Upper & Mid Back Pain
The upper and midback is the region of thoracic vertebrae. The thoracic vertebrae are involved in providing stability in contrast to the cervical and lumbar vertebrae which are involved in active movements.The most common cause of upper back pain is Myofascial pain involving the paraspinal muscles. The various conditions causing pain in thoracic region include the following:
1. Thoracic vertebral compression fractures:
They are common cause of middle to upper back pain. They are often due to osteoporosis combined with trauma or falls. They can be extremely painful and can cause lot of functional limitation. They are best treated early after its initial occurrence. There are wide variety of medical and interventional treatments options available such as Vertebroplasty and Kyphoplasty
2. Post herpetic Neuralgia (Shingles pain):
This is a painful disorder often seen in elderly patients that have had chicken pox or shingles outbreak in the past. Often the pain is described as burning and constant and can last long after the initial shingles outbreak has healed. Typically pain isconfined to areas of the body where shingles lesions erupt. There are several medical and Interventional treatments available for shingles.
3. Post Thoracotomy Pain syndrome:
Post thoracotomy pain syndrome is common in patients after chest wall or lung surgery. Surgical irritation of the nerves running along the ribs can cause both electric shock like pains to the chest wall as well as upper abdominal pain. There are many medical and interventional treatments such as Intercoastal nerve block and Pulse Radiofrequency for this syndrome
4. Thoracic radicular Pain:
Thoracic radicular pain syndrome is due to irritation of the nerves exiting the spine along the upper and middle back. It is often described as a sharp pain associated with weakness or numbness along the distribution of these nerves. The causes include thoracic disc bulges, vertebral compression fractures, bone overgrowth and narrowing of the spinal canal. This condition is amenable to wide variety of medical and interventional treatment options.
Costochondritis involves a weakening and inflammation of the connective tissue of the chest wall. This condition is often seen in smokers, people with arthritis and inflammatory disease and may be preceded with viral and bacterial infections. Pain occurs with deep breathing and slight pressure. There are several medical and interventional treatments for this condition.
6. Costosternal syndrome:
Costosternal syndrome involves a weakening and inflammation of the connective tissue between the rib joints. This condition is often brought on by trauma to the chest. Pain occurs on deep breathing and slight pressure and can be easily reproduced on medical examination. Many medical and interventional treatments are available for this syndrome.
7. Thoracic facet syndrome:
Also known as thoracic facet disease or thoracic osteoarthritis, is a degenerative spine condition that can cause severe back pain and other symptoms if left untreated. It is less common than the facet disease in cervical or lumbar levels.
Thoracic facet syndrome is a type of osteoarthritis that often develops gradually over time. Eventually the articular cartilage wears away, leading to bone to bone contact and inflammation, which promotes the development of osteophytes (bone spurs) and arthritic pain.
The treatment for this condition is first attempted conservatively with a combination of low impact excercises, application of heat, massage, NSAIDs, Physical therapy and stretching. If not responded to conservative management thoracic facet joint injection is given under fluoroscopic guidance.