What hurts most often?
The thoracic region is inactive: the vertebrae are connected to the ribs, and the entire structure is stable. Therefore, hernias are not common here, and the pain usually comes from small joints between the vertebrae and ribs, from overloaded muscles and their attachment points. Prolonged work bending forward, carrying heavy weights on one shoulder, or sudden unusual effort can easily cause such pain. In older people and with long-term use of hormones, an important cause is a vertebral compression fracture due to osteoporosis, which can occur even without a fall.
- Dysfunction of costovertebral and intervertebral joints
- Muscle strain and trigger points
- Osteoarthritis of the thoracic region
- Compression fracture due to osteoporosis
- Herpes zoster at an early stage
- Less commonly, disc herniation with radicular pain
- Scoliosis and Scheuermann's disease in adolescents
How to distinguish between heart pain and other causes
Pain from the spine usually changes with movement: it intensifies when turning, bending, taking a deep breath, pressing on a certain point, and often decreases if you find a comfortable position. Heart pain is associated with exertion, not with posture, feels like pressure or a burning sensation behind the sternum, radiates to the arm, neck or jaw, and is accompanied by shortness of breath and sweating. Pain from the stomach and esophagus is associated with food, pulmonary pain is associated with cough and fever. It’s difficult to figure it out on your own, so an ECG is performed at the first episode.
- Dependence on posture and movement - in favor of the spine
- Reproduction of pain when pressing on a rib or vertebra
- The connection with the load and the pressing nature are reasons to exclude the heart
- Connection with food - possible esophagus and stomach
- Cough, fever, shortness of breath - exclude lungs
- Rash along the rib - herpes zoster
Survey
They begin with an examination and assessment of whether the pain is reproduced by movement and palpation. For any new chest pain in an adult, it is reasonable to do an ECG, and if there are risk factors, discuss further cardiac examination. Chest X-rays show fractures, deformities and joint changes. Not everyone needs an MRI: it is prescribed for suspected hernia with radicular pain, spinal cord damage, tumor or inflammation. Tests help if an inflammatory or oncological process is suspected.
- Examination by a neurologist with manual testing
- ECG for new chest pain
- X-ray of the thoracic spine
- MRI of the chest for warning signs
- Chest X-ray for cough and shortness of breath
- Complete blood count, ESR, C-reactive protein if inflammation is suspected
- Densitometry for suspected osteoporosis
Treatment
For benign pain, the main thing is not to go into bed rest. Staying as active as possible speeds up recovery, while long rest increases stiffness. Your doctor may prescribe a short course of painkillers or muscle relaxants; They should not be taken for a long time without supervision. Warmth, gentle stretching, breathing exercises, and a gradual return to exercise work well. For persistent local pain, blockades are used. If the cause is a fracture, tumor, infection or herpes zoster, the underlying disease is treated and the tactics completely change.
- Stay active and avoid bed rest
- Warmth on the muscles and gentle stretching
- Short courses of painkillers as prescribed by a doctor
- Physical therapy for back extensors and thoracic mobility
- Breathing exercises
- Paravertebral block for persistent pain
- Treatment of the underlying disease with secondary pain
Prevention
The thoracic region suffers more from immobility than from stress. Regular extension and rotation exercises, strengthening the muscles of the back and shoulder blades significantly reduce the frequency of episodes of pain. It is important to organize your workplace so that you don’t sit for hours bending over and take short breaks. Women after menopause and people taking hormones for a long time should discuss with their doctor the prevention of osteoporosis: sufficient intake of calcium and vitamin D and, if necessary, examination.
- Thoracic mobility exercises 3–5 times a week
- Strengthening the muscles of the back and interscapular area
- Breaks and change of position every 40–45 minutes
- Proper lifting of weights with a straight back
- A backpack instead of a bag on one shoulder
- Prevention of osteoporosis after menopause
- Smoking cessation, weight control