The thoracic spine comprises 12 vertebrae which are separated by discs and attached laterally to ribs. Various conditions can create varying degrees and types of pain in the thoracic spine, very few of which are life threatening. Sprains are the most common, least serious, but sometimes the most painful. Tumors are the least common, most serious, but sometimes do not generate much pain.
Spondylosis
Spondylosis, the "wear and tear" type of spinal arthritis, is common among both sexes beyond the age of 45 and involves disc degeneration and bone spur growth. The early stages of spondylosis in the thoracic spine create an achy stiffness between the shoulder blades and sometimes laterally around the rib cage. This stiffness is worse in the morning, but abates with activity. Later stages of degeneration can irritate the nerve roots and create an intermittent, burning pain.
Fractures
Deep, dull, constant pain can be caused by fractures of the thoracic spine. Osteoporosis is the most common cause because of the reduced bone density, which leads to compression fractures. Trauma from a serious fall or car accident can fracture any part of the thoracic spine, which can result in sharp pain, especially with coughing and sneezing.
Scoliosis
Scoliosis is an unnatural lateral curvature of the spine and is most common in the thoracic region. It occurs most frequently in adolescent females and is of unknown cause. Pain from scoliosis can range from nonexistent to severe, depending on the degree of deformity and flexibility of the afflicted area. If severe deformity exists, then thoracic pain and tightness can result from simply breathing.
Sprained Joints
Sprained joints in the thoracic spine are the most common source of pain and can be the most severe. Two types of joints that become compressed or misaligned are the facet joints (which join the vertebrae together) and the costovertebral joints (which join the vertebrae to their corresponding ribs). Facet joint pain is usually sharp with restricted movement, whereas costovertebral pain is frequently described as stabbing or like an "ice pick." A severe, left-sided costovertebral sprain can mimic a heart attack in presentation.
Disc Herniation
Disc herniations can occur in the thoracic region, but they are not common. Trauma is the most common cause of thoracic herniations. A herniated disc can irritate local nerve roots, which results in burning or "shooting electric" pain, especially around the rib cage.
Ankylosing Spondylitis
Ankylosing spondylitis is a chronic inflammatory disorder of the spine and axial skeleton affecting mainly younger adult males. It can affect the thoracic region and create progressive, vice-like stiffness.Spinal fusion can occur in late stages, which often, paradoxically, stops producing pain.
Infection
Infection of the spine (termed osteomyelitis) is a serious disease that can become life threatening without antibiotics. Staphylococcus is the most common bacteria, which can eat away bone and create severe, constant pain. Drug addicts and the immuno-suppressed are the most predisposed, although diseases such as tuberculosis can also spread to the thoracic spine.
Tumors
Cancer is the most life threatening disease of the spine. The main primary tumor of the thoracic spine is multiple myeloma, which initially creates a dull, intermittent pain that can become constant and severe with progression. Advanced cancer can spread to the thoracic spine from other sites such as the breast, lung or prostate, which is a process termed metastasis. Lytic (bone eating) lesions can be excruciating, but blastic (bone expanding) lesions are frequently painless.
References
- "Essentials of Skeletal Radiology"; Terry R. Yochum, D.C.; 2004
- "Chiropractic Management of Spine Related Disorders"; Meridel I. Gatterman, D.C.; 2002
- Medline Plus: Spinal Diseases
