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 autonomous symptoms (shortness of breath, weakness, sweating, malaise) and the development of a severe pain syndrome. Thoracic osteochondrosis mimics cardiovascular disease, therefore, requires an accurate differential diagnosis. Therapy includes a wide range of treatments: medication, exercise therapy, physiotherapy, and massage.

Thoracic osteochondrosis is less common than cervical or lumbar ones. This is due to the specifics of the anatomical structure. The vertebral discs of the thoracic region occupy two-thirds of the entire spine in number, and they are also larger in diameter, but smaller in size than the lumbar region. This area is strong and has low mobility, and is protected by the rib cage and ribs. The physiological curvature is directed backwards. This leads to increased stress on the anterior part of the spine. In addition, the formation and growth of pathological bone structures on the vertebral bodies (osteophytes) occurs. Peripheral nerve endings are located among 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 associated with the corresponding clinical symptoms.
The clinical symptoms of thoracic osteochondrosis in women and men are approximately the same and do not have significant differences.

Prevalence

The diagnosis can be made at any age. The disease is common in adolescents with a weak musculoskeletal system, as well as due to their active growth. Pathology is often formed in 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 the upright posture of a person 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 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 marked 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 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.

Depending on the types of pain symptoms:

• Spinal thoracalgia is justified by the pathology of the spine.
• Nonvertebrogenic thoracalgia is caused by the formation of pathologies of internal organs: 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 damaging 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 in the muscles of the back and intervertebral segment. Sedentary work and poor organization of the workplace are an additional factor in thoracic osteochondrosis.
• Improper weight lifting and various injuries. Excessive stress that disrupts the functioning of the spine. In this situation, the muscles and intervertebral discs cannot withstand the load.
• Acquired lesions and curvature of the spine. Against the background of these pathologies, the work of the spine is disturbed 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 bone tissue, the bones weaken and the likelihood of damage to the musculoskeletal system increases.
• Pregnancy as a combination of the main factors: an increased load on the spine and a lack of minerals and vitamins.

Important!Hereditary predisposition plays an important role. If damage to the musculoskeletal system is observed along a related line, you should pay attention to your health and prevention of damage. A competent system of preventive measures prevents the massive destruction of bone tissue.

Who is at risk

Often, the factors of formation of degenerative changes in the spine are combined.

• Decreased immune status associated with increased susceptibility to infections which may increase 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.
• Non-compliance with the principles of ergonomics (weight bearing).
• Vertebral lesions of various origins.
• Muscle spasms.
• Osteoporotic degeneration of the musculoskeletal system.

Symptoms

Main symptoms of thoracic osteochondrosis

• Burning sensation appearing in the intercostal spaces.
• Paroxysmal and persistent chest pain, predominantly throbbing.
• With thoracalgia, the pain syndrome is throbbing, constricting, and painful.
• Pain in the belt.
• Pain in one side of the trunk.
• During movement, the cracking of the vertebrae is noted.
• Symptoms of pain increase dramatically with movement, deep inhalation, coughing, and sneezing, which is the main difference between chest 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 awkward position.

Varieties of pain syndromes in osteochondrosis of the thoracic spine:

• Lower neck injury. There is pain in the upper part of the chest, which can radiate to the neck, arms, and also 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 shoulder blades.
• The defeat of the scapulo-costal area. Painful symptoms are sharp, painful, and throbbing in nature. Looks like 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 peripectoral and frontal axillary lines.

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

• Dorsago - severe 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.

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

Spinal thoracalgiamay cause the following symptoms:

• radicular (painful symptoms);
• violation of innervation of the thoracic zone (visceral manifestations: a number of patients have painful symptoms of a throbbing 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. The damage to the heart of ischemic aetiology is distinguished by the regularity of occurrence during physical or psycho-emotional stress and the relief of a crisis by the intake of nitrates.

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

The clinical signs of osteochondrosis can be 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 pectoral muscles are in constant tension.
   • There is high emotional lability, bouts of tearing and irritability.
   • In rare situations, the disease manifests itself in pronounced intercostal neuralgia.
2. Different types of painful sensations:
   • Dorsago: sharp, sharp pain in the chest spine, sometimes making it difficult to breathe. Movement of the cervical and thoracic spine is limited. It manifests itself or gets worse when you sit in a crooked position.
   • Back pain: Painful symptoms take two to three weeks to form. Therefore, it proceeds early without clinical manifestations for the patient. There is a slight discomfort in the chest. The pain is aggravated by turning the body on its sides and breathing deeply. With the final stabilization of the pathological process, a persistent pain syndrome is formed.
   • Intercostal neuralgia: girdle pain radiating along the intercostal spaces. When you breathe heavily, a throbbing pain appears in the area 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 in the ThI segments with the development of reflex angina pectoris. The difference between organ damage to the cardiovascular system is the appearance of pain when bending or rotating the spine. They intensify with a prolonged stay in a forced position. There is pain on palpation of the spinous processes of the thoracic spine.
   • Radicular syndrome: pain in the intercostal spaces (Erb points).
   • Visceral syndrome: dysfunction of the abdominal organs with lesions in the thoracic vertebrae V-XII. It is expressed by pain in the belt, heaviness in the right hypochondrium, heartburn.

Clinical symptoms depending on the level of thoracic spine injury:

* The defeat of nervous processes in thoracic osteochondrosis occurs with the appearance of osteophytes - bony growths 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 attacks of arrhythmia and coronary heart disease. Thus, symptoms of chronic pain in chest pain can cause organic dysfunction of the cardiovascular system.
• Defeat at Th4-Th5 level. Organs with damaged nerve fibers: pleurisy and bronchitis, pneumonia, bronchial asthma.
• Th5-Th6: the bile ducts and the gallbladder are affected. The absorption of fat in the body decreases.
• Th6-Th7: affects the liver and solar plexus region. 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 loose 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 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.

Diagnosis of thoracic osteochondrosis

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. A complete patient history should be collected in order to accurately establish or exclude the factors leading to the formation of osteochondrosis of the thoracic spine.

The very first diagnostic method is an x-ray. Further studies are conducted based on clinical history data and the need for differential diagnosis.
Any doctor can first examine the patient. The main thing is a competent and fully collected clinical 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, consultation with a traumatologist is necessary.

• Radiographic examination of the thorax in two projections. 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.
• Discography makes it possible to examine the structure of the nucleus pulposus through the use of contrast.
• Computed tomography is used to visualize nerve fibers, muscles, ligaments, and joints.
• Electromyography allows a differential diagnosis with neurological diseases.
• Endoscopic diagnostic methods may be prescribed for the purpose of examining the circulatory and digestive organs.
• An ECG is done 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 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 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 to the symptoms of diseases of internal organs. In particular, pancreatitis, inflammation of the appendages, stomach ulcers, coronary heart disease, angina, pleurisy.
• Neurosis-type disorders associated 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. The pain resulting from spinal thoracalgia and coronary artery disease (IHD) has a number of differences, which allows for an accurate diagnosis.

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

By the duration of the pain:

• IHD: Short-term attack, in minutes.
• Thoracic osteochondrosis is characterized by fading or prolonged pain, in some cases it does not go away during the day.

Change in body position:

• With ischemic heart disease, the strength and intensity of the pain does not vary with physical activity.
• With chest pain, even relatively light movements cause increased pain or the onset of a new attack.

Response to physical activity:

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

Cupping for taking medication:

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

Influence of physiotherapeutic factors and manual therapy:

• With ischemic heart disease, it gives unstable and mild 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 a competent therapy, it is necessary to establish in advance 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 first 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 treatment regimen

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

Drugs which affect the production of interleukins. They help 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 in affected nerves.

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

Hormonal drugs (steroids). They have a strong 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 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 very active pain symptoms are eliminated.

Massage

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

Effects of massage techniques:

• elimination of muscle hypertonia;
• strengthen 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 system of regular exercise therapy.

Physiotherapy

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

Manual therapy. Allows to restore 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 are recommended (green vegetables, nuts, cereals).
• Omega-3, 6 fatty acids found in fish.
• Cartilage tissue regeneration stimulants in the form of food additives help maintain tissue resistance and maintain elasticity of tissue structures.

Complications

When making the diagnosis of thoracic osteochondrosis, one should take into account the possible cascade of probable organic pathologies that develop over time.

• Damage to the cardiovascular system: the persistent pain syndrome leads to a 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 increased 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 observance of 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 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 muscular frame.
• Pumping of the muscles of the thoracic spine. There is both a complex of exercise therapy and the use of myostimulation when independent training is not possible.
• Organization of the workstation: the back of the work chair must support the spine. In order for the load on the spine not to increase, you need to warm up every 30 minutes in the form of stretching or walking. This is because the sitting position puts more stress on the spine.
• Correct spine position at night: buy orthopedic accessories for sleeping. Completely rigid surface is not rational due to the violation of the physiological curves of the spine.
• Respect for ergonomic principles: 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).