Thoracic back pain is the pain or discomfort that occurs in the thoracic spine. The thoracic spine is the longest section of the spine, and the only one attached to the ribcage. It starts at the base of the neck, goes down to the abdomen and connects to the cervical spine (above), and the lumbar spine (below). The thoracic spine has 12 vertebrae (T1 through T12 vertebrae) that sit on top of each other, and which form the basis of the thoracic spinal column which gives support to the rib cage, neck, nerves, blood vessels and the flexibility of joints.
The main functions of the thoracic spine include:
- Protecting the spinal cord: The spinal cord is a bundle of nerves that is responsible for sending electrical signals throughout the body. It runs from the base of the brain through the vertebral canal of the cervical spine and thoracic spine and then branches into smaller nerve bundles in the lumbar spine.
- Anchoring the rib cage: The rib cage is supported by the thoracic spine in the back, which is a structure that surrounds and protects organs such as the lungs and heart.
The cervical and lumbar spine are built more for mobility, while the thoracic spine is built more for stability.
Causes of Thoracic Pain
The primary cause of thoracic back pain is inflammation of the soft tissues or muscles of the thoracic spine, which occur as a result of:
- A sudden strain or sprain gotten through an accident or injury
- Standing or sitting in a slouched position over time
- Using a backpack
- Lack of muscular strength
- Overuse by repeating a movement persistently
Other causes include:
- Thoracic stenosis which is narrowing of the spine usually due to wear and tear
- Slipped discs
- Fractures of the vertebrae
- Spinal infection
- Spinal osteoarthritis
- Ankylosing spondylitis which is inflammation of the joints between the vertebrae
- Spinal tumours
- Scheuermann’s disease which is inflammation of the joints of the spine which results in spinal curvature
Other sources of thoracic spinal pain can come from problems affecting the lungs, the oesophagus, stomach, gallbladder and the pancreas.
Symptoms of Thoracic Pain
Thoracic spinal pain usually affects the soft tissue without radiating into the arms, around the chest or down the legs. Pain which is radiating from the spine into the chest area could mean there is a pinching of the nerves in the spine and might require a surgery.
Other symptoms include:
- Lower back pain that may persist for more than 10 days
- Inability to tiptoe or walk on heels
- Lower back stiffness which may restrict range in motion
- Pain or stiffness that makes one unable to maintain ordinary posture
- Spasms of the muscles
Diagnosis of Thoracic Pain
If the pain from the thoracic region is persisting and is accompanied by any of the above symptoms, the doctor may recommend the following tests:
- Blood tests
- Magnetic Resonance Imaging (MRI)
- CT scan
- Electromyography or nerve conduction velocity testing
Treatment of Thoracic Pain
Some cases of thoracic pain are easily treated with a reduction in physical activities or bed rest for a certain amount of time. Medication such as nonsteroidal anti-inflammatory (NSAIDs) can be used to control the pain if ranges from mild to moderate. Narcotic medication and muscle relaxants can be added in cases of severe pain.
Physical therapy may also be recommended which may include pelvic traction, gentle massage, heat and ice therapy, electrical muscle stimulation, ultrasound and stretching exercises.
Thoracic spine surgery which is only considered when the other treatment options fail may be recommended. The surgical procedures include mini-thoracotomy, or fusion.
The techniques used in thoracic spine surgery are similar to that of the lumbar spine. These techniques include:
- Discectomy: This relieves pressure from a nerve root that is pressed on by a bone spur or a bulging disc.
- Foraminotomy: A surgical procedure that opens up the bony hole in the spinal canal, known as the foramen, where the nerve root exits.
- Spinal fusion: This cuts down on painful motion and makes the spine stronger. It involves removing the discs between two or more vertebrae and fusing the vertebrae next to each other with special metal screws or bone grafts.
The only difference in the treatments is thoracic spinal surgery can take longer to heal compared to lumbar spinal surgery as it involves major organs, in addition to the rib cage.
NOTE: Duration of the procedure, downtime, and recovery vary on a case by case basis
At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our multidisciplinary team of expert doctors, nurses, physio therapists are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.
BOOK AN APPOINTMENT