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Thoracic Back Pain

Back Pain

Thoracic back pain is common in people of all ages, mostly due to poor posture or heavy lifting affecting the joints between the ribs and vertebrae. And the other conditions affecting the thoracic spine tend to be different from the ones affecting the lumbar spine.

Thoracic back pain is a very difficult diagnostic problem, but in certain rare instances it can be related to heart failure and/or vascular problems. If there is an aneurysm of the vein in the chest, and if the aneurysm is getting larger, it can be causing thoracic back pain and be related to heart failure.

Thoracic Back Pain

Thoracic back pain occurs within the backbone, which (or vertebral column) is composed of 32 vertebrae – 7 cervical (neck), 12 thoracic, 5 lumbar, 5 sacral, and 3 coccygeal. The 12 thoracic vertebrae are considered the upper back while the lumbar region is the lower back. The thoracic back differ from the others in that the 12 ribs are attached to the 12 vertebrae respectively. The costovertebral joints (between the ribs and the vertebrae) hence provide another cause of pain. On the other hand, the thoracic vertebrae, being higher up than the lumbar, don’t support as much weight, hence prolapsed discs don’t happen very often at all. In addition, the thorax contains the heart, lungs, and great vessels – which can be a cause of referred pain to the back.

Thoracic back pain may occur in aching diseases, especially in ankylosing spondylitis and in severe osteoporosis. Some other intraspinal, intrathoracal and intra-abdominal diseases, such as tumors, may also result in back symptoms. Usually, it is common that the pain may be felt in the thoracic spine (referred pain). Skeletal metastases of cancer from other sites are frequently localized to the thoracic spine; it is especially true of metastatic breast, lung, kidney and thyroid cancers. This is extremely rare for a thoracic disc to rupture, the incidence being 0.25 to 0.5% of all intervertebral disc ruptures.

The most common cause is muscular and ligamentous strains (mainly postural) and Vertebral dysfunction. Vertebral dysfunction – this occurs commonly in 20 to 40 year olds, and is related to poor posture. It causes dull, aching, and occasionally sharp pain normally felt posteriourly behind the scapulae. It is made worse with activity and poor posture, or sleeping on beds that are too soft or too hard. Scheuermann’s disorder – typically begins ages 11 to 17, causing increasing thoracic kyphosis over 1 to 2 months, with wedging of the vertebrae, and pain, especially on bending. The serious heart and lung conditions or infections have varying natural histories but all require early diagnosis and instant management or they can be fatal.

Thoracic back pain is treated with easy analgesics for painful episodes, appropriate exercises (after consultation with physiotherapist) and spinal mobilization. Treatment for thoracic back pain involves extension exercises, postural correction, and consideration for bracing or surgery if serious deformity. Treatment for scoliosis may involve bracing until skeletal maturity is reached (this will only halt the process), or surgical correction for more acute curvatures. Osteoporosis- can be treated with general measures (alter diet, stop smoking, alcohol), calcium supplementation, and medications such as bisphosphonates, Vitamin D and oestrogen replacement.

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