Thoracic osteochondrosis

Thoracic osteochondrosis is a degenerative injury of the spine (exhaustion and destruction of the bone structure of the vertebra). It begins with an injury to the posture, the appearance of autonomic symptoms (shortness of breath, weakness, sweating, malaise) and the development of a severe pain syndrome. Thoracic osteochondrosis mimics cardiovascular disease, requiring an accurate differential diagnosis. Therapy involves a wide range of treatments: medications, exercise therapy, physical therapy, and massage.

Thoracic osteochondrosis is less common than cervical or lumbar. This is due to the specific characteristics of the anatomical structure. The vertebral discs in the thoracic region occupy two-thirds of the entire spine in number, and are also larger in diameter, but smaller in size than the lumbar region. This area is strong and of low 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 front of the spine. In addition, the formation and growth of pathological bone structures occurs in the vertebral bodies (osteophytes). Peripheral nerve endings are located between ligaments and muscle tissue, their tension leads to compression with the development of pain.

There are also polysegmental lesions of the spine with osteochondrosis. At the same time, the degeneration of the cervical, thoracic and lumbar regions is combined with the corresponding clinical symptoms.
The clinical symptoms of thoracic osteochondrosis between women and men are approximately the same and do not have significant differences.

Predominance

The diagnosis can be made at any age. The disease is common among adolescents with a weak musculoskeletal system, as well as as a result of their active growth. Pathology is often formed among pregnant women due to the pronounced load on the thoracic region during gestation.

Everyone is predisposed to the formation of osteochondrosis of the thoracic region. This is due to the upright posture of a person and, as a result, a large load on the spinal section.

Classification

The thoracalgic 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 compression of the nerves by muscles and ligaments.

Degrees of thoracic osteochondrosis:

• The first degree is characterized by the absence of pronounced clinical manifestations. There is a loss of elasticity by the intervertebral discs and their bulges are formed.
• The second degree is characterized by a greater loss of elasticity of the intervertebral discs and a decrease in their height. The probability of a hernia increases. Pain syndrome appears, concomitant pain symptoms are possible.
• In third degree, the pain syndrome increases. It is possible the appearance of a herniated disc located between the vertebrae. The severity of symptoms depends on the location of the hernia.
• The fourth degree with a complete violation of elasticity and loss of function of the intervertebral discs, destruction of the bone structure of the vertebrae. Neurological disorders are the most pronounced.

According to the types of pain symptoms:

• Vertebral thoracalgia is justified by the pathology of the spine.
• Non-vertebrogenic thoracalgia is caused by the formation of internal organ pathologies: cardiovascular diseases, gastroduodenal reflux, traumatic and inflammatory lesions of the musculoskeletal system.
• Psychogenic thoracalgia is caused by panic attacks and organ damage of neuronal genesis.

Causes and risk factors

Osteochondrosis does not form without injury factors. Various reasons or their combination leads 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 the intervertebral segment. Sedentary work and improper organization of the workplace acts as an additional factor in thoracic osteochondrosis.
• Improper lifting of weights and a variety of injuries. Excessive stress that alters the functioning of the spine. In this situation, the muscles and intervertebral discs cannot support the load.
• Acquired injuries and curvature of the spine. Against the background of these pathologies, the work of the spine is disrupted and the likelihood of the formation of osteochondrosis increases. The destruction intensifies if the doctor's recommendations are not followed.
• Lack of necessary minerals and vitamins. With an insufficient concentration of calcium in the bone tissue, the bones weaken 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 an important role. If musculoskeletal system injuries are observed along a related line, then you need to take care of 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 increased susceptibility to infections that can enhance the clinical manifestations of osteochondrosis due to muscle inflammation.
• Stressful influences that can cause psychogenic thoracalgia. This is due to the large release of catecholamines, which cause increased pain.
• Damage to the nervous system of non-infectious and infectious etiology.
• Physical overloads.
• Non-compliance with ergonomic principles (weight transport).
• 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 chest pains, predominantly stabbing.
• With thoracalgia, the pain syndrome is stabbing, oppressive, and painful.
• Waist pain
• Pain on one side of the trunk.
• During movement, the crunching of the vertebrae is noticeable.
• 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, that is, they can be palpated 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 in an uncomfortable position.

Varieties of pain syndromes in osteochondrosis of the thoracic spine:

• Lower neck injury. There is pain in the upper chest, which can radiate to the neck, arms, and also to the left half of the body.
• Damage to the upper thoracic spine. The pain is painful in nature, affects the central part of the chest. Frequent combination with pain in the area of the shoulder blades.
• The defeat of the scapular-costal zone. Painful symptoms are sharp, painful, and stabbing in nature. It has the appearance of attacks, both long and short. It occupies the lateral region and is also concentrated in the area of the shoulder blades.
• The appearance of pain in the anterior chest wall, of different duration. They arise between the peri-pectoral and frontal axillary lines.

In addition to the main signs, there are two types of pain syndromes in thoracic osteochondrosis:

• Dorsago: severe pain, but short-term, at the site of the affected intervertebral discs. Alteration of normal breathing.
• Back pain: mild but prolonged pain in the area of the affected intervertebral discs.

Spondylogenic thoracalgiaassociated with damage to the musculoskeletal system, it is often accompanied by severe pain and instability of the vertebrae of the thoracic spine (their increased mobility). The defeat is expressed in a violation of the mobility of the thoracic spine, stabbing and cutting pains in the intercostal spaces.

Vertebral thoracalgiacan cause the following symptoms:

• radicular (pain symptoms);
• violation of the innervation of the thoracic zone (visceral manifestations - several patients have painful symptoms of a shooting nature in the digestive tract or cardiovascular system);
• root 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. Damage to the heart of ischemic etiology is distinguished by the regularity of its appearance during physical or psycho-emotional stress and the relief of an attack by taking nitrates.

A psychogenic attack of thoracalgia is accompanied by the appearance of panic, anxiety, suffocation and mental disorder. It turns out that the disease is a consequence of problems with psychological stability.

The clinical signs of osteochondrosis are divided into two main parts:

1. Neuralgic symptoms:
   • With thoracic osteochondrosis, numbness and tingling can occur both in the upper extremities and along the intercostal spaces, spreading to the anterior surface of the chest.
   • The latissimus dorsi and chest muscles are in constant tension.
   • There is great emotional lability, crying spells, and irritability.
   • In rare situations, the disease manifests itself as pronounced intercostal neuralgia.
2. Various types of pain sensations:
   • Dorsago - sharp, sharp pain in the thoracic spine, sometimes making it difficult to breathe. Movement in the cervical and thoracic spine is limited. It manifests or worsens when sitting in a crooked position.
   • Back pain: the formation of pain symptoms takes two to three weeks, therefore, at first it progresses without clinical manifestations for the patient. There is slight discomfort in the chest. The pain is aggravated by turning the body sideways and taking deep breaths. With the final stabilization of the pathological process, a persistent pain syndrome is formed.
   • Intercostal neuralgia: waist pain that radiates along the intercostal spaces. When you breathe hard, a shooting pain appears in the region of the heart. As a result, the pathology is often mistaken for damage to the cardiovascular system.
   • The cardiac or pseudocoronary syndrome is formed with lesions at the level of the ThI segments with the development of reflex angina pectoris. The difference from organ damage to the cardiovascular system is the appearance 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 the abdominal organs with lesions at the level of the V-XII thoracic vertebrae. It is expressed in waist pain, heaviness in the right hypochondrium, heartburn.

Clinical symptoms according to the level of injury to the thoracic spine:

* The defeat of nervous processes in thoracic osteochondrosis occurs in cases of the appearance of osteophytes - bone outgrowths on the vertebrae. This is due to the rate of destruction. Therefore, the symptoms below are not an integral part of the disease.

• Deformation of the nervous process at the Th2 and Th3 levels. Damage to the cardiovascular system occurs with the appearance of arrhythmia attacks and coronary heart disease. Therefore, the symptoms of chronic pain in thoracalgia can cause organic dysfunction of the cardiovascular system.
• Defeat at Rh4-Rh5 level. Organs with damaged nerve fibers: pleurisy and bronchitis, pneumonia, bronchial asthma.
• Th5-Th6: the bile ducts and gallbladder are affected. Decreases the absorption of fats in the body.
• Th6-Th7: affects the liver and the solar plexus area. The functioning of the hepatobiliary tract is affected.
• 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 loose stools.
• Th9-Th10: damage to the nerve cells of the 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 appear.
• Th11-Th12: kidney function is impaired, leading 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, that is, trouble urinating.

Diagnosis of thoracic osteochondrosis

If you suspect osteochondrosis, you can contact a therapist or neurologist.

The patient is examined with the record of all clinical data. During the formation of stages 2-3, the skeleton undergoes significant deformation. A complete history of the patient should be collected to accurately establish or exclude the factors that lead to the formation of osteochondrosis of the thoracic spine.

The first method of diagnosis is radiography. Further studies are conducted based on the data from the medical history and the need for differential diagnosis.
Any doctor can initially examine the patient. The main thing is a competent and fully compiled medical history. This will allow you to accurately establish the etiology 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, a consultation with a traumatologist is required.

• X-ray examination of the chest in two projections. Allows you to set the presence and size of osteophytes, to determine the contours and height of intervertebral discs, to establish changes in the shape of the disc.
• Discography allows the structure of the nucleus pulposus to be examined using contrast.
• Computed tomography is used to visualize nerve fibers, muscles, ligaments, and joints.
• Electromyography allows 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 various diseases.

• Abnormalities in the formation of the spine, trauma, tumor, inflammation. There are several options for these pathologies. For example, an additional congenital process, displacement or fusion of the vertebrae (spondylolisthesis), osteomyelitis, ankylosing spondylitis, among others.
• Damage to the musculoskeletal system (different lengths of lower limbs, muscle spasms, muscle inflammation and others).
• Not associated with damage to the musculoskeletal system, but similar in symptoms of internal organ diseases. In particular, pancreatitis, inflammation of the appendages, stomach ulcers, coronary artery disease, angina pectoris, pleurisy.
• Neurosis-like disorders, combined with migratory pain with increased fatigue, irritability, mood swings.

Thoracic osteochondrosis and ischemic heart disease

It is extremely important to conduct a competent differential diagnosis with the most similar pathologies. Pain derived from vertebral thoracalgia and coronary artery disease (IC) has a number of differences, allowing the diagnosis to be accurately established.

The nature of pain: with coronary artery disease, they have a burning and oppressive character, accompanied by fear of death.

For the duration of the pain:

• IHD: Short-term attack, in a few minutes.
• Thoracic osteochondrosis is characterized by pain that fades or lasts, in some cases they do not subside during the day.

Change in body position:

• With ischemic heart disease, the strength and intensity of pain do not vary with physical activity.
• With thoracalgia, even relatively slight movements cause increased pain or the appearance of a new attack.

Reaction to physical activity:

• With ischemic heart disease, pain appears during physical exertion and stops at rest.
• The thoracalgia, on the contrary, weakens, but does not stop at rest.

Suction cups for taking medicine:

• With an ischemic attack, pain is easily relieved by taking nitrates.
• Thoracalgia is relieved with the use of pain relievers.

Influence of physiotherapeutic factors and manual therapy:

• With ischemic heart disease, it gives a slight and unstable improvement.
• With osteochondrosis, there is a significant positive dynamics in the patient's condition.

Treatment of thoracic osteochondrosis.

Osteochondrosis is treated by a neurologist.

For the organization of competent therapy, it is first required to establish the etiological prerequisites. Identifying the cause of the pathology allows you to choose the appropriate treatment regimen.

Preparations for the regeneration of bone tissue 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 volume of mobility of the thorax, as well as the range of motion in the thoracic spine.

Drugs that affect the production of interleukins. They make it possible to stop the inflammatory cascade and normalize the balance of the enzymes that cause the destruction of the myelin sheaths of the nerves.

Antispasmodics are also used.

The B vitamins help stop the inflammation of the affected nerves.

Preparations that preserve the concentration of collagen and elastane allow you to retain fluid in the intervertebral discs. This increases the elasticity of the tissue and prevents further degeneration.

Hormonal drugs (steroids). They have a powerful anti-inflammatory effect, but they are used only for acute thoracalgia, as they negatively affect the body in general.

Diuretics in the acute period of the disease help to relieve swelling of the nerve endings. Preference is given to potassium-sparing diuretics.

Anti-inflammatory ointments and gels. By rubbing the affected area of the back, the local inflammatory process decreases and the symptoms of very active pain are eliminated.

Massage

The therapeutic effect of massage is to relieve spasm of the thoracic spine muscle corset and normalize local blood circulation.

Effects of massage techniques:

• elimination of muscular 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. Eliminates or reduces muscle spasms and also reduces pain symptoms.

Manual therapy. It allows you to bring the systemic circulation to a normal state in the intercostal space. This conditions the supply of nutrients to the tissues, improves their trophism and stimulates oxygenation of the blood.

Nutrition for osteochondrosis of the thoracic spine.

Compliance with certain nutritional principles allows you to achieve the maximum therapeutic effect.

• Foods rich in vitamins A, B, C and E (vegetables, nuts, cereals) are recommended.
• Omega-3 fatty acids. 6 found in fish.
• Stimulants of the regeneration of cartilage tissue in the form of food additives make it possible to maintain the strength of the tissues and maintain the elasticity of the tissue structures.

Complications

When establishing the diagnosis of thoracic osteochondrosis, the possible cascade of probable organ pathologies that develop over time should be taken into account.

• Damage to the cardiovascular system: persistent pain syndrome leads to destabilization of the ion exchange of the myocardial muscle, which is a prerequisite for the development of coronary artery disease.
• Disorders of the functioning of the abdominal organs: stomach, duodenum, pancreas. This is due to high epinephrine secretion with persistent pain syndrome, which leads to increased secretion of VIP (vasointestinal peptides).
• Dyskinesia of the gallbladder is justified by an increased lithogenicity of the bile in the context of a chronic inflammatory process.

With regular adherence to the principles of therapy, the exercise therapy system, the maintenance of posture and the 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 is not actively manifested.

Prophylaxis

• Hypodynamic elimination, therapeutic exercises. Anti-force exercises, perpendicular loads with displacement, stretching of the spine are selected.
• When driving a car for a long time, the selection of special exercises to relax the muscle structure.
• Pumping the muscles of the thoracic spine. There is both 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 should support the spine. So that the load on the spine does not increase, you need to 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 position of the spine at night: buy orthopedic accessories for sleep. 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.
• Formation of a correct posture.
• Optimization of blood circulation and lymphatic flow through a stretch mark system or the use of special procedures (pressotherapy).