The thoracic spine is part of the backbone that extends from the bottom of the neck to the lower lumbar spine. It comprises 12 vertebrae which are separated by intervertebral discs. Attached laterally to the thoracic vertebra are ribs, which function to protect the organs of the torso, but also contribute to the thoracic spine’s inflexibility. The thoracic region is less problematic than the rest of the spine, and it is estimated that about 10 percent of people will suffer pain in the thoracic spine during their lifetimes.
Muscle Strains
Muscle tension and strains are common around the spine, usually due to overuse, poor posture or trauma, and are the most common problem in the thoracic region that cause symptoms. Symptoms include sore and inflamed muscles, achy diffuse pain and reduced range of motion.
Ligament and Joint Sprains
Sprained ligaments and joints in the thoracic spine are other common sources of pain. The joints and surrounding ligaments that can become injured are the facet joints, which interconnect the vertebrae, and the costovertebral joints, which connect the vertebrae to ribs. Facet joint sprains often restrict movement and generate sharp and pulsating pain, whereas costovertebral sprains are often described as intense and stabbing. Athletic injury and sleeping on an inappropriate mattress and/or pillow are common causes of sprains.
Disc Herniations
Herniations occur less frequently in the thoracic spine due to its relative lack of flexibility. However, according to one medical study, 37 percent of asymptomatic patients were found to have a herniated thoracic disc on MRI scans and did not develop pain even 26 months later. But when symptomatic, herniated discs can irritate nerve roots, causing burning or electric pain, often around the rib cage. Trauma and advanced arthritis are causes of thoracic herniations.
Arthritis
The degenerative arthritis that occurs in the thoracic spine is called spondylosis, and is considered common among both sexes beyond age 45. Spondylosis involves disc degeneration and bone spur formation. The early stages of thoracic spondylosis can create achy stiffness between the shoulder blades. The stiffness is usually worse in the mornings, but better with activity. Advanced joint and disc degeneration can lead to herniations and nerve entrapments.
Osteoporosis
Osteoporosis is a disease of reduced bone density and mineralization. With progression, the main consequence is a vertebral compression fracture, which happens more often in the thoracic region than anywhere else in the spine. The symptoms of the fractures are sudden, sharp thoracic pain, sometimes with shooting nerve pain, and made worse by coughing and sneezing. Multiple thoracic fractures lead to stooped posture, loss of height and chronic pain with loss of mobility.
Scoliosis
Scoliosis is an unnatural curvature of the spine that most commonly occurs in the thoracic region. It most frequently affects adolescent females, and has no known cause. Pain from scoliosis can range from none to severe, depending on the extent of deformity and loss of flexibility. If there is a severe thoracic deformity, then mere breathing can cause pain.
Other Rare Conditions
Ankylosing spondylitis is a chronic inflammatory disorder of the thoracic spine that affects mainly younger adult males. It can cause progressive, vice-like stiffness, and eventual fusion. Infection of the spine, called osteomyelitis, is life-threatening and can destroy bone, causing severe, constant pain. Cancer, in particular multiple myeloma, is the most life-threatening disease of the thoracic spine. The cancer can eat away the spine and eventually spread to other sites such as the breasts or lungs.
References
- “The Clinical Anatomy and Management of Thoracic Spine Pain”; K.P. Singer, et al.; 2000
- "Journal Bone Joint Surgery Am"; Magnetic resonance imaging of the thoracic spine; K.B. Wood et al; Vol 77 1995
- "Essentials of Physical Medicine and Rehabilitation"; W.R. Fronter et al; 2008
- "The Spine Journal: Official Journal of the North American Spine Society"; Osteoporotic compression fractures of the spine: current options and considerations for treatment; D.H. Kim and A.R. Vaccaro; Vol. 6, 2006
- "Chiropractic Management of Spine Related Disorders"; Meridel I. Gatterman D.C.; 2001
