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What is thoracic pain?

Thoracic pain is defined as pain experienced in the area bounded superiorly by a transverse line through the tips of the spinous process of T1, inferiorly by that of T12, and laterally along the lateral margins of the erector muscle.

What are the causes of thoracic pain?

A) Nonspinal causes

1) Musculoskeletal

Postthoracotomy syndrome

Polymyalgia rheumatica

Fibromyalgia

Rib fractures

Intercostal neuralgia

2) Intrathoracic

Cardiovascular

Pulmonary

Mediastinal

3) Intra-abdominal

Hepatobiliary

Retroperitoneal

Gastrointestinal

B) Spinal causes

1) Degenerative

Degenerative disc disease

Facet syndrome

Spondylosis

Spinal stenosis

2) Neoplastic

Primary

Metastatic

3) Infectious

4) Metabolic

Osteoporosis

Osteomalacia

5) Neurogenic

Disc herniation

Spinal cord neoplasm

Inflammatory (e.g., herpes zoster)

Arteriovenous malformation

6) Deformity

Scoliosis

Kyphosis

Trauma

What is Thoracic Facet Joint Pain?

The facet joints are the small joints located at the back of the spine that connect the vertebrae.These joints work in tandem with the intervertebral discs that are found between the vertebrae and act as shock absorbers. Together, the facet joints and intervertebral discs work together to stabilize the spine and provide mobility. But if these joints are damaged because of an injury or simply because of age, they can be quite painful.

Thoracic facet joint pain is most often a consequence of getting older. As we age, the intervertebral discs, which are made up of fibrous connective tissue with a gel-like centre, start to dry out, causing them to loose some of their thickness. This forces the vertebrae closer together and puts additional pressure on the facet joints.

Not only can this be painful, but the inflamed joints can irritate the surrounding muscles, causing pain and reducing movement. While this sort of degeneration is much more common in the lumbar, or lower, region of the spine, it can happen at the middle of the back.

The most common symptoms of thoracic facet joint pain are stiffness in the morning or after sitting in a fixed position for a long period of time. The pain can also increase when the affected part of the spine is extended, such as after bending town to put on your shoes. At times the pain may radiate out to the chest wall or the ribs.

Your doctor will be able to diagnosis a problem with your thoracic facet joints after studying your medical history and symptoms as well as a brief physical examination. An MRI or a CT scan can also be effective with a diagnosis.

Treatment for thoracic facet joint pain is aimed at relieving the inflammation in the joints. For milder cases, your doctor may begin by prescribing conservative treatments such as pain or anti-inflammatory medication with physical therapy. A heat pack can also help relieve the back pain and muscle spasms that are associated with the problem.

If this sort of treatment doesn’t provide relief after several months or for more severe cases, your doctor may suggest more aggressive treatment, such as corticosteroid injections to the joint to reduce inflammation or a procedure that can deaden the nerves in the facet joints, which doesn’t solve the underlying problem but will greatly reduce the amount of pain in the area.

What is Joint Dysfunction?

Sedentary postures or poor postures can contribute to loss of movement in these joints of the thoracic spine. Alternatively, trauma on the sporting field or a motor vehicle accident can result in irritation and poor function of these joints.

Patients with pain arising from the joints of the thoracic spine often present complaining of localised middle back pain which may radiate anteriorally around the rib cage. They often have difficulty taking a deep breath due to pain.

Joint mobilisation and manipulation to improve the movement in the thoracic spine region is done.

What is Scheurmann’s Disease?

This is the most common cause of pain in the thoracic spine region in adolescents. It is accentuated by a thoracic kyphosis arising from multiple vertebral end-plate irregularities. Thoracic kyphosis may also arise from habitual training postures which involve loading into flexion. Extended training periods in one posture (e.g. cycling) tend to be associated with adaptive changes and modification to training postures may need to be considered when recommending long-term management.

What is T4 Syndrome?

Occasionally, patients present with diffuse arm pain and sensory symptoms such as pins and needles or numbness in the upper arm due to intervertebral joint problems around the upper thoracic region. This vague presentation of symptoms has been labelled T4 syndrome. Examination often reveals hypomobility (stiffness) of the upper to middle thoracic segments. Restoration of full mobility to these joints by mobilisation or manipulation techniques can relieve the symptoms.

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