Chest pain is often a cause for concern. What's this? Symptoms of thoracic osteochondrosis or a heart attack?
Consider the features of the course, signs or symptoms of thoracic osteochondrosis.
A healthy spine is a beautiful posture, ease of movement and a guarantee of the normal functioning of the body as a whole. The thoracic spine has its own characteristics: a slight dynamic load, an extensive muscular "corset", all this makes the thoracic region less vulnerable to degenerative changes. But, unfortunately, even unexpressed thoracic osteochondrosis can cause a lot of trouble.
Mechanisms of development of thoracic osteochondrosis
The formation of osteochondrosis in the thoracic region is less intense than in the lumbar or cervical spine. Due to the fact that the thoracic spine is inactive, the intervertebral discs in it are slightly injured, therefore hernias of the thoracic discs with compression syndromes (compression of the roots of the spinal nerves or the spinal cord) appear less frequently than in the cervical or lumbosacral spine.
The main targets for degenerative changes at the thoracic level are the joints, but discs can also be affected. Thus, the symptoms of thoracic osteochondrosis are usually caused precisely by the defeat of the facet joints, costovertebral joints and their capsules.
In the clinical picture of thoracic osteochondrosis, the following syndromes are distinguishable:
- pain (vertebrogenic thoracalgia);
- compression (compression of the roots, spinal cord, arteries).
According to the frequency of occurrence, the syndromes are divided into the following:
Pain in the chest (thoracalgia).
The most common symptoms of thoracic osteochondrosis are vertebrogenic pain in the chest.
Osteochondrosis is characterized by dull, aching pains in the chest and spine, often unilateral or median localization. With the appearance of acute, piercing pain in the left or right half of the chest, it must be differentiated from acute coronary syndrome. At home, you can use a test with a venodilating agent from the nitrate group - if taking the drug under the tongue relieves pain, then most likely it is an angina attack and hospitalization is needed.
The key features of vertebrogenic thoracalgia are their dependence on movements, breathing, and body position.
Although in the vast majority of cases the problem is quite benign, it is worth paying close attention to the diagnosis of thoracalgia, because a number of serious diseases can be hidden under the guise of osteochondrosis. Often, such pain mimics peptic ulcer disease, cholecystitis, and even acute coronary syndrome.
At the thoracic level, a number of reflex syndromes associated with the formation of pathological muscle hypertonicity are distinguished, these are:
- scapular-rib syndrome;
- anterior chest wall syndrome (pectalgic syndrome);
- interscapular pain syndrome;
- abdominalgic syndrome (pseudovisceral pain).
Muscular syndromes are characterized by local muscle compactions, aching, aching pains that do not correspond to either the zones of innervation of the roots or the zones of innervation of the peripheral nerves.
For the clinic of thoracic osteochondrosis, compression of the roots is atypical. There are radicular syndromes with mechanical pressure of hernial protrusions or osteophytes on the roots of the spinal nerves and their arteries. The clinical picture depends on the level of the lesion. The main symptoms of thoracic osteochondrosis with radiculopathy are presented in the table.
First thoracic root Th1.
The pain zone covers the scapula, axillary region, arm up to the elbow along its inner surface. There may be pain or discomfort in the pharynx.
The skin loses sensitivity in the same region.
Thoracic roots from Th2 to Th6.
Interscapular region, axillary region and anterior chest wall to the lower edge of the sternum. Pain or discomfort in the esophagus, sometimes the stomach.
Numbness of the skin in the same area (comparable to a short T-shirt). There is a bulging of the scapula on the side of the lesion, due to muscle weakness. There may be sensations of a foreign body in the pharynx and esophagus.
Thoracic roots from Th7 to Th8.
Girdle pains descend from the angle of the scapula down to the lower edge of the ribs. There may be pain in the stomach, behind the sternum and in the heart.
Loss of skin sensitivity and pathological muscle tension of similar localization.
Thoracic roots from Th9 to Th10.
The pains are excruciating in nature. Location of pain in front from the lower edge of the ribs to the navel, behind - at the same level. There may be pain in the projection of the intestine.
Decreased sensation in the skin of the middle part of the abdomen. There is also muscle tension.
Thoracic roots Th11 to Th12.
The pain descends from the navel and down to the inguinal region. Behind, it runs along the lower part of the thoracic vertebrae.
Muscular hypertonicity and impaired sensitivity in the lower abdomen.
Typical radicular pain is most pronounced with deep breathing, coughing and sneezing. Sometimes pain is aggravated in the supine position.
Compression of the spinal cord and its arteries.
In the thoracic region, this is an extremely rare symptom of thoracic osteochondrosis, because. hernias of considerable size, narrowing the lumen of the spinal canal and compressing the spinal cord, are rare. Compression myelopathy at this level is manifested by local or girdle pain. Then revival of reflexes and loss of sensitivity in the lower extremities are shown. Subsequently, paralysis in the legs, dysfunction of the pelvic organs develop.
Compression of the arteries supplying the spinal cord at the thoracic level, with the development of ischemic myelopathy, is an extremely rare phenomenon, which is due to the anatomical and physiological characteristics of the blood supply to the thoracic spinal cord. But still it is possible with compression of Adamkevich's artery, in its main anatomical variant. Clinical signs of a developing ischemic lesion resemble intermittent claudication. There are paroxysmal weakness and numbness in the legs, sometimes urinary incontinence, which disappear after rest.
The course of neurological complications
Symptoms of thoracic osteochondrosis are characterized by alternating periods of exacerbation and improvement (remissions). After remissions, which can be short-term or last for years, the next exacerbations are usually supplemented by new symptoms and often take a longer and more difficult course. Provocations for new exacerbations are usually unfavorable static or dynamic loads (awkward movements, heavy lifting, especially in untrained individuals, prolonged stay in an uncomfortable position). The provoking role of other irritants (hypothermia, stress) that contribute to the development of reflex syndromes is also undoubted.
In old age, with the development of disc fibrosis and the development of other compensatory mechanisms, exacerbations become less pronounced, and then completely stop.
The insidiousness of the symptoms of thoracic osteochondrosis is that the nature and localization of pain can coincide with many diseases of the internal organs. Similar symptoms can be observed in other diseases of the spine: injuries, tumors, inflammatory processes. In each case, the spectrum of manifestations of the disease can complicate the diagnostic search.
What diseases should be excluded when making a diagnosis of thoracic osteochondrosis?
We will schematically divide them into 7 groups.
Somatic diseases(diseases of internal organs):
- diseases of the cardiovascular system (myocardial infarction, angina pectoris, aortic aneurysm, pulmonary embolism, etc. );
- diseases of the gastrointestinal tract (gastric ulcer and duodenal ulcer, pancreatitis, cholecystitis);
- diseases of the lungs and mediastinum (pneumonia, pleurisy, mediastinitis);
- kidney disease (pyelonephritis, glomerulonephritis, urolithiasis).
- secondary metastatic lesions of the vertebral bodies (with cancer of the breast, prostate, lung);
- benign tumors of the spine (hemangiomas, osteomas);
- malignant tumors of the spine and spinal cord.
- herpetic infection (herpes zoster);
- epidural abscess.
Injuries(compression fracture of a vertebra).
- ankylosing spondylitis;
- rheumatoid arthritis;
- psoriatic arthritis and spondylitis.
- postmenopausal osteoporosis;
- senile osteoporosis;
- osteoporosis in endocrine diseases (thyrotoxicosis, hypercortisolism, acromegaly, hypogonadism, hyperparathyroidism);
- secondary osteoporosis with calcium deficiency (malabsorption, alcoholism, lack of vitamin D).
Diseases of the nervous system(neuropathies, syringomyelia, amyotrophic lateral sclerosis).
The appearance of symptoms of thoracic osteochondrosis is not the case when you should engage in self-diagnosis and self-treatment. This is an occasion to consult a doctor to clarify the diagnosis and exclude a number of serious diseases. Particularly attentive to chest pain should be the elderly, children, and people with concomitant diseases of the internal organs.