pain, and a painful feeling of pressure or knocking in the affected spinal section is typical during the examination.
Regardless of the cause, the means of choice for imaging is always X-ray examination of the spinal column, usually in two planes, i.e. from the front and from the side. A precise neurological examination is always important in the case of a spinal column injury, since – depending on which segment or segments of the spine is/are affected by the fracture – there may be a lesion of the spinal cord which runs behind the vertebrae. Involvement of the spinal cord can be manifested by sensitive or motor deficits or disturbances in bladder or rectum function.
In this case, quick action is essential, otherwise in the worst case, the spinal cord can lead to cross-sectional symptoms. But even if the spinal cord is not affected, untreated healed vertebral body fractures can lead to complaints such as chronic pain or malpositioning. The treatment of a thoracic spine fracture depends, among other things, on the type of fracture and the age of the patient as well as the degree of impairment.
Fractures in this area can therefore be treated both conservatively and surgically. In the case of conservative measures, pain therapy and physiotherapeutic treatment are in the foreground. Depending on the fracture, a corset can be used to stabilize the fracture from the outside.
If a fracture requires surgical treatment, a so-called internal fixator is often used, a kind of metal scaffold that connects several vertebrae with each other by means of inserted screws and rods and thus stabilizes the fractured vertebra, this is also called spondylodesis. This procedure results in a stiffening of the affected vertebral segments, i.e. a restriction of mobility. Especially in the thoracic spine, however, it is a good procedure, since the possible range of motion here is by nature not too great.
The so-called kyphoplasty is another surgical procedure. It can be used for stable fractures, i.e. those in which the spinal cord is not at risk, in which the vertebral body is straightened by the introduction of material. This procedure is more frequently used for osteoporotic vertebral fractures.
