Thoracic osteochondrosis

Thoracic osteochondrosis is a degenerative lesion of the spine (exhaustion and destruction of the bone structure of the vertebra). It begins with a lesion of 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, therefore it requires an accurate differential diagnosis. Therapy involves a wide range of treatments: medications, physical therapy, physiotherapy and massage.

Thoracic osteochondrosis is less common than cervical or lumbar osteochondrosis. This is due to the specifics 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 has little mobility and is protected by the rib cage and ribs. 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 on the vertebral bodies (osteophytes) occurs. Peripheral nerve endings are located between the 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.
Clinical symptoms of thoracic osteochondrosis between women and men are approximately the same and do not differ significantly.

Prevalence

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

Everyone has a predisposition to the formation of osteochondrosis of the thoracic region. This is due to a person's upright posture and, as a result, a large 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 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 of the intervertebral discs and their protrusions are formed.
• The second degree is characterized by a further loss of elasticity of the intervertebral discs and a decrease in their height. The likelihood of a 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 the symptoms depends on the location of the hernia.
• The fourth degree with a complete violation of the 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 pathologies of the internal organs: cardiovascular diseases, gastroduodenal reflux, traumatic and inflammatory injuries of the locomotor system.
• Psychogenic thoracalgia is caused by panic attacks and damage to the organs of neural genesis.

Causes and risk factors

Osteochondrosis is not formed without injury factors. A number of 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 back muscles and the intervertebral segment. Sedentary work and improper workplace organization act as an additional factor in thoracic osteochondrosis.
• Improper lifting of weights and a variety of injuries. Excessive stress that disrupts the functioning of the spine. In this situation, the muscles and intervertebral discs cannot withstand 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. 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 become weaker and the likelihood of damage to the musculoskeletal system increases.
• Pregnancy as a combination of the main factors - an increase in the load on the spine and a lack of minerals and vitamins.

Important!Hereditary predisposition plays a significant role. If lesions of the musculoskeletal system are observed along a related line, attention should be paid to one's 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.

• A decrease in immune status associated with increased susceptibility to infections which may potentiate the clinical manifestations of osteochondrosis due to muscle inflammation.
• Stressful influences that can cause psychogenic chest pain. 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.
• Failure to comply with the principles of ergonomics (carrying of weights).
• Spinal injuries of various origins.
• Muscle spasm.
• Osteoporotic degeneration of the musculoskeletal system.

Symptoms

Main symptoms of thoracic osteochondrosis

• Burning sensation that occurs in the intercostal spaces.
• Paroxysmal and persistent chest pains, mostly stabbing.
• With thoracalgia, the pain syndrome is excruciating, constricting, and aching.
• Pain in the belt.
• Pain in one side of the trunk.
• During movement, the crunching of the vertebrae is noted.
• Pain symptoms significantly increase 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 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:

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

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

• Dorsago - intense, but short-term pain at the site of localization of the affected intervertebral discs. Disturbance of normal breathing.
• Back pain - mild, but prolonged pain in the area of the affected intervertebral discs.

Spondylogen thoracalgiaassociated 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 a violation of the mobility of the thoracic spine, stitching 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: a number of patients have painful symptoms of a stabbing 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 from cardiovascular disease and myalgia. Damage to the heart of ischemic etiology is distinguished by the regularity of onset during physical or psycho-emotional stress and the relief of an attack by taking nitrates.

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

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 limbs and along the intercostal spaces, spreading to the anterior surface of the chest.
   • The latissimus and chest muscles are in constant tension.
   • There is high emotional lability, bouts of crying 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, which sometimes makes breathing difficult. Movement in the cervical and thoracic spine is limited. It occurs or worsens when sitting in a contorted position.
   • Back pain - the formation of pain symptoms takes two to three weeks, so at first it proceeds without clinical manifestations for the patient. There is a slight discomfort in the chest. The pain is aggravated by turning the body to the sides and breathing deeply. With the final stabilization of the pathological process, a persistent pain syndrome is formed.
   • Intercostal neuralgia: pain in the girdle that radiates along the intercostal spaces. When you take a sharp breath, excruciating pain appears in the region of the heart. As a result, the pathology is often confused with damage to the cardiovascular system.
   • 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 in the thoracic spine.
   • Radicular 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 pain in the girdle, heaviness in the right hypochondrium, heartburn.

Clinical symptoms depending on the level of thoracic spine injury:

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

• Deformation of the nervous process at 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 result in organ dysfunction of the cardiovascular system.
• Defeat at Th4-Th5 level. Organs with damaged nerve fibers: pleurisy and bronchitis, pneumonia, bronchial asthma.
• Th5-Th6: bile ducts and gallbladder are affected. The absorption of fat in the body decreases.
• Th6-Th7: affects the area of the liver and solar plexus. 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: alterations in the functioning of the duodenum and pancreas. Manifestations: duodenitis, pancreatitis and soft stools.
• Th9-Th10: damage to nerve cells of 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 - 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.

Thoracic osteochondrosis diagnostics

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

The patient is examined with the recording of all clinical data. During the formation of stages 2-3, the skeleton undergoes significant deformation. It is necessary to collect a complete medical history of the patient in order to accurately establish or exclude the factors leading to the formation of osteochondrosis of the thoracic spine.

The first diagnostic method is radiography. Further studies are carried out on the basis of 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 medical history. This will allow you to accurately establish the etiology of the disease and select a treatment regimen. Therapist, neurologist, rheumatologist are involved in the treatment of thoracic osteochondrosis. In case of traumatic effects on the spinal region, a consultation with a traumatologist is necessary.

• Chest X-ray examination in two projections. It allows to establish the presence and size of osteophytes, to determine the contours and height of the intervertebral discs, to establish changes in the shape of the disc.
• The discography allows to examine the structure of the nucleus pulposus through the use of contrast.
• Computed tomography is used to view nerve fibers, muscles, ligaments, and joints.
• Electromyography allows differential diagnosis with neurological diseases.
• Endoscopic diagnostic methods can 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 should be distinguished from a number of diseases.

• Abnormalities in the formation of the spinal column, trauma, tumors, inflammation. There are several options for these pathologies. For example, a further congenital process, displacement or fusion of the 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 diseases of internal organs. In particular, pancreatitis, inflammation of the appendages, gastric ulcers, ischemic 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 conduct a competent differential diagnosis with the most similar pathologies. Pain resulting from vertebral thoracalgia and coronary heart disease (IHD) has a number of differences, which allow the diagnosis to be accurately established.

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

For the duration of the pain:

• IHD: short-term attack, within minutes.
• Thoracic osteochondrosis is characterized by faded or prolonged pain, in some cases they do not subside during the day.

Change of body position:

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

Reaction to physical activity:

• With ischemic heart disease, pain appears during physical exertion, stopping at rest.
• Chest pain, on the other hand, weakens, but does not stop at rest.

Cupping for taking medication:

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

Influence of physiotherapeutic factors and manual therapy:

• With ischemic heart disease, it gives an unstable and slight 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 necessary to first establish the etiological prerequisites. Identifying the cause of the pathology allows you to choose the right 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 treatment regimen, the individual characteristics of the organism are taken into account.

Standard therapeutic regimen

Non-steroidal anti-inflammatory drugs help relieve chest pain caused by inflammatory reactions. This increases the volume of mobility in the chest, as well as the range of motion in the thoracic spine.

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

Antispasmodics are also used.

B vitamins help stop inflammation of the affected nerves.

Preparations that preserve the concentration of collagen and elastane allow to keep the intervertebral discs fluid. This increases the elasticity of the tissues and prevents further degeneration.

Hormonal medicines (steroids). They have a powerful anti-inflammatory effect, but are used only for acute chest pain, as they negatively affect the body as a whole.

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

Anti-inflammatory ointments and gels. When 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 spasm from the muscular corset of the thoracic spine and normalize local blood circulation.

Effects of massage techniques:

• removal of muscle hypertonus;
• strengthen the structure of the bodies of the intervertebral discs.

The use of massage techniques is combined with a visit to a chiropractor in conjunction with a regular physical therapy system.

Physiotherapy

Acupuncture. Eliminates or reduces muscle spasm and also reduces pain symptoms.

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

Nutrition for osteochondrosis of the thoracic spine

The respect of certain nutritional principles allows to obtain the maximum therapeutic effect.

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

complications

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

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

With regular adherence to the principles of therapy, the system of physical therapy, 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 does not actively manifest itself.

Prophylaxis

• Elimination of hypodynamia, 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 of the thoracic spine muscles. There is both a physical therapy complex and the use of myostimulation when independent training is impossible.
• Workplace Organization: The back of the work chair should provide support for the spine. So that the load on the spine does not increase, you should warm up every 30 minutes in the form of stretching or walking. This is because sitting puts more stress on the spine.
• Correct position of the spine at night: buy orthopedic accessories for sleeping. A completely rigid surface is not rational due to the violation of the physiological curves of the spine.
• Respect for the principles of ergonomics: do not lift weights that could injure the spine.
• Formation of correct posture.
• Optimization of blood and lymphatic circulation through a stretch mark system or the use of special procedures (pressotherapy).