Thoracic osteochondrosis is a degenerative lesion of the spine (depletion and destruction of the bone structure of the vertebra). It starts with a posture injury, the appearance of autonomic symptoms (shortness of breath, weakness, sweating, malaise) and the development of an intense pain syndrome. Thoracic osteochondrosis mimics cardiovascular disease and therefore requires an accurate differential diagnosis. Therapy involves a wide range of treatments: medications, exercise therapy, physiotherapy and massage.
<1_img_blockxx>Thoracic osteochondrosis is less common than cervical or lumbar osteochondrosis. This is due to the specificities of the anatomical structure. Vertebral discs in the thoracic region occupy two-thirds of the entire spine and are also larger in diameter but smaller in size than the lumbar region. This area is strong and has little mobility and is protected by the rib cage and ribs. The physiological curvature is directed towards the back. This leads to increased stress on the anterior part of the spine. In addition, pathological bone structures form and grow in the vertebral bodies (osteophytes). Peripheral nerve endings are located between ligaments and muscle tissue, their tension causing compression with the development of pain.
There are also polysegmental spinal injuries with osteochondrosis. At the same time, degeneration of the cervical, thoracic, and lumbar regions is combined with corresponding clinical symptoms.
The clinical symptoms of thoracic osteochondrosis between women and men are approximately the same and do not show significant differences.
Prevalence
Diagnosis can be made at any age. The disease is common in adolescents with a weakened musculoskeletal system and also as a result of their active growth. The pathology usually forms among pregnant women due to the pronounced burden in the thoracic region during pregnancy.
Everyone is predisposed to the formation of osteochondrosis in the thoracic region. This is due to the person's upright posture and, as a result, a heavy load on the spinal section.
Classification
Chest pain syndrome is characterized by severe chest pain of an intense nature. The syndrome is associated with peripheral nerve damage. The defeat is due to the compression of the nerves by the muscles and ligaments.
Grades of thoracic osteochondrosis:
- The first degree is characterized by the absence of pronounced clinical manifestations. There is a loss of elasticity of the intervertebral discs and their protrusions are formed.
- Second degree is marked by a further loss of elasticity of the intervertebral discs and a decrease in their height. The probability of hernia increases. Pain syndrome appears, concomitant pain symptoms are possible.
- In the third degree, the pain syndrome increases. The appearance of a herniated disc located between the vertebrae is possible. The severity of symptoms depends on the location of the hernia.
- The fourth degree with complete violation of the elasticity and loss of function of the intervertebral discs, destruction of the bone structure of the vertebrae. Neurological disorders are more pronounced.
According to the types of pain symptoms:
- Vertebral chest pain is justified by spinal pathology.
- Non-vertebrogenic chest pain is caused by the formation of internal organ pathologies: cardiovascular diseases, gastroduodenal reflux, traumatic and inflammatory injuries of the musculoskeletal system.
- Psychogenic chest pain is caused by panic attacks and damage to the organs of neural genesis.
Causes and risk factors
Osteochondrosis does not form without injury factors. A number of reasons or their combination lead to the development of the disease in the thoracic region.
- Sedentary lifestyle. Lack of physical activity leads to weakness of the muscles of the back and intervertebral segment. Sedentary work and inadequate organization of the workplace act as an additional factor in thoracic osteochondrosis.
- Improper lifting of weights and a variety of injuries. Excessive stress that hinders the functioning of the spine. In this situation, the muscles and intervertebral discs cannot support the load.
- Acquired lesions and spinal curvature. In the context of these pathologies, the work of the spine is interrupted and the probability of osteochondrosis formation increases. Destruction intensifies if the doctor's recommendations are not followed.
- Lack of necessary vitamins and minerals. With an insufficient concentration of calcium in bone tissue, bones become weaker and the likelihood of damage to the musculoskeletal system increases.
- Pregnancy as a combination of the main factors: increased load on the spine and lack of minerals and vitamins.
Important!Hereditary predisposition plays a significant role. If musculoskeletal system injuries are observed along a related line, you should be careful about your health and injury prevention. A competent system of preventive measures prevents massive destruction of bone tissue.
who is at risk
Often, the factors for the formation of degenerative changes in the spine are combined.
- Decreased immune status associated with greater susceptibility to infections that can enhance the clinical manifestations of osteochondrosis by muscle inflammation.
- Stressful influences that can cause psychogenic chest pain. This is due to the large release of catecholamines, which cause increased pain.
- Nervous system damage of non-infectious and infectious etiology.
- Physical overloads.
- Failure to comply with the principles of ergonomics (carrying weights).
- Spinal injuries of various origins.
- Muscle spasm.
- Osteoporotic degeneration of the musculoskeletal system.
Symptoms
Main symptoms of thoracic osteochondrosis
- Burning sensation arising in the intercostal spaces.
- Paroxysmal and persistent pains in the chest, predominantly from stabbing.
- In chest pain, the pain syndrome is acute, constrictive, and painful.
- Pain in the waist.
- Pain in one side of the trunk.
- During movement, compression of the vertebrae is observed.
- Pain symptoms increase significantly with movement, deep inhalation, coughing and sneezing, which is the main difference between thoracic osteochondrosis and angina pectoris.
- The affected areas are palpable, meaning they can be felt and are located along the affected nerves.
- Numbness of the skin along the intercostal spaces.
- The patient's condition worsens when exposed to low temperatures or prolonged stay in an uncomfortable position.
Varieties of pain syndromes in osteochondrosis of the thoracic spine:
- Injury to the lower part of the neck. There is pain in the upper chest, which can radiate to the neck, arms, and also the left half of the body.
- Upper thoracic spine damage. Pain is painful in nature, affects the central part of the chest. Frequent combination with pain in the shoulder blade region.
- The defeat of the scapular-costal zone. Painful symptoms are sharp, painful and penetrating. It has the appearance of attacks, both long and short. It occupies the lateral region and is also concentrated in the shoulder blade region.
- The appearance of pain in the anterior chest wall, with different duration. They arise between the perpectoral and frontal axillary lines.
In addition to the main signs, there are two types of pain syndromes in thoracic osteochondrosis:
- Dorsago - severe but short-term pain at the site of location of the affected intervertebral discs. Disturbance of normal breathing.
- Dorsalgia - mild but prolonged pain in the area of the affected intervertebral discs.
spondylogenic chest painassociated with damage to the musculoskeletal system, it is often accompanied by severe pain and instability of the vertebrae in the thoracic spine (their increased mobility). The defeat is expressed in the violation of the mobility of the thoracic spine, sewing and cutting pains in the intercostal spaces.
vertebral chest paincan cause the following symptoms:
- radicular (pain symptoms);
- violation of innervation of the thoracic zone (visceral manifestations: several patients present with painful symptoms of an acute nature in the digestive tract or cardiovascular system);
- radicular syndrome with vegetative signs (pain in the intercostal spaces).
When diagnosing a problem, it is necessary to distinguish the symptoms of cardiovascular disease and myalgia. Heart damage of ischemic etiology is distinguished by the regularity of occurrence during physical or psycho-emotional stress and the relief of an attack by ingesting nitrates.
A psychogenic attack of chest pain is accompanied by the onset of panic, anxiety, suffocation, and mental disorder. It turns out that the illness is a consequence of problems with psychological stability.
The clinical signs of osteochondrosis are divided into two main parts:
- In thoracic osteochondrosis, numbness and tingling can occur both in the upper limbs and along the intercostal spaces, spreading to the anterior surface of the chest.
- The latissimus muscles of the back and chest are in constant tension.
- There is high emotional lability, crying spells and irritability.
- In rare situations, the disease manifests as pronounced intercostal neuralgia.
- Dorsago: Sharp, sharp pain in the thoracic spine, sometimes making breathing difficult. Movement of the cervical and thoracic spine is limited. It manifests or worsens when sitting in a twisted position.
- Back pain: the formation of pain symptoms takes two to three weeks, therefore, at first, it elapses without clinical manifestations for the patient. There is slight discomfort in the chest. The pain is aggravated by turning the body sideways and breathing deeply. With the final stabilization of the pathological process, a persistent pain syndrome is formed.
- Intercostal neuralgia: pain in the waist that radiates along the intercostal spaces. When you take a deep breath, a sharp pain appears in the heart region. As a result, the pathology is often confused with damage to the cardiovascular system.
- Cardiac or pseudocoronary syndrome is formed by lesions at the level of ThI segments with the development of reflex angina pectoris. The difference between organ damage and the cardiovascular system is the onset of pain when bending or rotating the spine. They intensify with prolonged stay in a forced position. There is pain on palpation of the spinous processes of the thoracic spine.
- Root syndrome: pain in the intercostal spaces (Erb points).
- Visceral syndrome: dysfunction of Organs abdominal organs with injuries to the V-XII thoracic vertebrae. It is expressed as pain in the waist, heaviness in the right hypochondrium, heartburn.
Clinical symptoms, depending on the level of injury to the thoracic spine:
- Deformation of the nervous process at Th2 and Th3 levels. Damage to the cardiovascular system occurs with the onset of arrhythmia attacks and coronary heart disease. Thus, the symptoms of chronic pain in chest pain can cause organic dysfunctions of the cardiovascular system.
- Defeat at level Th4-Th5. Organs with damaged nerve fibers: pleurisy and bronchitis, pneumonia, bronchial asthma.
- Th5-Th6: The bile ducts and gallbladder are affected. The absorption of fats in the body decreases.
- Th6-Th7: affects the liver and solar plexus area. The functioning of the hepatobiliary tract is impaired.
- Th7-Th8: The stomach is affected. Main pathologies: ulcerative lesions of the duodenum and stomach, dyspepsia and gastritis.
- Th8-Th9: changes in the functioning of the duodenum and pancreas. Manifestations: duodenitis, pancreatitis and soft stools.
- Th9-Th10: damage to nerve cells in internal organs (spleen and diaphragm). Hiccups and breathing problems occur.
- Th10-Th11: the adrenal glands are affected. The activity of the immune system decreases and allergies develop.
- Th11-Th12: renal function is impaired, which leads to the formation of pyelonephritis and urolithiasis.
- Th12-L1 (level of the first lumbar vertebra). The kidneys and ureters are damaged. This leads to dysuria - problems with urination.
Diagnosis of thoracic osteochondrosis
If you suspect osteochondrosis, you can contact a therapist or neurologist.
The patient is examined with a record of all clinical data. During the formation of stages 2-3, the skeleton undergoes significant deformation. A complete patient history should be taken to accurately establish or exclude factors that lead to the formation of osteochondrosis of the thoracic spine.
The first diagnostic method is radiography. New studies are carried out based on clinical history data and the need for differential diagnosis.
Any doctor can initially examine the patient. The main thing is a competent and fully collected clinical history. This will allow you to accurately establish the aetiology of the disease and select a therapy regimen. Therapist, neurologist, rheumatologist are involved in the treatment of thoracic osteochondrosis. In case of traumatic effects in the spinal region, consultation with a traumatologist is necessary.
- Chest radiological examination in two projections. It allows establishing the presence and size of osteophytes, determining the contours and height of the intervertebral discs, establishing changes in the shape of the disc.
- Discography makes it possible to examine the structure of the nucleus pulposus through contrast.
- A CT scan is used to visualize nerve fibers, muscles, ligaments and joints.
- Electromyography allows for the differential diagnosis with neurological diseases.
- Endoscopic diagnostic methods may be prescribed for the purpose of examining the circulatory and digestive organs.
- An ECG is performed to establish the etiology of cardiovascular disease.
- Electroencephalography - to establish pathologies of the nervous system.
Differential diagnosis
Thoracic osteochondrosis must be distinguished from a number of diseases.
- Anomalies in spine formation, trauma, tumor, inflammation. There are several options for these pathologies. For example, an additional congenital process, displacement or fusion of vertebrae (spondylolisthesis), osteomyelitis, ankylosing spondylitis and others.
- Damage to the musculoskeletal system (different lengths of the lower limbs, muscle spasms, muscle inflammation and others).
- Not associated with damage to the musculoskeletal system, but similar in symptoms of internal organ disease. In particular, pancreatitis, inflammation of the appendices, stomach ulcers, coronary heart disease, angina pectoris, pleurisy.
- Disorders similar to neurosis, combined with migratory pain with increased fatigue, irritability, mood swings.
Thoracic osteochondrosis and ischemic heart disease
It is extremely important to make a competent differential diagnosis with the most similar pathologies. Pain resulting from vertebral chest pain and coronary heart disease (CHD) present a number of differences, which allows for a precise diagnosis to be established.
The nature of pain: with coronary artery disease, they have a burning and constrictive character, accompanied by fear of death.
For the duration of the pain:
- IHD: short term attack, within minutes.
- Thoracic osteochondrosis is characterized by fading or prolonged pain, which in some cases does not subside during the day.
Change in body position:
- In ischemic heart disease, the strength and intensity of pain do not vary with physical activity.
- In chest pain, even relatively light movements cause increased pain or a new attack to occur.
Reaction to physical activity:
- In ischemic heart disease, pain appears during physical exertion, stopping at rest.
- Thoracic pain, on the contrary, weakens but does not stop at rest.
Suction cup for taking medication:
- With an ischemic attack, pain is easily relieved by taking nitrates.
- Thoracic pain is relieved with the use of pain relievers.
Influence of physical therapy factors and manual therapy:
- In ischemic heart disease, it presents an unstable and slight improvement.
- With osteochondrosis, there is a significant positive dynamic in the patient's condition.
Treatment of thoracic osteochondrosis
Osteochondrosis is treated by a neurologist.
For the organization of competent therapy, it is first necessary to establish the etiological prerequisites. Identifying the cause of the condition allows you to choose the right treatment regimen.
Preparations for bone tissue regeneration are selected taking into account all the functional characteristics of the body. It is advisable to preliminarily clarify the concentration of collagen and elastane in the body. When choosing a therapy regimen, the individual characteristics of the organism are taken into account.
standard therapy regimen
Nonsteroidal anti-inflammatory drugs help relieve chest pain caused by inflammatory reactions. This increases the amount of mobility in the chest as well as the range of motion of the thoracic spine.
Medicines that affect the production of interleukins. They allow you to stop the inflammatory cascade and normalize the balance of enzymes that cause the destruction of myelin sheaths in nerves.
Antispasmodics are also used.
B vitamins help stop inflammation in the affected nerves.
Preparations that preserve the concentration of collagen and elastane allow you to maintain fluid in the intervertebral discs. This increases tissue elasticity and prevents further degeneration.
Hormonal drugs (steroids). They have a powerful anti-inflammatory effect but are only used for acute chest pain as they negatively affect the body as a whole.
Diuretics in the acute period of the illness help to relieve swelling of the nerve endings. Potassium sparing diuretics are preferred.
Anti-inflammatory ointments and gels. By rubbing the affected area of the back, the local inflammatory process decreases and highly active pain symptoms are eliminated.
Massage
The therapeutic effect of massage is to relieve the spasm of the muscular corset of the thoracic spine and to normalize local blood circulation.
Effects of massage techniques:
- removal of muscle hypertonia;
- strengthening of the structure of the bodies of the intervertebral discs.
The use of massage techniques is combined with a visit to a chiropractor in combination with a regular exercise therapy system.
Physiotherapy
Acupuncture. It eliminates or reduces muscle spasm and also reduces pain symptoms.
Manual therapy. Allows systemic circulation to be brought to a normal state in the intercostal space. This conditions the supply of nutrients to tissues, improves their trophism and stimulates blood oxygenation.
Nutrition for osteochondrosis of the thoracic spine
Adhering to certain nutritional principles allows you to achieve maximum therapeutic effect.
- Foods rich in vitamins A, B, C and E are recommended (vegetables, nuts, cereals).
- Omega-3, 6 fatty acids found in fish.
- Stimulants of cartilage tissue regeneration in the form of food additives help maintain tissue strength and maintain the elasticity of tissue structures.
complications
When establishing the diagnosis of thoracic osteochondrosis, one must take into account the possible cascade of probable organ pathologies that develop over time.
- Damage to the cardiovascular system: persistent pain syndrome leads to destabilization of myocardial muscle ion exchange, which is a prerequisite for the development of coronary heart disease.
- Disorders in the functioning of Organs abdominal organs: stomach, duodenum, pancreas. This is due to high adrenaline secretion with persistent pain syndrome, which leads to increased secretion of VIP (vasointestinal peptides).
- Gallbladder dyskinesia is justified by an increase in bile lithogenicity in the context of a chronic inflammatory process.
With regular adherence to the principles of therapy, exercise therapy system, maintenance of posture, and elimination of risk factors, the course of the disease is reduced to regression. The prognosis is considered favorable if the pathology does not develop further and the disease does not actively manifest itself.
Prophylaxis
- Elimination of hypodynamics, therapeutic exercises. Anti-strength exercises, perpendicular loads with displacement, stretching of the spine are selected.
- When driving a car for a long time, selecting special exercises to relax the muscle structure.
- Pumping of the muscles of the thoracic spine. There is a complex of exercise therapy and the use of myostimulation when independent training is impossible.
- Organization of the workplace: the back of the work chair must provide support for the spine. So that the load on your spine doesn't increase, you should warm up every 30 minutes in the form of stretching or walking. This is because the sitting position puts more pressure on the spine.
- Correct spine position at night: buy orthopedic sleeping accessories. A completely rigid surface is not rational due to the violation of the physiological curves of the spine.
- Compliance with ergonomic principles: do not lift weights that could injure the spine.
- Correct posture training.
- Optimization of blood circulation and lymphatic flow through the streak system or the use of special procedures (pressure therapy).