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THORACIC SPINE PAINThe MID-BACKTHORACIC SPINE PAIN is rarely serious but frequently can be very irritating. Metastases from known cancers of the lungs and breast should be kept in mind, but they are very much the exception. There are twelve thoracic vertebrae, each attached via three joints to a rib on each side (thus six in total), which in turn is joined to the breastbone. It stretches from the base of the neck to the bottom of the ribcage.
This means that each thoracic vertebra has 8 joints associated with them: two with the bones above and below, and six with the ribs. A great many joints (12 x 8 = 96) in total, each with supporting ligaments and muscles, making it a complex and sometimes painful area.
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Seen from the side, the thoracic spine has a natural curve called a kyphosis. This provides the spine with a certain amount of 'give' when for example jumping from a height onto the ground. A straight spine would tend to give too much axial compression, and fracture the bones. However, the kyphosis can increase for pathological reasons causing thoracic spine pain. The most common is the so-called kyphotic (bent) spine of the elderly. It is usually associated with osteoporosis and anterior wedging of the vertebrae, as seen in this MRI of a spine with an anterior compression fracture. For more on the causes of osteoporosis, click here.
Another fairly common condition, Scheuermann's disease can cause an increased kyphosis affecting teenagers. It causes pain usually between the shoulder blades (and less commonly in the low back) and is the cause of the poor posture and slumped shoulders seen in about 5% of teenagers. The attachments of the ribs firstly to the spine via the
costo-spinal joints,
and secondly, in front, to the
breastbone
or sternum is also a common cause of thoracic spine pain seen in the chiropractic clinic. This latter condition, sometimes called
Tietze's Syndrome,
is quite often, if it affects the ribs on the left, confused with a
heart attack
because the pain is directly over the heart, and may be increased wih exercise which stresses the heart (as in angina), but also the rib-sternum joint when breathing deeply.
The upper thoracic spine is a unique area for two reasons. Firstly, it is an area of change, where the highly flexible neck meets the very rigid mid-back. The C6-T2 area is thus very prone to injury and tingling or pain in the arm. The second reason is the presence of the shoulderblades or scapula(e). These large flat bones are the anchor points for many of the large shoulder muscles, and are themselves firmly anchored to the thoracic spine. As you can appreciate, there are a great many muscles, ligaments, joints and bones in the mid-back. The injuries associated with them are not usually serious, but are the cause of many niggling, aching pains between the shoulder blades.
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