Causes of Thoracic Pain
Thoracic pain can be caused by various factors, including:
Muscle irritation or tension: Muscle irritation and tightness can result in pain, often as a result of exercise/sports-related injuries, poor posture, prolonged sitting, certain sleeping positions.
Ligament sprains: Ligaments, which hold bone and muscle together, may overstretch or tear, leading to pain in the thoracic region.
Overuse injuries: Repetitive motions or activities, such as lifting, bending, or twisting, can lead to overuse and micro-injuries causing pain in the thoracic region.
Degenerative changes of the spine: As we age, conditions such as osteoarthritis, degenerative disc disease, or spondylosis may cause changes in the cartilage, discs, and bones of the thoracic spine, resulting in pain. Degeneration of vertebral discs, bulging or herniation of vertebral discs, or bony formations may result in increased friction between bones, narrowed spinal canal, or nerve impingement.
Spinal fracture: Spinal fractures in the thoracic region are less common than in the cervical or lumbar regions of the spine, though individuals with osteoporosis are more prone to fractures in this area, particularly compression fractures.
Trauma: Trauma to the thoracic spine may cause pain, possibly from vertebral fracture in severe cases; ribcage injuries may also produce pain in the thoracic region.
Spinal tumors: Spinal tumors most commonly occur in the thoracic region of the spine; in adults the most common cause of a spinal tumor is the spread or metastasis from another primary tumor site.
Symptoms of Thoracic Pain
The symptoms of thoracic pain may vary, depending on the structures involved in causing the pain. Most commonly thoracic pain will involve sharp or aching pain in the middle to lower region of the back. Muscle stiffness or reduced mobility may also occur. If nerves are involved, additional symptoms may include:
- Tingling and/or weakness around the rib cage, or radiating into the arms or legs
- Decreased sensation or loss of sensation in the arms or legs
- Difficulty breathing
- Loss of feeling in the genital and/or rectal region
- Loss of bladder or bowel control
Thoracic Herniated Disc
Diagnosis of Thoracic Pain
Diagnosing thoracic pain typically involves:
Medical History: Discussion of symptoms, past medical conditions, and any history of back injuries.
Physical Examination: Assessment of reflexes, muscle strength, and sensation.
Diagnostic Imaging: X-rays to assess spinal alignment and bone fractures, CT scans or MRI scans to visualize spinal and soft tissue structures and detect narrowing, and myelography (contrast dye injection followed by imaging) in some cases.
Prognosis of Thoracic Pain
The prognosis for thoracic pain is generally good, with most cases resolving within a few weeks, especially when the cause is related to muscle irritation, strain, or overuse. Prognosis depends on the underlying cause, and recovery may take longer depending on the severity of the condition and responsiveness to treatments.
Treatment of Thoracic Pain
Treatment options include:
Conservative Treatments: Non-surgical approaches include:
Medications: Such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants for pain management.
Physical Therapy: Exercises to strengthen back and abdominal muscles, improve range of motion, and improve posture.
Acupuncture or Chiropractic Care: Some patients find relief through alternative therapies.
Pain Medicine Intervention: When conservative measures are ineffective or symptoms worsen, more invasive pain interventions may be considered:
Epidural Steroid Injections: Targeted injections around the spinal cord to reduce inflammation and alleviate pain.
Nerve Blocks: Targeted injections of local anesthetic near affected nerves to reduce pain.
Nerve stimulation (Peripheral Nerve Stimulation, Spinal Cord Stimulation): Electrodes are placed near the spinal cord or near peripheral nerves to interrupt pain signals to the brain.
Decompression Surgery: Removing bone spurs, parts of the vertebrae, or other structures compressing the spinal cord or nerve roots.
Procedure Videos
Thoracic MBB/RFA
Thoracic ESI
Paravertebral Block
Intercostal nerve block
PNS
SCS
Erector Spinae Plane Block
References
Rex Michael AL, Newman J, Seetharam Rao A. The assessment of thoracic pain. Orthop Trauma. 2010;24(1):63-73.
van Kleef M, Stolker RJ, Lataster A, Geurts J, Benzon HT, Mekhail N. 10. Thoracic pain: 10. Thoracic pain. Pain Pract. 2010;10(4):327-338.
Upper and Middle Back Pain Symptoms & Causes. NewYork-Presbyterian. https://www.nyp.org/ochspine/upper-back-pain/symptoms. Accessed December 5, 2024
Thoracic Spine. Cleveland Clinic. https://my.clevelandclinic.org/health/body/22460-thoracic-spine. Accessed December 5, 2024
