Chest osteochondrosis

Thoracic osteochondrosis is a degenerative lesion of the spine (depletion and destruction of the bone structure of the vertebra). It begins with a lesion in posture, the appearance of autonomic symptoms (shortness of breath, weakness, sweating, malaise) and the development of severe pain syndrome. Thoracic osteochondrosis mimics cardiovascular diseases, therefore, requires an accurate differential diagnosis. Therapy involves a wide range of treatments: drugs, exercise therapy, physiotherapy and massage.

Thoracic osteochondrosis is less common than cervical or lumbar. 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 they are also larger in diameter, but inferior in size to the lumbar region. This area is strong and has low mobility, and is protected by the ribcage and ribs. The physiological curvature is directed towards the back. This leads to increased stress on the anterior part of the spinal column. Further, the formation and growth of pathological bone structures on the vertebral bodies (osteophytes) occurs. Peripheral nerve endings are located among 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, degeneration of the cervical, thoracic and lumbar regions is combined with the corresponding clinical symptoms.
The clinical symptoms of thoracic osteochondrosis among women and men are approximately the same and have no significant differences.

Prevalence

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 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 region.

Classification

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 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 most pronounced.

According to the types of pain symptoms:

• Vertebral 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 lesions of the musculoskeletal system.
• Psychogenic thoracalgia is caused by panic attacks and damage to organs of neural genesis.

Causes and risk factors

Osteochondrosis does not form without lesion 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 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 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 spinal column is disrupted and the likelihood of the formation of osteochondrosis increases. Destruction intensifies if the doctor's recommendations are not followed.
• Lack of required 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, then you should be careful about your health and the prevention of lesions. 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 the immune status associated with a greater 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 provoke an increase in pain syndrome.
• Damage to the nervous system 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

Leading symptoms of thoracic osteochondrosis

• Burning sensation arising in the intercostal spaces.
• Paroxysmal and persistent pains in the chest, predominantly stabbing.
• With thoracalgia, the pain syndrome is stabbing, constricting and aching.
• Girdle pain.
• Pain in one side of the trunk.
• During movement, the crunch of the vertebrae is noted.
• Pain symptoms significantly increase with movement, deep inhalation, coughing and sneezing, which is the leading 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:

• Lesion of the lower neck. There is soreness in the upper 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 aching 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 have a cutting, aching and stabbing character. Has the appearance of attacks, both long and short. It occupies the lateral region, and also concentrates in the area of the shoulder blades.
• The appearance of pain in the anterior chest wall, differing in duration. They arise between the peri-pectoral and frontal axillary lines.

In addition to the leading 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.
• Dorsalgia - 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 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 provoke 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 the cardiovascular system);
• radicular syndrome with vegetative signs (soreness in the intercostal spaces).

When diagnosing a problem, it is required to distinguish symptoms from cardiovascular disease and myalgia. Damage to the heart of ischemic etiology is distinguished by the regularity of occurrence 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 limbs 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 a high emotional lability, bouts of tearfulness and irritability.
   • In rare situations, the disease manifests itself as severe intercostal neuralgia.
2. Various types of pain sensations:
   • Dorsago: sharp, acute soreness in the thoracic spine, sometimes making breathing difficult. Movement in the cervical and thoracic spine is limited. It manifests itself or worsens when sitting in a twisted position.
   • Dorsalgia: the formation of pain symptoms takes from two to three weeks, therefore, at first it proceeds without clinical manifestations for the patient. There is slight discomfort in the chest. The pain is aggravated by turning the body to the sides and deep breathing. 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 take a sharp breath, a stabbing pain appears in the region of the heart. As a result, pathology is often confused with damage to the cardiovascular system.
   • Cardiac or pseudocoronary syndrome is formed with lesions at the level of 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: soreness 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 girdle pain, heaviness in the right hypochondrium, heartburn.

Clinical symptoms depending on the level of lesion of the thoracic spine:

* The defeat of the nerve 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 nerve process at the Th2 and Th3 levels. Damage to the cardiovascular system occurs with the appearance of arrhythmia attacks and coronary heart disease. Thus, chronic pain symptoms in thoracalgia can provoke organ dysfunction of the cardiovascular system.
• Defeat at the 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 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 loose stools.
• Th9-Th10: damage to the 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: kidney 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.

Diagnostics of the 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 history of the patient 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 radiography. Further studies are carried out based on the data of the clinical history and the need for differential diagnosis.
Any physician can initially 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 therapy 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 required.

• X-ray examination of the chest in two projections. Allows you to establish 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 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 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.

• Anomalies 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 in symptoms of diseases of the internal organs. In particular, pancreatitis, inflammation of the appendages, stomach ulcers, coronary heart disease, angina pectoris, pleurisy.
• Neurosis-like disorders, combined with migratory pain with increased fatigue, irritability, mood swings.

Chest osteochondrosis and ischemic heart disease

It is extremely important to conduct a competent differential diagnosis with the most similar pathologies. Pain arising from vertebral thoracalgia and coronary heart disease (IHD) have a number of differences, which makes it possible to accurately establish the 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 pain:

• IHD: Short-term, within a few minutes attack.
• Chest osteochondrosis is characterized by fading or prolonged pains, in some cases they do not subside during the day.

Change in body position:

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

Reaction 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 medications:

• 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 chest osteochondrosis

Osteochondrosis is treated by a neurologist.

For the organization of competent therapy, it is required to first establish the etiological prerequisites. Identifying the cause of the pathology 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

Non-steroidal anti-inflammatory drugs help relieve chest pain caused by inflammatory reactions. This increases the volume of mobility of 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 destruction of the myelin sheaths of the nerves.

Antispasmodics are also used.

B vitamins help to stop inflammation of the affected nerves.

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

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

Diuretics in the acute period of the disease help relieve swelling from 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 the massage is to relieve spasm from the muscle corset of the thoracic spine and normalize local blood circulation.

Effects of massage techniques:

• removal of muscle hypertonia;
• strengthening 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 spasm, and also reduces pain symptoms.

Manual therapy. Allows you to bring the systemic circulation to a normal state in the intercostal space. This conditions the supply of nutrients to 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 (greens, nuts, cereals).
• Omega-3. 6 fatty acids found in fish.
• Stimulants of cartilage tissue regeneration in the form of food additives allow maintaining the strength of tissues and maintain the elasticity of tissue structures.

Complications

When establishing the diagnosis of thoracic osteochondrosis, one should 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 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 adherence to the principles of therapy, exercise therapy system, maintaining posture and eliminating 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 manifest itself actively.

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 frame.
• Pumping the muscles of the thoracic spine. There is both an exercise therapy complex and the use of myostimulation when independent training is impossible.
• Organization of the workplace: the back of the working 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 the sitting position puts more stress on the spine.
• Correct position of the spine at night: purchase orthopedic accessories for sleep. A completely rigid surface is not rational due to the violation of the physiological curves of the spine.
• Compliance with the principles of ergonomics: do not lift weights that could injure the spine.
• Formation of correct posture.
• Optimization of blood circulation and lymph flow through a system of stretch marks or the use of special procedures (pressotherapy).