Thoracic and chest pain

by Jason

I have been experiencing thoracic back pain for the past 9 months. The pain runs down my upper back causing local soreness and further travels into my chest, mainly down the sternum. I often wake up with a sore sternum. When I perform the overhead stretch for Teres Major and lean over to one side, I feel discomfort across one of the ribs. Occasionally, the bottom of my hands (pinkie finger area) fall numb during sleep. I have noticed that this only occurs when I sleep on my sides. Also, my back cracks a lot when I move my arms and my chest also cracks-up when I push down on it.

I went ahead and got x-rays done for my whole spine, but the results came back negative for any problems. So, I was wondering, can a radiologist determine or suspect disk problems from a x-ray, or do I need to book a MRI appointment? As for the MRI, if I do need one, will a conventional lying down one do the job? The reason I am asking this is because my symptoms are at their worse when I am standing or sitting. They ease up when I lie down.

I was researching this issue online and came across people posting that when you lie down, your spine aligns itself up causing disk problems to go unnoticed in a MRI scan. Now I don't know how true this is, but is it really possible for a serious problem to go undetected due to this reason? I wonder this because I was once told by a doctor that a disk herniation will show up in a MRI no matter the position you are in. Therefore, I was thinking maybe I should get a weight bearing or a stand-up MRI done instead for better results.

I would appreciate if you could shed some light onto this matter. Finally, it would be great if you could assess my situation and provide me with some sort of explanation. Also, have you ever come across a similar case and if so, how did the patient find relief. Thank you.

Hello Jason,
Disc injuries in the thoracic spine are rare, and in any case this presents like a rib problem rather than a spinal one, although they sometimes go hand in glove.

Does taking in a deep breath hurt? Coughing or sneezing?

If you press on the joint between the sternum and firstly the collarbone, and secondly the ribs, is it tender, and is there a small palpable lump?

It would appear to me that you have what's known as costochondral syndrome, sometimes progressing to Tietze's.

I would recommend a chest x-ray as well, looking particularly at the ribs too; see if you can locate exactly which one hurts.

To my knowledge there aren't many standing MRI machines and in anycase, at this stage I don't believe it's appropriate.

You would have to ask a radiologist about research concerning reduction of a proven herniation when the MRI is taken lying down; I'm not sure.

The reason I mention Tietze's syndrome is that if the collarbone is involved it may affect the brachial plexus in the thoracic outlet, and the pinkie is most often affected.

Start phoning around to see if you can find a chiropractor who knows about Tietze's syndrome; a thorough examination is called for to see if there is any substance to my suspicions. A small warning here: a heavy manipulation in the midback may worsen the condition; I use the so-called Anterior Thoracic technique. Perhaps print this out and take it with you.

This is complex stuff with many possibilities; it's encouraging that are applying your own mind to the problem. Let me know how you get on.

Dr B

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Aug 07, 2017
Thoracic pain
by: Jason

Thanks for replying doc. Now recently, I got a few MRIs done for both my neck and back. For the neck, a few minor protrusions were discovered and as for the thoracic, nothing major. Just a few disc space narrowings. When I cough, I don't feel much pain in my chest, but there are a few tender spots right beside my sternum. So, when I push into my chest, I hear a lot of cracking and pain is present as well. Also, pain also runs down the sides of my thoracic spine where the ribs come in contact with the spine.

It's almost as if the two of them are are not in harmony with each other (ribs and the vertebrae). The pain is further aggravated when I hold the push-up stance or do a couple of push-ups. The pain starts to run down right beside the spine and into the edges of my shoulder blades. As for a Chiropractor, I have started to see one. He performs a couple of techniques. One of them is where you lie on your stomach and he pushes down on it as you breathe out. The other I believe is the Anterior Thoracic technique. Just to confirm, this is the one where the patient lies on his back with his arms crossed hugging himself tight and the doctor puts his hand underneath the spine and lies on top of you and jerks your spine as you breathe out. As for the pressure applied, I will ask him to keep that in check. I will also let him know about the Tietze syndrome.

Also, if you can share your thoughts on this post, that would be great, Doc.

This is almost a rib related problem, Jason, and it's affecting the whole bone from your back to your breast bone.

Press ups mean contracting the rhomboids to stabilise your shoulders; they lie between the spine and the scapula.

Those cracking sounds means instability and perhaps degeneration of the ligaments and joint cartilage. I would greatly increase the omega-3 in your diet; either fatty fish like salmon and pilchards with the full oil complement (not those in saline or vegetable oil), freshly ground flax seed and walnuts.

I'm afraid that like many chronic medical conditions, you are probably not going to be 'cured'. A regular treatment every month or two, more exercise and a focus on diet is the solution. Skipping with or without a rope would be a good start. A sports massage would help too.

No heavy midback adjustments.

Dr B

Let me know in a couple months how you are getting on.

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

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