What Causes Thoracic Pain?
The thoracic spine is a complex anatomical area composed of the vertebraes that supports the rib cage, ribs, provide mobility and stability to the lung cage. It has multiple layers of muscle and ligament that provide stability and function.
Thoracic pain may result from abnormalities in the soft tissues – the muscles, ligaments, and nerves – as well as in bones and joints of the spine. It can also be referred from the neck, thoracic structures such as major blood vessels, lungs, etc. The most common causes of thoracic pain are soft tissue abnormalities due to injury or prolonged wear and tear. In rare cases, infection or tumors may cause thoracic pain. In some people, neck problems may be the source of pain in the upper back, shoulders or arms. Conditions such a vertebral compression fractures, postural abnormalities, trauma and surgery, can create distinct diagnostic and therapeutic challenges.
Degenerative Process – Degenerative diseases that cause thoracic pain include osteoarthritis and rheumatoid arthritis. Osteoarthritis usually occurs in older people as a result of wear of the joints between the bones in the spine. Rheumatoid arthritis can cause destruction of the joints of the back. Both of these major types of arthritis can cause stiffness and pain.
Thoracic disk degeneration also can cause thoracic pain. The disk acts as a shock absorber between the bones in the neck. In thoracic disk degeneration (typically age 40 onwards), the normal gelatin-like center of the disk degenerates and the space between the vertebrae narrows. As the disk space narrows, added stress is applied to the joints of the spine causing further wear and degenerative disease. The thoracic disk may also protrude and cause pressure on the spinal cord or nerve roots when the rim of the disk weakens. This is known as a herniated thoracic disk. Although not as frequent as the lumbar or cervical, the treatment is usually more challenging.
Trauma – Motor vehicle or diving accidents, contact sports, and falls may result in thoracic spine injury. The regular use of safety belts in motor vehicles can help to prevent or minimize injury. Most common injuries are to the soft tissues, i.e., muscles and ligaments. Severe injury to the chest and ribs are usually associated with thoracic spine injury.
Uncommon causes of thoracic pain include tumors, infections, or congenital abnormalities of the vertebrae.
When Should You Seek Medical Care?
If severe thoracic pain occurs following an injury (motor vehicle accident, diving accident, fall), a trained professional, such as a paramedic, should immobilize the patient to avoid the risk of further injury and possible paralysis. Medical care should be sought immediately. Other conditions such as severe chest pain and shortness of breath are indications to see medical attention immediately.
If there has not been an injury, you should seek medical care when neck pain is:
- Continuous and persistent
- Accompanied by pain that radiates down the arms or legs
- Accompanied by headaches, numbness, tingling, or weakness
Initially the patients are usually evaluated by their primary care provider or chiropractor. Most of the conditions causing neck pain can be treated conservatively. Modalities such a as short-term rest, analgesics, muscle relaxants can be use as adjuvants to physical therapy and chiropractic manipulation. If the pain persists and according to the associated symptoms, additional diagnostic evaluation may be needed.
X-ray studies often will be done to examine the bones in thoracic spine. Conditions such as fractures, degenerative changes and anatomical abnormalities can be diagnosed. Other studies which yield more information about the spinal column and it’s nerves, as well as assessing the nerve functions should be considered.
Patients who require further evaluation may undergo one or more of the following examinations:
- MRI (magnetic resonance imaging). This non X-ray study allows an evaluation of the spinal cord and nerve roots.
- CT (computed tomography). This specialized X-ray study allows careful evaluation of the bone and spinal canal.
- Myelogram (injection of a dye or contrast material into the spinal canal). This specific X-ray study also allows careful evaluation of the spinal canal and nerve roots.
- EMG (electromyogram). This test evaluates nerve and muscle function.
Your primary care provider or specialist (neurologist, orthopedist, neurosurgeon and pain management) may supplement your evaluation with blood tests, and, if necessary, will consult with other medical specialists.
How thoracic pain is treated depends on what the diagnosis reveals. However, most patients are treated successfully with rest, medication, immobilization, physical therapy, exercise, activity modifications or a combination of these methods.
For example, if pain is caused by inflammation as a result of stretching muscles and ligaments beyond their limits, rest and a neck collar may be prescribed for a specified period of time, as well as medication to reduce inflammation. If medication is prescribed to reduce pain, it should be used only as directed and should not be taken for extended periods of time.
When the thoracic pain persists or is chronic, a rehabilitation program may be recommended, that includes an exercise program and various types of physical therapy to help you relieve your pain and prevent it from coming back.
Very few patients require surgery to relieve neck pain. For the vast majority of patients, a combination of rest, medication and physical therapy will relieve neck pain.
Pain Management Interventions such as diagnostic and therapeutic injections are frequently performed to alleviate the inflammation in the muscles, nerve and joint of the neck. More importantly, the diagnostic value will determine future therapeutic interventions in a more precise and effective way. Some of these interventions are epidural steroid injections, facet injections, trigger point injections and discography.
Surgery may be necessary to reduce pressure on the spinal cord or a nerve root when pain is caused by, a herniated disk or bony narrowing of the spinal canal. Surgery may also be required following an injury, to stabilize the neck and minimize the possibility of paralysis such as when a fracture results in instability of the neck.