Osteochondrosis of the chest

Thoracic osteochondrosis is a degenerative lesion of the spine (exhaustion and destruction of the bone structure of the spine). It begins with a lesion in posture, the appearance of autonomic symptoms (difficulty breathing, weakness, sweating, fatigue) and the development of severe pain syndrome. Thoracic osteochondrosis mimics cardiovascular disease and therefore requires an accurate differential diagnosis. Therapy includes a wide range of treatments: medications, exercise therapy, physiotherapy and massage.

Thoracic osteochondrosis is less common than cervical or lumbar. This is due to the specificity of the anatomical structure. The spinal rings in the thoracic region occupy two thirds of the entire spine, and they are also larger in diameter, but inferior in size in relation to the lumbar part. This area is strong and poorly mobile, and is protected by ribs and ribs. The physiological curvature is directed toward the back. This leads to increased stress on the front of the spine. Further, there is the formation and growth of pathological bone structures on the vertebral bodies (osteophytes). Peripheral nerve endings are located between the ligaments and muscle tissue, their tension leading 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 corresponding clinical symptoms.
The clinical symptoms of thoracic osteochondrosis in 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 is often created in pregnant women due to the pronounced load on the thoracic region during gestation.

They all have a predisposition to create osteochondrosis of the thoracic region. This is due to the upright posture of the person and, as a result, a large load on the spinal part.

Classification

Thoracic pain syndrome is characterized by severe chest pain of an intense nature. The syndrome is associated with damage to peripheral nerves. Defeat is due to compression of nerves by muscles and ligaments.

Degree of thoracic osteochondrosis:

• The first degree is characterized by the absence of pronounced clinical manifestations. Intervertebral discs lose elasticity and their protrusions form.
• 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, simultaneous symptoms of pain are possible.
• In the third degree, the pain syndrome increases. A herniated disc located between the vertebrae is possible. The severity of the symptoms depends on the location of the hernia.
• Fourth degree with complete violation of elasticity and loss of function of intervertebral discs, destruction of the bony structure of the vertebrae. Neurological disorders are the most pronounced.

According to the types of pain symptoms:

• Vertebral thoracalgia is justified by spinal pathology.
• Nonvertebrogenic thoracalgia is caused by the creation of pathologies of internal organs: cardiovascular diseases, gastroduodenal reflux, traumatic and inflammatory lesions of the musculoskeletal system.
• Psychogenic thoracalgia occurs with panic attacks and damage to organs of neural genesis.

Causes and risk factors

Osteochondrosis does not form without lesion factors. Numerous reasons or a combination of them lead to the development of diseases in the thoracic region.

• Sedentary lifestyle. Lack of physical activity leads to weakness of the back muscles and the intervertebral segment. Inactive work and improper workplace organization 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. In the background of these pathologies, the work of the spinal column is disturbed and the probability of osteochondrosis increases. Destruction is intensified 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 probability 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.

Bitan!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 lesion prevention. The competent system of preventive measures prevents the mass destruction of bone tissue.

Who is in danger

Factors often combine to create degenerative changes in the spine.

• Decreased immune status associated with greater susceptibility to infections that may exacerbate 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 that cause increased pain.
• Nervous system damage of non-infectious and infectious etiology.
• Physical overload.
• Non-compliance with the principle 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 that occurs in the intercostal spaces.
• Paroxysmal and persistent chest pain, mostly stabbing.
• In thoracalgia, the pain syndrome is stabbing, constricting and painful.
• Low back pain.
• Pain in one side of the torso.
• Vertebral contraction was noted during movement.
• Symptoms of pain are significantly increased by movements, 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 along the intercostal spaces.
• The patient's condition worsens when exposed to low temperatures or prolonged stay in an awkward position.

Types of pain syndrome in thoracic spine osteochondrosis:

• Lower neck lesion. The pain is in the upper part of the 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, affecting the central part of the chest. Frequent combination with pain in the shoulder blades.
• Defeat of the scapular-rib zone. Painful symptoms have a cutting, painful and stabbing character. There are seizures, both long and short. It occupies the lateral area and also concentrates on the shoulder blade area.
• Occurrence of pain in the front wall of the chest, of different duration. They occur between the peripheral and frontal axillary lines.

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

• Dorsago - intense but short-lived pain at the site of localization of the affected intervertebral discs. Disorder of normal breathing.
• Dorsalgia - mild but long-lasting 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). Defeat is expressed by violation of the mobility of the thoracic spine, pain in suturing and cutting in the intercostal spaces.

Vertebral thoracalgiamay 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 piercing nature in the digestive tract or cardiovascular system);
• radicular syndrome with vegetative signs (pain in the intercostal spaces).

When diagnosing the problem, it is necessary to distinguish symptoms from cardiovascular disease and myalgia. Heart damage of ischemic etiology differs in the regularity of its occurrence during physical or psycho-emotional stress and the alleviation of attacks 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 the result of problems with psychological stability.

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

1. Neuralgic symptoms:
   • In thoracic osteochondrosis, numbness and tingling may occur in both the upper limbs 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 crying and irritability.
   • In rare situations, the disease manifests as pronounced intercostal neuralgia.
2. Different types of pain sensations:
   • Dorsago: sharp, acute pain in the thoracic spine, sometimes difficult to breathe. Movements in the cervical and thoracic spine are limited. It manifests or worsens when you sit in a twisted position.
   • Dorsalgia: the formation of pain symptoms lasts from two to three weeks, so it initially takes place without clinical manifestations for the patient. There is mild chest discomfort. The pain is intensified by turning the body to the sides and taking deep breaths. The final stabilization of the pathological process results in a permanent pain syndrome.
   • Intercostal neuralgia: pain in the girdle radiating along the intercostal spaces. When you inhale sharply, a stabbing 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 rotating the spine. They are reinforced by prolonged stay in a forced position. The pain is palpation of 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 thoracic spine V-XII. It is expressed in the belt of pain, heaviness in the right hypochondrium, heartburn.

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

* Defeat of nervous processes in thoracic osteochondrosis occurs in cases of osteophytes - bone growths on 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 appearance of arrhythmia attacks and coronary heart disease. Thus, chronic symptoms of thoracic pain can cause dysfunction of the organs of the cardiovascular system.
• Defeat at the level of Th4-Th5. 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 is reduced.
• 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: changes in duodenal and pancreatic function. 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: impaired renal function, leading to 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 osteochondrosis is suspected, you can contact a therapist or neurologist.

The patient is examined with all clinical data recorded. During the formation of phase 2-3, the skeleton is subjected to significant deformations. A complete history of the patient should be collected in order to accurately determine or exclude the factors that lead to the formation of osteochondrosis of the thoracic spine.

The first diagnostic method is radiography. Further investigations are conducted based on data from clinical history and the need for differential diagnosis.
Any doctor can initially examine a patient. The main thing is a competent and fully collected clinical history. This will allow you to accurately determine the etiology of the disease and choose the treatment regimen. A 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.

• Chest X-ray in two projections. It allows you to determine the presence and size of osteophytes, determine the contours and height of intervertebral discs, determine changes in the shape of the disc.
• Discography allows the examination of the structure of the nucleus pulposus using contrast.
• Computed tomography is used to visualize nerve fibers, muscles, ligaments and joints.
• Electromyography enables the differential diagnosis of neurological diseases.
• Endoscopic diagnostic methods may be prescribed for examination of the circulatory and digestive organs.
• An ECG is performed to determine the etiology of cardiovascular disease.
• Electroencephalography - to determine the pathology of the nervous system.

Differential diagnosis

Thoracic osteochondrosis should be distinguished from a number of diseases.

• Anomalies in the formation of the spine, trauma, tumors, 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 lengths of the lower limbs, muscle cramps, muscle inflammation and others).
• It is not associated with damage to the musculoskeletal system, but it is similar to the symptoms of diseases of internal organs. In particular, pancreatitis, inflammation of the appendages, gastric ulcer, coronary heart disease, angina pectoris, pleurisy.
• Disorders similar to neurosis, combined with migratory pain with increased fatigue, irritability, mood swings.

Osteochondrosis and ischemic heart disease in the chest

It is extremely important to make a competent differential diagnosis with the most similar pathologies. Pain resulting from vertebral thoracalgia and coronary heart disease (IHD) has numerous differences, which enables accurate diagnosis.

The nature of pain: in diseases of the coronary arteries, they have a burning and constricting character, accompanied by the fear of death.

According to the duration of pain:

• IHD: In the short term, within minutes of an attack.
• Osteochondrosis in the chest is characterized by disappearance or long-lasting 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 do not vary depending on physical activity.
• In thoracalgia, even relatively mild movements cause increased pain or the appearance of a new attack.

Reaction to physical activity:

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

Medication Cup:

• With an ischemic attack, the pain is easily alleviated 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 in the chest

Osteochondrosis is treated by a neurologist.

For the organization of competent therapy it is necessary to first establish the etiological prerequisites. Determining 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 beforehand. 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 interleukin production. They allow stopping the inflammatory cascade and normalizing the balance of enzymes that cause the destruction of myelin sheaths of nerves.

Antispasmodics are also used.

B vitamins help stop inflammation of the affected nerves.

Preparations that preserve the concentration of collagen and elastane enable fluid retention in the intervertebral discs. This increases the elasticity of the tissue and prevents further degeneration.

Hormonal (steroid) drugs. They have a strong anti-inflammatory effect, but are used only for acute thoracic pain, because they negatively affect the body as a whole.

Diuretics in the acute period of the disease help to alleviate the swelling of the nerve endings. Potassium-sparing diuretics are preferred.

Anti-inflammatory ointments and gels. When you rub 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 cramps in the muscular corset of the thoracic spine and normalize local blood circulation.

Effects of massage techniques:

• removal of muscular hypertension;
• strengthening the body structure of 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 cramps and also reduces pain symptoms.

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

Diet for 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 (greens, nuts, cereals) are recommended.
• Omega-3, 6 fatty acids found in fish.
• Stimulants of cartilage tissue regeneration in the form of food additives enable maintenance of tissue strength and maintenance of elasticity of tissue structures.

Complications

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

• Damage to the cardiovascular system: persistent pain syndrome leads to destabilization of ion exchange of myocardial muscles, which is a prerequisite for the development of coronary heart disease.
• Abdominal disorders: stomach, duodenum, pancreas. This is due to the high secretion of adrenaline with the syndrome of permanent pain, which leads to increased secretion of VIP (vasointestinal peptides).
• Gallbladder dyskinesia is justified by an increase in bile lithogenicity in the background of a chronic inflammatory process.

By regularly adhering 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 if the disease does not manifest itself actively.

Prophylaxis

• Removal of hypodynamics, therapeutic exercises. Exercises against force, vertical loads with displacement, stretching of the spine were selected.
• When driving a car for a long time, choose special exercises to relax the muscular frame.
• By pumping the muscles of the thoracic spine. There is also a complex of exercise therapy and the use of myostimulation when independent training is impossible.
• Workplace organization: the back of the work chair should provide support to the spine. In order not to increase the load on the spine, warm up every 30 minutes in the form of stretching or walking. This is because the sitting position puts more strain on the spine.
• Correct position of the spine at night: buy orthopedic sleeping accessories. 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.
• Forming proper posture.
• Optimization of blood circulation and lymph flow through the stretch mark system or the use of special procedures (pressure therapy).