Thoracic Spine Pain

Causes

A thoracic vertebra can contribute to upper back pain in different ways, such as:
1. Poor Posture and sedentary lifestyle.
2. Sudden sprain or strain (as in car accidents or sports injuries).
3. Trauma: An accident or collision could cause a rib or vertebrae to break (fracture) or become misaligned or displaced.
4. Osteoarthritis: Wear and tear within the facet joints and/or costovertebral joints resulting in inflammation, osteophytes (bone spurs), and pain.
5. Compression Vertebral fracture .
6. Kyphosis and Scoliosis: T extreme the kyphosis, the more likely that it can stress muscles to cause upper back pain.
7. Slipped discs - these are common but rarely cause pain.
8. Shingles and Post herpetic neuralgia.
9. Ankylosing spondylitis - inflammation of the joints between the vertebrae.
10. Scheuermann's disease - an inflammation of the joints of the spine which results in spinal curvature.
11. Spinal tumor.

Clinical Presentation

There are several different symptoms that encompass middle back pain. Symptoms will depend on the cause of your pain. Some of the most common symptoms of mid back pain include:
1. Muscle aches.
2. Dull pain.
3. A burning sensation.
4. Sharp or stabbing pain.
5. Muscle tightness or stiffness.
Other more serious symptoms may include:
1. Tingling or numbness in the legs, arms, or chest.
2. Chest pain.
3. Weakness in the legs or arms.
4. Loss of bowel or bladder control.
RED FLAGS or ALARMING FEATURES
If you have thoracic spine pain, these are the alarm features to look out for:
1. Recent serious injury, such as a car accident or a fall from a height.
2. Minor injury or even just heavy lifting in people with osteoporosis.
3. Age under 20 or over 50 years when the pain first starts.
4. A history of cancer, drug misuse, HIV infection or use of steroids for a long time.
5. A high temperature (fever), chills and unexplained weight loss.
6. A recent bacterial infection.
7. Pain that is there all the time, severe and getting worse.
8. Pain that wasn't caused by a sprain or strain (non-mechanical).
9. Pain that doesn't get better after 2-4 weeks of treatment.
10. Pain that is accompanied by severe stiffness in the morning.
11. Changes to the shape of the spine, including the appearance of lumps or bumps.
12. Pins and needles, numbness or weakness of the legs that is severe or gets worse over time.
13. Bowel and bladder incontinence.

Investigation

If it is a short-lived mild pain with an obvious explanation , your doctor will probably suggest some treatment before arranging tests. However, because back pain is more likely to be serious if it occurs in the thoracic area rather than in your neck or lower back, your doctor is likely to suggest tests if the pain persists, is severe, or is accompanied by any of the red flag features.
The tests will depend on the conditions that the doctor wants to rule out. They are likely to include blood tests such as a full blood count and inflammatory markers, and maybe an MRI scan or CT Scan. An ordinary 'plain' X-ray doesn't give much information unless you have an unusual appearance of the spine or a fracture is suspected.
Thoracic back pain treatment
You can also work toward improving your posture to help ease back pain. Try these tips:
1. Avoid slouching.
2. Keep your shoulders back when standing.
3. Take standing breaks if you sit for 4. long periods of time.
5. If you have a desk job, adjusting your chair and computer monitor height, keyboard, and mouse positioning can all enable good posture.
Several methods you can do at home to treat middle back pain:
1. Ice the area and later apply heat. This is one of the most common methods that can provide immediate relief.
2. Consider taking over-the-counter pain medications, such as ibuprofen and naproxen , to reduce swelling and pain.
3. Stretch and strengthen the back muscles by doing exercises such as yoga.
Specific treatment:
1. If you have an underlying cause, this will need treatment of its own accord e.g Ankylosing spondyloarthritis may need DMARDS, herpetic neuralgia will need neuropathic pain medications and opioids.
2. If the pain is coming from a joint in the spine (a facet joint) this may be helped by an injection performed under X-ray vision (imaging-guided intra-articular injection).
3. If there is some nerve root irritation, fluoroscopic guided epidural blocks, Radio-frequency ablation can be done to relieve pain.
4. Percutaneous thoracic intervertebral disc nucleoplasty or laminectomy or vetebroplasty or kyphoplasty may need to treat your pain as per the diagnosis.