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How Do You Treat Thoracic Nerve Pain

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Learn More About Pinched Nerves

How to Eliminate Nerve Pain in Your Arm (Thoracic Outlet)

A pinched nerve occurs when a single nerve or group of nerves get compressed. This compression is often caused by pressure from bones, ligaments, tendons and even soft tissue that impinge or pinch the nerve. The medical term for a pinched nerve in the spine is Radiculopathy.

Your spinal cord extends from your brain and runs down your spinal canal through the center of your vertebrae. Nerve roots branch off your spinal cord and go between the vertebrae through small openings called foramina. These nerves travel to all ends of the body and transmit signals to the brain.

Our spines endure extreme pressure on a daily basis making them susceptible to injury. Sometimes this pressure or injury cause changes in the foramina resulting in radiculopathy, or a pinched nerve.

How Is Thoracic Radiculopathy Diagnosed What Can A Thoracic Mri Detect

Most of the time Thoracic Radiculopathy is diagnosed with a combination of history and exam plus a thoracic MRI. An MRI can detect a disc bulge or arthritis that might irritate a nerve . However, this is where some patients may experience issues in getting properly diagnosed.

Most physicians are very comfortable with neck and lower back issues. However, many never really perform a proper examination of the thoracic spine. Lets dig in there a bit.

VectorMine/Shutterstock

For example, there are spinal nerves that supply the skin as shown above. Each stripe across has a letter and number, so T2 means the second thoracic spinal nerve. The location where the pain/numbness/tinging wraps around can therefore pinpoint which thoracic level we should pay attention to on MRI or in treatment. However, few physicians perform an examination of these areas. What would that look like?

A proper thoracic exam uses a pinwheel where the doctor goes up and down on your upper back looking for areas that feel less or more. These areas that feel different can be linked to irritated spinal nerves. How many physician specialists out of 100 perform this exam? Very, very few.

Cleveland Clinic Heart Vascular & Thoracic Institute Vascular Medicine Specialists And Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart, Vascular & Thoracic Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:

Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

You may also use our MyConsult second opinion consultation using the Internet.

The Heart, Vascular & Thoracic Institute also has specialized centers and clinics to treat certain populations of patients:

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What Are The Symptoms Of Thoracic Nerve Damage

With thoracic nerve damage, the symptoms will depend on which vertebral levels have incurred the damage. Injury to the thoracic nerves usually result in paraplegia. If the T-1 to T-5 nerves near the top of the thoracic spine are affected, it can cause issues in the chest and upper torso. Injury to T-6 to T-12 thoracic nerves may also result in problems controlling the bowels or bladder.

Your thoracic nerves may have been damaged if you are experiencing any of these symptoms:

  • Pain that starts from the lower neck to the shoulder, back, and chest

Types Of Nerve Root Injections

Thoracic Outlet Syndrome Tests, Treatment &  Symptoms ...

Selective Nerve Root Block : This is a diagnostic-only procedure. It tests to see if a specific nerve is causing pain by blocking it with a strong anesthetic. No steroid is used. The anesthetic may cause temporary numbness, tingling, and/or mild weakness in the affected leg. These symptoms and any pain relief only last until the anesthetic wears off.

Nerve Root Injection : This is a diagnostic and therapeutic injection. Both a strong anesthetic and steroid are used and injected around the nerve and into the epidural space.

Transforaminal Epidural Steroid Injection : This is primarily a therapeutic procedure aimed at relieving pain when the physician knows which nerve is affected. A lighter anesthetic and steroid are injected around the nerve and epidural space.

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Translation Into Practice: Practice Pearls/performance Improvement In Practice /changes In Clinical Practice Behaviors And Skills

Thoracic myelopathy and radiculopathy may occur secondary to degenerative, congenital, infectious, traumatic, vascular, endocrine, neoplastic or iatrogenic causes. The physical exam can provide clues to the diagnosis, but oftentimes MRI is required to make a definitive diagnosis. If radiculopathy is expected, it is reasonable to delay MRI, thus reducing unnecessary costs while a trial of conservative treatment is tried for 4-6 weeks.

What Is Upper And Middle Back Pain

Upper and middle back pain can occur anywhere from the base of your neck to the bottom of your rib cage.

Your ribs attach to a long, flat bone in the center of the chest called the sternum and attach to and wrap around your back. If a nerve in this area is pinched, irritated, or injured, you may also feel pain in other places where the nerve travels, such as your arms, legs, chest, and belly.

The upper and middle back has:

  • 12 vertebrae. These bones attach to your rib cage. They make up the longest part of your back.
  • Discs that separate each vertebra and absorb shock as you move.
  • Muscles and ligaments that hold the spine together.

See a picture of the spine.

Upper and middle back pain is not as common as low back pain or neck pain, because the bones in this area of the back don’t flex or move as much as the bones in your lower back or neck. Instead, they work with the ribs to keep the back stable and help protect vital organs, such as the heart and lungs.

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How Is Long Thoracic Nerve Damage Diagnosed

testinglong thoracic nerve

Self-care:

  • Rest as directed. Move slowly and carefully.
  • Apply ice or heat as directed. Ice decreases pain and swelling and may help decrease tissue damage.
  • Use an elastic wrap or back brace as directed. These will help keep the injured area from moving so it can heal.
  • Go to physical therapy as directed.
  • Conceiçao Caubilla

    Is It Something To Worry About

    Single Best Treatment for Mid-Back or Thoracic Pain (Do-It-Yourself)

    The short answer, in most cases, is no. Most people with thoracic spine pain get better without treatment in a couple of weeks.

    However, thoracic back pain is more likely to be due to a serious cause than pain in other areas of the spine. There is a whole list of things to look out for that might indicate there’s a problem. The sort of red flags I’m going on about include pain coming on shortly after an accident, having a condition that causes a wonky immune system, feeling generally unwell, or having pain that’s getting worse after a couple of weeks’ treatment.

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    What Causes Upper And Middle Back Pain

    Upper and middle back pain may be caused by:

    • Overuse, muscle strain, or injury to the muscles, ligaments, and discs that support your spine.
    • Poor posture.
    • Pressure on thespinal nerves from certain problems, such as a herniated disc.
    • A fracture of one of the vertebrae.
    • Osteoarthritis caused by the breakdown of cartilage that cushions the small facet joints in the spine.
    • Myofascial pain that affects the connective tissue of a muscle or group of muscles.

    In rare cases, pain may be caused by other problems, such as gallbladder disease, cancer, or an infection.

    Arterial / Vascular Tos

    Arterial thoracic outlet syndrome is thought to be very rare. It has infact been estimated that approximately 95% of the thoracic outlet syndrome cases are related to neurogenic symptoms . But, how reliable is this estimate? First of all, neurogenic TOS is in general misdiagnosed, overlooked, etc even though it is the most easily triggered type of pain. Arterial TOS is much more subtle, and may mimic many other issues. It is therefore extremely difficult to quantify its involvement and thus, in my view, highly unlikely that this estimate is reliable.

    The most common symptoms of arterial and/or venous TOS is:

    • Dizziness / vertigo
    • Feeling heavy-headed or as if wearing a tight helmet
    • Difficult to concentrate
    • More rare ischemia of the arm or hand
    • Also rare swelling

    Most of these symptoms may have several other potential causes, which is why you need to do a probability estimate of whether thoracic outlet compression may be involved or not. One factor that often holds true, is visible increase of pressure in the external jugular vein. This is almost always caused by tightness of the SCM and scalenes, and/or depression of the clavicle , as it compresses the subclavian artery and thus compromises these structures. You can also have the patient elevate the arm, then evaluate whether or not the radial pulse diminishes, which would indicate compromisation of blood flow and thus also arterial TOS.

    Fig. 23 Source: tos-syndrome.com

    Fig. 24

    Fig. 24

    Fig. x

    Fig. x

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    Thoracic Back Pain Treatment

    • You may not need any treatment as many cases settle down without it.
    • If you have an underlying cause, this will need treatment of its own accord.
    • If the pain is coming from a joint in the spine this may be helped by an injection performed under X-ray vision .
    • Surgery which opens the covering of the spinal canal to treat a slipped disc causing thoracic spine pain can be a dangerous operation. However, a less risky technique involving surgery through the skin is sometimes performed.

    Disease Progression Including Natural History Disease Phases Or Stages Disease Trajectory

    Medical illustration detailing thoracic outlet syndrome ...

    Thoracic radiculopathy is generally a reversible disease well managed by conservative treatment. Asymptomatic thoracic disc herniations usually resolve without intervention and overtreatment must be avoided.7 Retrospective studies suggest that 77% of patients with symptomatic TDH managed non-surgically to return to their prior level of activity.11 Some patients with radiculopathy will have progression of disease to include sensory deficits, and motor weakness, which may or may not be reversible. The potential deficits include loss of sensation in a band of skin on the abdomen or chest, weakness of the intercostal muscles and potentially weakness of the abdominal muscles. If the T1 nerve is involved deficits can be seen with intrinsic hand function, but aside from this, thoracic radiculopathy tends to less functionally debilitating than either cervical or lumbar radiculopathy.

    Thoracic myelopathy can progress from subtle gait complaints to complete spinal cord injury. As the majority of patients with thoracic radiculopathy can be treated conservatively, signs of myelopathy such as bowel or bladder incontinence, profound motor weakness or hyperreflexia prompt evaluation by surgical colleagues.

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    Helpful Stretches And Exercises

    Sometimes, stretches and exercises may help relieve the symptoms of a pinched nerve in the upper back.

    Yoga or pilates can lessen pressure in the area, which could alleviate the symptoms. It is important that people avoid overstretching, as this could make the condition worse. If any pain or discomfort occurs, a person should stop immediately to avoid further damage.

    A doctor may also suggest physical therapy, as a combination of massage, exercise, and gentle stretching may help eliminate the symptoms and pain associated with a pinched nerve.

    The Median Nerve Compression Sites

    Most of the same principles of both identification and correction apply to the median nerve. The entrapment points of the median nerve are underneath the pronator teres muscle, and within the carpal tunnel.

    The carpal tunnel is a little different than the rest of the compression points in this article. Eleven tendons pass through the CT, and even slight hypertrophy of these will greatly reduce the space within the tunnel. Flexor dominance will lead to hypertrophy, and may thus lead to strangulation of the median nerve within the carpal tunnel. Stretching the finger flexors followed by strengthening of the finger and wrist extensors may be a very beneficial and rewarding protocol.

    Fig. 18

    Pronator teres syndrome. Squeeze into the pronator teres and see whether it reproduces median neuralgia. If it does, MMT it by having the client resist your attempt to supinate their wrist. If its weak, strengthen it with the exercise provided in the video about wrist supination and pronation, further up.

    Fig. 19 MMT for the pronator teres

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    How To Treat Spinal Hemangioma

    As we mentioned above, thoracic hemangioma are benign tumors meaning they are not usually inherently harmful. However, because they develop and grow so close to the spine, they have the potential to interfere with the spinal nerves, discs, and other structures. This can, in turn, result in immense pain and loss of feeling. Treating hemangiomas can involve injections, radiation therapy, chemotherapy, and surgery. Surgical removal of the tumors is typically the best and most efficient method for long-term care.

    If you recognize any of the symptoms of thoracic hemangioma in yourself, or if you have been diagnosed with the condition, speak to a spine specialist to discuss your options for treatment.

    Signs Of Thoracic Hemangioma

    Mid-Back Pain or Thoracic Pain: How to Treat!

    The first step in treating a hemangioma is successful identification and diagnosis. Here are a few signs that might indicate a diagnosis of thoracic hemangioma:

    • Pain in the mid to low back
    • Pain or numbness in the extremities

    If you experience these symptoms, make an appointment with your doctor to diagnose the condition. Your physician will likely perform a physical exam and order one of more imaging tests to better visualize the hemangioma.

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    At Different Disease Stages

    Treatment depends on the etiology. The natural history of TDH favors non-surgical treatments. Surgical procedures are relegated to progressive compressive myelopathy or unrelenting compressive radiculopathy. Interventional spine procedures including epidural steroid injections and selective nerve blocks, can provide significant pain relief, and also have the potential to provide diagnostic information. There is fair evidence supporting the use of thoracic interlaminar steroid injections for relieving radiating pain 22Progressive disease with no response to conservative treatment should be referred for surgical consultation. Newer thoracoscopic microsurgical techniques show less complications with almost 80% of patients reporting good or excellent pain outcomes.23 If chronic pain significantly interferes with daily activities, the recommended treatment consists of a comprehensive integrated interdisciplinary approach. Chronic spasticity management in spinal cord injured patients may require the use of oral baclofen or the implantation of a catheter-pump system for the delivery of intrathecal baclofen.

    Cutting Edge Concepts And Practice

    Regenerative Medicine techniques including injections with stem cells and platelet rich plasma may provide relief to patients 24, but these techniques are still being investigated to demonstrate safety and efficacy. Neural stem cell transplantation is currently being investigated in murine embryonic stem cells.25

    The use of functional electrical stimulation and other related devices, including FES bikes, are being promoted in aiding gait, mobility and improving cardiovascular status.

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    Available Or Current Treatment Guidelines

    Rehabilitation treatment of thoracic radiculopathy will depend on the symptoms presentNonsteroidal anti-inflammatories, a short course of glucocorticoids and/or physical therapy are commonly utilized treatment options but lack evidence in terms of outcomes. There is evidence to support transcutaneous electrical nerve stimulation being a useful modality for pain control, and it is relatively inexpensive and low risk.19 For long standing neuropathic pain, agents such as gabapentin, pregabalin, amitriptyline and other anticonvulsants may be considered because they have shown efficacy for neuropathic pain.20,21 Opioid pain medications may be used in refractory cases but given their significant addictive potential and side effect profile, discretion must be used.

    What Are The Symptoms

    How Do You Treat A Bulging Disc

    Common symptoms of upper and middle back pain are:

    • A dull, burning, or sharp pain.
    • Muscle tightness or stiffness.

    More serious symptoms that need to be treated right away include:

    • Weakness in your arms or legs.
    • Numbness or tingling in your arms, legs, chest, or belly.
    • Loss of bowel or bladder control.

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    Surgical Options For The Treatment Of Radiculopathy

    The aim of surgery is to relieve nerve compression, restore mobility, and relieve pain. There are several different surgical procedures which may be used, depending on the location of the pinched nerve and the underlying cause. Surgical options include:

    Microdiscectomy: This surgical procedure can be used to relieve the symptoms of lumbar radiculopathy caused by a herniated disc. This procedure involves the removal of a small piece of the disc from the area where the nerve root is being compressed. This allows the root more room so it can heal.

    Prior to this procedure, you will be given a general anesthetic. The surgeon will make a small incision in your back above the affected vertebra. After moving the muscle, the surgeon will remove a small piece of vertebral bone for surgical access to the disc. The damaged herniated disc and surrounding tissue will then be removed, decompressing the nerve. The incision will then be sutured.

    You should be able to return home within 24 hours. You should avoid heavy lifting or strenuous exercise and should be fully recovered after six weeks.

    What Is Thoracic Outlet Syndrome

    Thoracic outlet syndrome is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels in the lower neck and upper chest area. Thoracic outlet syndrome is named for the space between your lower neck and upper chest where this grouping of nerves and blood vessels is found.

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