Osteochondrosis of the chest

Thoracic osteochondrosis is a degenerative lesion of the spine (depletion and destruction of the bone structure of the vertebrae). 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 disease and therefore requires an accurate differential diagnosis. The therapy includes a wide range of treatments: drugs, exercise, 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 and are also larger in diameter but smaller than the lumbar region. This area is strong and low mobility and is protected by the chest 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 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, degeneration of the cervical, thoracic and lumbar region is combined with the corresponding clinical symptoms.
The clinical symptoms of thoracic osteochondrosis in women and men are approximately the same and do not differ significantly.

Distribution

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. The pathology is often formed among pregnant women due to the pronounced load on the chest area during pregnancy.

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 of this large load on the spine.

Classification

The thoracic pain syndrome is characterized by severe chest pain of intense nature. The syndrome is associated with damage to peripheral nerves. The lesion 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 of the intervertebral discs and their protrusions are formed.
• The second stage is characterized by an additional loss of elasticity of the intervertebral discs and a reduction in their height. The likelihood of a hernia increases. Pain syndrome occurs, concomitant symptoms of pain are possible.
• In the third degree, the pain syndrome increases. Disc herniation between the vertebrae may occur. The severity of the 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 the 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 the internal organs: cardiovascular disease, gastroduodenal reflux, traumatic and inflammatory lesions of the musculoskeletal system.
• Psychogenic thoracalgia is caused by panic attacks and organ damage of neuronal origin.

Causes and risk factors

Osteochondrosis does not form without lesion factors. A number of causes or their combination lead to the development of the disease in the chest area.

• Sedentary way of life. Lack of physical activity leads to weakness of the muscles of the back and intervertebral segment. Sedentary work and improper organization of the workplace act as 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 disrupted and the likelihood of osteochondrosis increases. The destruction is intensified if the doctor's recommendations are not followed.
• Lack of necessary minerals and vitamins. Insufficient concentration of calcium in the bone tissue makes the bones 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 lesions of the musculoskeletal system are observed in a connected line, then you need to take care of your health and to prevent lesions. The 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 may improve 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.
• Damage to the nervous system of non-infectious and infectious etiology.
• Physical overload.
• 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 occurring in the intercostal spaces.
• Paroxysmal and persistent chest pain, mostly piercing.
• In thoracalgia, the pain syndrome is piercing, constricting and painful.
• Belt pain.
• Pain in one side of the trunk.
• During movement, the crunch of the vertebrae is noted.
• The symptoms of pain are significantly increased by movement, deep breathing, coughing and sneezing, which is the leading difference between thoracic osteochondrosis and angina pectoris.
• The affected areas are palpable, ie they can be felt and are located along the affected nerves.
• Numbness of the skin in the intercostal spaces.
• The patient's condition worsens with exposure to low temperatures or prolonged stay in an awkward position.

Varieties of pain syndromes in osteochondrosis of the thoracic spine:

• Lesion of the lower neck. There is pain in the upper chest that can radiate to the neck, arms, and also the left half of the body.
• Damage to the upper thoracic spine. The pain is of a nature, affecting the central part of the chest. Frequent combination with pain in the shoulder blades.
• The defeat of the scapular-rib zone. The painful symptoms are sharp, painful and piercing. There are attacks, both long and short. It occupies the lateral area and also concentrates in the area of the shoulder blades.
• The appearance of pain in the anterior chest wall, varying in duration. They occur between the thoracic 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. Disorder of normal breathing.
• Dorsalgia - mild but prolonged pain in 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 lesion is expressed in impaired mobility of the thoracic spine, pain in suturing and cutting in the intercostal spaces.

Vertebral thoracalgiamay provoke the following symptoms:

• radicular (symptoms of pain);
• violation of the innervation of the chest area (visceral manifestations: a number of patients have painful symptoms with a puncture in the digestive tract or cardiovascular system);
• radicular syndrome with vegetative signs (pain in the intercostal spaces).

When a problem is diagnosed, it is required to distinguish the symptoms from cardiovascular disease and myalgia. Heart damage of ischemic etiology is characterized by the regularity of occurrence during physical or psycho-emotional stress and relief of the attack by taking nitrates.

The 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:
   • In thoracic osteochondrosis, tingling and numbness may occur in both the upper limbs and the intercostal spaces, spreading to the anterior surface of the chest.
   • Latissimus dorsi and pectoral muscles are in constant tension.
   • Has high emotional lability, bouts of crying and irritability.
   • In rare situations, the disease manifests itself as pronounced intercostal neuralgia.
2. Different types of pain sensations:
   • Dorsago: acute, sharp pain in the chest, sometimes difficult to breathe. Movement in the cervical and thoracic spine is limited. Manifested or worsened when sitting in a twisted position.
   • Dorsalgia: the onset of pain symptoms takes two to three weeks, therefore initially proceeds without clinical manifestations for the patient. There is a slight discomfort in the chest. The pain is exacerbated by turning the body to the sides and breathing deeply. With the final stabilization of the pathological process, a permanent pain syndrome is formed.
   • Intercostal neuralgia: pain in the girdle radiating to the intercostal spaces. When you take a deep breath, a sharp 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 at the level of the ThI segments with the development of reflex angina pectoris. The difference from damage to the organs of the cardiovascular system is the appearance of pain when bending or turning the spine. They are intensified during 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 pain in the waist, heaviness in the right hypochondrium, heartburn.

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

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

• Deformation of the nervous process at the levels of Th2 and Th3. Damage to the cardiovascular system occurs with the onset of arrhythmia attacks and coronary heart disease. Thus, the symptoms of chronic thoracic pain can provoke organ dysfunction of the cardiovascular system.
• Defeat at the level of 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 fat in the body decreases.
• Th6-Th7: affects the liver and the area of the 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: changes in the functioning of the duodenum and pancreas. Manifestations: duodenitis, pancreatitis and loose 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, 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 - 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 collected to accurately identify or rule out factors leading to the formation of thoracic osteochondrosis.

The first diagnostic method is radiography. Further studies are performed based on clinical history and the need for a differential diagnosis.
Each doctor can initially examine the patient. The main thing is a competent and fully collected clinical history. This will allow you to determine the exact etiology of the disease and choose a treatment regimen. Therapist, neurologist, rheumatologist involved in the treatment of thoracic osteochondrosis. In case of traumatic effects on the spinal region, a consultation with a traumatologist is required.

• Chest X-ray in two projections. Allows you to determine the presence and size of osteophytes, to determine the contours and height of the intervertebral discs, to detect changes in the shape of the disc.
• Discography makes it possible to study the structure of the pulpal nucleus 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 to examine the circulatory and digestive organs.
• An ECG is performed to determine the etiology of cardiovascular disease.
• Electroencephalography - to identify pathologies of the nervous system.

Differential diagnosis

Thoracic osteochondrosis must be distinguished from a number of diseases.

• Abnormalities in the formation of the spine, trauma, tumor, inflammation. There are several possibilities for these pathologies. For example, additional congenital process, displacement or fusion of the vertebrae (spondylolisthesis), osteomyelitis, ankylosing spondylitis and others.
• Damage to the musculoskeletal system (different length of the lower limbs, muscle spasms, muscle inflammation, etc. ).
• It is not associated with damage to the musculoskeletal system, but similar in symptoms to diseases of the internal organs. In particular, pancreatitis, inflammation of the appendages, gastric ulcer, coronary heart disease, angina pectoris, pleurisy.
• Neurosis-like disorders combined with migratory pain with increased fatigue, irritability, mood swings.

Osteochondrosis of the chest and ischemic heart disease

It is extremely important to make a competent differential diagnosis with the most similar pathologies. The pain resulting from vertebral thoracalgia and coronary heart disease (CHD) has a number of differences that make it possible to make an accurate diagnosis.

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

By duration of pain:

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

Change in body position:

• In ischemic heart disease, the strength and intensity of the pain does not vary depending on physical activity.
• In thoracalgia, even relatively light movements cause increased pain or a new attack.

Reaction to physical activity:

• In ischemic heart disease, the pain occurs during exercise, stopping at rest.
• Thoracic pain, on the other hand, weakens but does not stop at rest.

Medication cup:

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

Influence of physiotherapeutic factors and manual therapy:

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

Treatment of osteochondrosis of the chest

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 bone regeneration are selected taking into account all the functional characteristics of the body. It is advisable to clarify the concentration of collagen and elastane in the body in advance. When choosing a therapeutic 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 chest mobility 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 to normalize the balance of enzymes that cause destruction of the myelin sheaths of the nerves.

Antispasmodics are also used.

B vitamins help stop inflammation of the affected nerves.

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

Hormonal (steroid) drugs. They have a powerful anti-inflammatory effect, but are used only in acute thoracic pain, as they adversely affect the body as a whole.

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. When rubbing the affected area of the back, the local inflammatory process is reduced and the highly active symptoms of pain are eliminated.

Massage

The therapeutic effect of the massage is to relieve spasm of the muscular corset of the chest and to normalize local blood circulation.

Effects of massage techniques:

• elimination of muscular hypertension;
• 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 system of exercise therapy.

Physiotherapy

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

Manual therapy. Allows you to bring the systemic circulation to normal in the intercostal space. This determines the supply of nutrients to tissues, improves their trophism and stimulates blood oxygenation.

Nutrition in osteochondrosis of the thoracic spine

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

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

Complications

When diagnosing thoracic osteochondrosis, the possible cascade of possible organ pathologies that develop over time should be considered.

• Damage to the cardiovascular system: the syndrome of persistent pain leads to destabilization of the ion exchange of the myocardial muscle, which is a prerequisite for the development of coronary heart disease.
• Abnormalities in 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, the system of exercise therapy, 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 is not active.

Prevention

• Elimination of hypodynamics, therapeutic exercises. Anti-strength exercises, perpendicular loads with displacement, stretching of the spine are chosen.
• When driving for a long time, the choice of special exercises to relax the muscular frame.
• Pumping the muscles of the thoracic spine. There is both a complex for exercise therapy and the use of myostimulation, when self-study is impossible.
• Workplace organization: the back of the work chair should provide support for the spine. In order not to increase the load on the spine, you should warm up every 30 minutes in the form of stretching or walking. This is because a sitting position puts more strain on the spine.
• Proper position of the spine at night: buy orthopedic sleeping accessories. A completely hard 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 can injure the spine.
• Forming a proper posture.
• Optimization of blood circulation and lymph flow through a system of stretch marks or the use of special procedures (pressure therapy).