Upper (Thoracic) Back Pain | Understanding Why it Hurts

Upper back pain refers to any type of discomfort or pain in the thoracic spine region. This article will provide an in-depth overview of upper back pain, including its causes, symptoms, diagnosis, and treatment options. We aim to help readers understand the anatomy of the upper back, why pain occurs, and how it can be managed effectively.

Anatomy of the Upper Back

The upper back, known medically as the thoracic spine, consists of 12 vertebrae labeled T1-T12. These vertebrae connect to the rib cage, which provides stability and protects vital organs like the heart and lungs.

Thoracic Vertebrae and Discs

The thoracic vertebrae serve as the anchoring points for the ribs. Between each vertebra is an intervertebral disc which acts as a cushion. Discs consist of a softer inner gel-like layer called the nucleus pulposus, surrounded by a tougher exterior called the annulus fibrosus.

Over time, discs can begin to break down or herniate, allowing the inner gel to push outward. This can cause pain if the herniated portion presses on nearby nerves.

Muscles and Ligaments

An intricate network of muscles spans the thoracic region, enabling movement and providing support. These include the trapezius, latissimus dorsi, rhomboids, and serratus muscles.

Ligaments also help stabilize the vertebral joints. The anterior and posterior longitudinal ligaments run vertically along the spinal column. Straining or tearing these muscles or ligaments can trigger pain.

Nerves and Nerve Roots

Spinal nerves emerge from between the vertebrae, relaying signals to and from the brain to control sensation and movement. Irritation, inflammation, or compression of these nerves can result in radiating pain, numbness or tingling.

Differences Between Upper, Middle and Lower Back

The terms “upper back” and “middle back” are sometimes used interchangeably to refer to the thoracic region. Strictly speaking, the upper back refers to the area closest to the neck (T1-T4) while the middle back spans the mid-region (T5-T8).

The lower back (lumbar spine) begins below the last thoracic vertebra (T12) and bears more body weight during movement putting it at higher risk for pain.

Common Symptoms

Upper back pain manifests in various ways depending on the underlying cause. Common symptoms include:

Types of Pain

Sharp, stabbing pain usually indicates irritation of nerve pathways caused by a herniated disc, arthritis, or muscle strain. Aching pain suggests ongoing inflammation such as from poor posture or injury. Muscular pain often feels better with rest.

Radiating Pain

Pain that radiates from the upper back area into the ribs, chest, or arms implies nerve involvement. Pressure on nerves can generate pain, numbness or tingling along the nerve’s path. This is called radiculopathy.

Muscle Spasms

Painful muscle spasms might occur along with strained muscles or ligaments. Spasms are involuntary contractions triggered by irritation of the nerves supplying the muscle.

Stiffness and Reduced Mobility

Inflammation, muscle tightness, or joint dysfunction can reduce flexibility and range of motion in the upper back. Tasks requiring reaching or rotation might be painful.

Numbness and Tingling

Beyond pain, nerve irritation or damage can cause symptoms like numbness, pins and needles, or burning sensations. This often results from disc herniations or bone spurs (osteophytes) compressing nerves.

Causes and Risk Factors

Many conditions can contribute to upper back pain. Major causes include:

Muscular Irritation

Muscle strains and sprains are common culprits often tied to overuse, poor posture, or improper lifting. Prolonged awkward positioning strains muscles leading to inflammation and spasms.

Poor posture like slouching, slumping, or bending forward can fatigue muscles, reduce blood flow, and compress discs. This irritates nerve pathways.

Structural Issues

Spinal conditions directly affect vertebrae, discs, facet joints, and surrounding tissues:

• Herniated discs – Wear and tear causes outer disc wall to weaken. Inner nucleus pushes outward, pressing on nerves.
• Spinal arthritis – Breakdown of tissues cushioning vertebrae. Bones rub together causing inflammation.
• Spinal stenosis – Narrowing of spinal canal places pressure on nerves and spinal cord.
• Fractures – Traumatic incidents like falls may fracture vertebrae or ribs, damaging surrounding nerves.

Other Medical Conditions

Sometimes systemic diseases generate referred pain perceived in the upper back, including gallbladder inflammation or lung tumors. Referred pain originates from a problem elsewhere, even though you feel it in your upper back.

Risk Factors

A variety of factors raise susceptibility to upper back pain:

• Age – Discs break down over time. Arthritis risk increases with age.
• Weight – Excess weight strains muscles and compressed discs.
• Smoking – Restricts blood flow, delaying disc nutrition and healing.
• Repeated motions – Cumulative wear and tear raises injury risk.

Diagnosis

Identifying the cause of upper back pain involves investigating symptoms, medical history, and conducting a physical examination. Diagnostic tests provide further information.

Medical History

Doctors first ask about symptom quality, timing, triggers, trauma history, and daily habits. This helps narrow down the list of likely culprits based on pain patterns. Details like radiation, varies pain intensity, relieving/aggravating factors help exclude some diagnoses.

Recent injuries provide clues to affected structures. Habits like posture, work ergonomics and lifting mechanics also offer insight.

Physical Exam

During a physical exam, doctors thoroughly evaluate the exact area of pain or tenderness, test range of motion and spinal alignment, assess muscle strength, and check neurological function. They manually palpate for muscle spasms or soft tissue injury, examine sensation and strength in the arms and legs to help determine if nerves are being impacted.

Imaging Tests

If history and examination findings prove unclear, imaging studies like x-rays or MRI scans visualize soft tissues, nerves, and bone structures:

• X-ray – Good for viewing fractures, arthritis, bone spurs, and spinal alignment.
• MRI Scan – Provides clear pictures of soft tissues like discs and nerves. Can detect subtle abnormalities.
• CT Scan – More detailed bony anatomy views than x-ray. Sometimes done alongside spinal injection procedures for precision.

Other Tests

Additional diagnostic testing options include:

• Bone Density Testing – Helps diagnose spinal fragility conditions like osteoporosis.
• Blood Tests – Check for signs of infection or systemic arthritis.
• Electrodiagnostic – Nerve conduction studies can confirm nerve dysfunction.

Putting together data from all testing allows pinpointing anatomical problems responsible for symptoms.

Treatment Options

Effective treatments for upper back pain range from simple home remedies like ice or pain medications to prescription drug therapies, injections, chiropractic care, physiotherapy, and sometimes surgery for advanced cases when conservative methods fail to help sufficiently.

Prevention Strategies

Lifestyle measures to reduce injury risk involve building muscle strength, maintaining proper posture and alignment, managing weight, proper lifting mechanics, and sufficient stretching.

Conclusion

In summary, upper back pain is a common problem with various potential causes. Typical symptoms include localized pain, muscle tightness, stiffness, and restricted mobility. Diagnosis aims to identify anatomical structures contributing to pain through physical examination, medical history, and sometimes imaging tests. Treatments range from home remedies to prescription medication, injections, physiotherapy, chiropractic treatment, or possibly surgery for persistent cases unresponsive to conservative care. Preventative measures like building strength, maintaining proper posture and technique, weight control, and stretching can help reduce injury risk and future back problems.