Thoracic Spine Pain
What is the thoracic spine?
The thoracic spine is the mid-back region that connects the neck (cervical spine) to the low back (lumbar spine). It is composed of 12 vertebrae, labeled T1 to T12. The main function of the thoracic spine is to hold the rib cage and protect the vital organs of the thorax, namely the heart and lungs. Another function the thoracic spine is to protect the spinal cord as it courses through the bony canal formed by the vertebrae. At each level of the thoracic spine, there are two primary nerves (one on each side) called the intercostal nerves. The main function of the intercostal nerves is to supply sensation to the skin at their respective levels and supply the muscles in between the ribs that aid in respiration. Motion is limited within the thoracic spine.
What are the potential causes of thoracic spine pain?
Because motion is limited in the thoracic spine, the most common cause of thoracic spine pain is myofascial (muscle and its associated connective tissue) in etiology. There are many muscles that attach to the thoracic spine. These muscles produce movement in the shoulders and arms. With postural abnormalities, these muscles can be a significant pain generator in the thoracic region. Another potential cause of pain in the thoracic spine is facet related. The facet joints are the small joints in the back part of the spine that provide stability and allow movement. Pain in the thoracic spine that is worse with extension can suggest possible facet joint involvement. Vertebral compression fractures are another potentially severe cause of thoracic spine pain. Compression fractures are more common in patients who have sustained a trauma and those who are elderly or have a history of osteoporosis or osteopenia. Pain with compression fractures are often quite severe and require early and more aggressive interventions. While thoracic radiculopathies and post-herpetic neuralgia are rare, they can also be a source of thoracic spine pain. Patients with these conditions complain of burning electric pain that starts in the thoracic region and wraps around to the front of the chest or abdomen. It is important to note that not all patients with post-herpetic neuralgia have a history of shingles and the related rash. Disc bulges and protrusions are less common in the thoracic spine when compared to the cervical and lumbar spine and are not usually a source of pain.
How is thoracic spine pain treated?
Physical therapy is one of the mainstays of treatment for thoracic spine pain. The purpose of physical therapy is to increase normal and reduce abnormal range of motion and to address any postural abnormalities that are present. Medications, including non-steroidal anti-inflammatories and acetaminophen can be beneficial in patients with thoracic pain. Dry needling and ultrasound-guided trigger point injections may also be beneficial in those with primary myofascial pain. Fluoroscopically-guided facet joint injections or radiofrequency ablation can be effective interventions for those with facet-related pain. Patients with thoracic vertebral compression fractures are initially treated with analgesic medications, physical therapy, and possibly bracing. In those patients who fail more conservative treatment, kyphoplasty and vertebroplasty can be an effective intervention. These procedures involve placing a bone cement in the fractured vertebrae under X-ray guidance to prevent further compression and reduce pain. Thoracic radiculopathies and post-herpetic neuralgia can be treated with special medications to decrease the abnormal firing of damaged nerves, nerve blocks, and even spinal cord stimulation.