Pain in the mid-back or thoracic spine (also known as the dorsal spine) usually arisen in similar ways to pain the lower back or neck, except that disc protrusions are less common and nerves are less likely to be trapped. Thoracic pain should always be investigated by a doctor.

Spine Anatomy
Spine Anatomy

Causes

Acute attacks may be caused by a fall or stumble, repeated heavy lifting, an awkward bend, a violent twist or wrench, a cough or sneeze, or a trivial uncoordinated movement, such as turning over in bed or getting up from a chair. The actual physical causes are probably due to mechanical dysfunction: a facet or rib joint strain or protrusion. More long-standing pain that develops gradually may be related to scoliosis.

Symptoms

The thorax houses important organs, such as the heart and lungs, which can refer pain to the front, side, or back of the chest. Symptoms include central or one-sided thoracic pain: it may hurt more when coughing, sneezing, or breathing deeply, and it invariably hurts to rotate the trunk in one direction more than the other. Central, severe pain that is made worse by bending forwards or backwards and radiates through to the front directly is more suggestive of a disc problem. In an older person who is coughing violently,a stress fracture of a rib is a possibility. Similarly, a young athlete may develop a stress fracture through repetitive strain, or may pull or tear one of the large muscles of the back in a violent movement. Pain that is worse a night may signify an underlying illness or disease. Pain may be referred to the abdomen or as low as the groin in any of the above conditions.

Risks and Complications

It is important that you rule out any potentially serious causes of thoracic pain, as it may be linked to diseases of the heart, aorta, lungs, pancreas, or kidneys. Infection in a disc or vertebra involves the thoracic spine more than any other area of the back. Very rarely, the cause of pain is secondary cancer.

Treatment – Mechanical

  • If you have acute thoracic pain of mechanical origin, you should:
    • see a doctor
    • use ice pack
    • take pain killers
    • try not to rest for more than 3 days
  • If your condition is slow to improve, you should:
    • consult a physiotherapist for treatment
  • If after 14 – 21 days you are not able to resume normal activities, you should:
    • consult your doctor for further examination, advice or treatment.
  • If after 6-8 weeks, you are not recovering as expected, you should:
    • seek further advice fro your doctor, who may consider arranging investigations such as an MRI or blood test.

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If you have suffered from a neck problem for three months or more, your pain will be described as “chronic”. The pain may be severe or mild, constant or intermittent; these factors will determine the degree to which it affects your life.

Neck Pain
Neck Pain

Causes

Precise causes of chronic neck pain are often difficult to determine. In more than 50 per cent of sufferers, it stems from the facet joints as a result of osteoarthritis, spondylosis, or a previous trauma such as a whiplash injury. If you have nerve-root pain, the most probable cause is a prolapsed disc. Less common causes of chronic neck pain include myofascial pain and, very rarely, cancer.

Symptoms

The symptoms of chronic neck pain are similar to  those of acute neck. Older people with degenerative changes in their neck may experience grinding or grating when moving, causing stiffness and aching. Recurrent episodes of more disabling pain can be triggered by trivial movements such as rotating your neck suddenly, jolting or jarring, and extending your neck or bending forwards for sustained periods of time. Numbness, pins and needles, and weakness in your hands may be a sign of cervical myelopathy – when the spinal cord in the neck is squeezed by degenerative changes in the bones and discs, leading to impairment of the nerves, affecting the arms and sometimes the legs – or spinal cord compression. Advanced cervical myelopathy may affect walking and gait. Chronic nerve-root pain may cause neuropathic features – when a nerve or nerves are damaged over a long period, leading to abnormal processing of pain – such as burning sensations. Mood and sleep patterns may become disturbed; the impact of the pain on your life can cause frustration and sometimes depression.

Risks and Complications

The physical risks of chronic neck pain are associated with the more serious conditions of major disc prolapse or cervical myelopathy leading to spinal cord compression. In rheumatoid disease, the neck can become unstable due to ligament damage. Other significant complications of chronic pain relate to its effect on your life, work, relationships, mood, and fitness.

Treatment for Facet Joint Pain

  • If your pain has been diagnosed as being caused by a facet joint problem, you should
    • take painkillers
    • start physiotherpy
  • If your pain is moderate to severe,and you have not improved with physiotherapy, you should see a specialist. The specialist may:
    • perform MRI and injections to the neck.
  • If the specialist decides that injections are not appropriate or are not working, he may:
    • suggest a functional rehabilitation programme
    • suggest an operation
  • If a more specific diagnosis leading to effective treatment has not been made
    • use medication wisely and appropriately.

Treatment for Myofascial Pain Syndrome

  • If your pain has been diagnosed as being caused by a myofascial problem, you should:
    • take painkillers
    • start physiotherpy
  • If you are still in pain, your doctor may refer you to a specialist, who may:
    • consider giving you a low dose of an antidepressant to relax your muscles and improve sleep quality.
    • identify trigger points. If these are found, he may use trigger-point injections.
  • If after several months you are still in pain, your specialist may:
    • suggest a functional rehabilitation programme.

Treatment for Disc-Related Pain

 

  • If your pain has been diagnosed as disc-related, you should:
    • take painkillers
    • start physiotherapy
  • If your pain is moderate or severe and it has not improved with physiotherapy, then you should see a specialist. He may:
    • perform MRI.
    • offer further treatment, such as prolotherapy.
  • If your spine has degenerated of the disc is badly damaged, your specialist may:
    • suggest surgery
  • If your specialist feels that treatment is not working,
    • a functional rehabilitation programme to improve the range of motion.
    • suggest surgery
  • If treatment has improved your symptoms, you should:
    • continue to practise good neck care

Call +65 64712674 for an appointment to treat Chronic Neck and Nerve Root Pain today. Same day appointment.

Acute neck and nerve-root pain describes several conditions that affect the cervical spine region, and can also cause head pain. In the long term, it is rarely as disabling as low-back pain, but the severity of acute nerve-root pain ca be just as bad as sciatica.

Neck Pain
Neck Pain

Causes

This pain can be caused by strain of the facet joints and ligaments, and disc herniation. Muscular pain is more of a chronic condition but can flare up. Your neck is also vulnerable to extend indirect trauma, as in whiplash syndrome. When acute neck pain arises spontaneously in young adults or adolescents it is called acute torticollis, or “wry neck”. Disc prolapse with nerve-root compression is the cause of the most severe pain.

Symptoms

You may feel sharp pain, centrally or to one side of the neck, with intense, dull aching that can spread further into the shoulder blade area and half-way down the thoracic spine. You may have stiffness due to your spine being trapped by a muscle spasm (known as “splinting”), and worse pain on certain movements such as bending forwards, backwards, sideways, or rotating. You may also find it hard to sit in a car or at a computer for long periods. The pain is often troublesome at night and lying down may make it worse. If a nerve is compressed or irritated, a sharp pain will radiate down your arm as far as your hand, accompanied by sensory disturbance such as pins and needles or numbness. If your motor nerve fibres have been damages, you may develop weakness in your upper arm/or forearm.

Risks and Complications

The risk of serious consequences of acute neck pain is extremely small. Most of the time the pain eases over a few weeks without specific treatment The main risk lies in too much rest, the fear of triggering pain through everyday movements, and the idea that more pain means further harm, as these can lead to loss of confidence and mobility. If you have developed pain after direct trauma such as a blow to the back of the neck, then you should obtain immediate medical advice.

Treatment for Cervical Disc Herniation

Herniated Disc

Seek Medical Attention

If you suspect your pain is caused by a cervical disc herniation, you should:

  • Relieve your pain by finding the least painful position.
  • Use ice pack for the first day of pain.
  • Take painkillers.
  • Try not to rest for more than 2-3 days.

If after 7-10 days and you are still feeling pain, you should:

  • Stay as active and mobile as you can, while being careful to avoid extreme movements of your neck.
  • Avoid prolonged reaching or working with your arms extended.
  • Ssee a doctor for stronger painkillers.

If after 2 – 4 weeks and you are still feeling pain, you should:

  • Consult a doctor for further examination and treatment.
  • See a specialist for an epidural steroid or nerve-root injection.

If after 6 – 8 weeks and you are still feeling pain, you should:

  • You may need to have an X-ray, MRI or blood test for further evaluation.

Treatment for Acute Torticollis

Seek Medical Attention

If you suspect your pain is caused by acute torticollis, you should:

  • Use ice packs and take some painkillers

If after 3 days and the pain increases, you should:

  • Avoid prolonged static positions

If after 7-10 days and the pain increases, you should:

  • Consult a doctor for further examination, advice, or treatment.

If after 6-8 weeks and the pain increases, you should:

  • You may need to have an X-ray, MRI or blood test for further evaluation.

Treatment for Whiplash

Whiplash Injury

If you suspect your pain is caused by whiplash, you should:

  • See a doctor to get your neck assessed to exclude more serious bone or nerve injury.

If after 7-10 days you are not able to resume normal activities, you should:

  • Consult a doctor for further examination, advice, or treatment.

If after 6-8 weeks you are not recovering as expected, you should:

  • See a specialist regarding the benefit from facet joint injections.
  • You may need to have an X-ray, MRI or blood test for further evaluation.

Call +65 64712674 for an appointment to treat Acute Neck and Nerve Root Pain today. Same day appointment.

When the annulus – the cover around the disc – tears, pain may occur. The annulus has nerve fibres, unlike the nucleus. When a tear occurs in the annulus, you may feel pain in the neck or lower back and areas overlying and around the tear. Pain may also travel down the arm or leg as with a true disc herniation.

Although an annular tear may produce pain that is referred or travels from the neck to an arm or from the lower back to a leg, it can never produce weakness or numbness. Only compression of the root can do that. Annular tears usually heal inn two to three months. However, they can tear again and cause pain again. This phenomenon is part of chronic discogenic pain. Discogenic pain, to the extent it is understood arises from abnormalities within the disc iteself and has nothing to do with pain from a herniation, which occurs as a result of root compression by herniated disc.

Diagnosing Discogenic Pain

If an MRI shows a tear in the annulus or disc covering, usually coupled with other signs of disc degeneration.

Conservative Treatment of Discogenic Pain

Most people with annular tears recover with rest, pain medications, and a gradual resumption of normal activity. NSAIDs, muscle relaxants for spasm, and narcotics should be used as needed. Sometimes physiotherapy or epidural steroid injections may be used.

Most discogenic pain comes from an annular tear, although that may not be the whole story. Although there is no pressure on a spinal root in this condition, it does hurt. Activity reduction and lifestyle modification so as not to bear down – risking a further tear or a disc herniation through the tear – is important.

The vast majority of annular tears causing discogenic pain heal without difficulty. For those that don’t, there are several minimally interventional treatments presented below.

Epidural Steroid Injections

Besides acting on the swollen, inflamed nerves, the liquid in the steroid epidural injection also flushes away the chemicals produced by the annular tears that cause root inflammation and pain. Studies on epidurals show that they work well for a very small specific group of people, such as those under forty who have not previously has surgery or those with pain lasting less than three months. If used at all, epidural injections are most appropriate as a short-term treatment for those whose spine-related pain also travels or radiates down a leg or arm.

Key Points about Discogenic Back Pain

  • Discogenic back pain arises from abnormalities within the disc itself. It has nothing to do with pain from a herniation, which occurs as a result of root decompression by the herniated disc.
  • Most people with discogenic back pain recover with rest, pain-relieving medications, and other conservative treatment.
  • Epidural injections work well for short-term relief on some people with this type of pain.
  • There is no need surgery for most discogenic back pain.

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As we age and our spinal discs begin to dry out, shrink, and become less stable, they can herniate, lose their covering, press on a nerve, and cause all manner of trouble. A herniated disc is an extrusion of a piece of nucleus (the gel-like center) through a tear in the annulus (the tough, leatherlike outer cover). Most disc ruptures occur between ages thirty and forty; the discs still contain a normal amount of gel, but the annulus is beginning to wear out. If the gel remains inside the cover, it is a disc protrusion. If it escapes through a torn annulus, it is a disc extrusion. Extruded pieces of disc may move up or down the spinal canal a quarter to a half-inch or so from the area of herniation. Discs may protrude to the front, the sides, or to the back.

Herniated Disc

Most disc herniations occur in areas where the spine is maximally bent forward. The forward bending of these segments results in the vertebral bodies coming closer together toward the spinal canal than in the front of the spine. This places more stress on that part of the annulus and disc facing the spinal canal. The lower neck and the lowermost lumbar spine cause the most problems. Lumbar discs are herniated several times more frequently that their cervical counterparts. Presumably, this is because of greater weight on the lumbar spine. Thoracic herniations are rare; those causing problems are even less frequent. Disc herniations may be preceded by a history of intermittent episodes of back or neck pain, possibly with twinges in the leg or arm. This is from the annulus;s being stretched and under tension.  After the disc fully herniates, the pain increases and is usually accompanied by pain radiating down the leg or arm, depending on which root or roots are irritated.

Prolapsed Intervertebral Disc

If a herniated disc does compress a nerve root, it can cause not only pain but also possible weakness, numbness, and loss of normal reflexes in the area supplied by the root. Cervical or thoracic-herniated discs can compress the spinal cord, and the large lumbar discs can significantly compress the cauda equina. These herniations can result in arm or leg weakness, numbness below the area of the cord or cauda equina compressed by the disc, and bowel and bladder disturbance. Significant compression of the cauda equina usually also causes severe pain in both legs. Depending on the extent of deficit caused by this type of herniation, emergency neurosurgical decompression my be required to minimise the damage to the nervous system and prevent the creation of permanent nerve damage.

Disc herniations are common; 70 percent to 80 percent improve with time and care. Some herniate and heal, then herniate and heal again. Too often, however, people rush to have unnecessary surgery. They then may spend the rest of their lives repairing the repair.

Cervical Discs

Cervical-disc herniations are less common than lumbar disc herniations even though you move your neck more often than you do your lower back. There is substantially less weight in the neck than in the lumbar area. Nevertheless, because the cervical spine has a smaller internal diameter – canal – and smaller foramen than other parts of the spine, small herniations are more likely to impinge on a spinal root and cause pain to radiate down the arm. Numbing and tingling may occur a far down as the fingertips. The pain is usually most severe when the disc first herniates and compresses the root. A cervical-disc herniation into the canal can also damage the spinal cord.

  • Herniation of the C4-5 disc can affect the C5 nerve root. This causes pain in the neck and over to the side of the shoulder and weakness in the other shoulder muscles and in the muscle that bends the elbow. The biceps reflex may be reduced. Sensory changes, such as numbness and tingling, may also occur in the deltoid area, on the side of the shoulder.
  • Herniation of the C5-6 disc affects the C6 root. This can cause pain running from the neck down the arm and hand to the thumb and forefinger. Weakness of some shoulder muscles, the biceps, and the wrist muscles that bend the wrists down and to the inside may exist. Sensory changes, along with pain, may extend to the lower arm and the thumb side of the hand. The biceps reflex may be reduced. This is one of the most common results of a cerivcal disc herniation.
  • Herniation of C6-7 disc affects the C7 root. Like the previous level, this is also a common site of disc herniation. Pain may radiate down to deep in the forearm and into the middle finger, and sensory changes may occur in the same area. Damage to this root causes weakness in the muscle that bends the wrist down and inward, other muscles that bend the wrist downward, and those that bend the finger, the triceps, and the muscles that raise the wrist inward, and some muscles that straighten the fingers. The triceps reflex may be reduced.
  • Herniation of the C7-T1 disc affects the C8 root. Pain may radiate down along the small-finger side of the arm and terminate in the little finger. Sensory changes may occur in the same area. Damage to this root causes weakness in the triceps, the muscles that raise and bend the wrist and fingers, and those that allow you to spread apart and bring together your fingers. The triceps reflex may be reduced.

These are typical but not absolute pain patterns. The same applies to the lumbar roots described below. Some people are wired a little differently.

Arm pain from a herniated cervical disc is common, usually occurring in thirty- to fifty-year-olds. Unlike lumbar discs, which usually herniate from lifting, carrying, or excessive bending, cervical discs are often herniated while we sleep.

Turning the head from side to side or sleeping on the stomach with the head turned to the side is a good position to herniate an already weakened cervical disc. This change in position in bed often occurs as we enter and leave the state of dream sleep. So we may awaken with a crick in our neck, which travels down an arm. Cervical-disc herniations may produce worse pain when a person carries or lifts on the side of the herniation, turns the head to the side, or strains ot bears down through lifting a heavy load, coughing, sneezing, or having a bowel movement.

Bearing down makes all disc herniation pain at any spinal level worse because the pressure within the chest and abdomen increases during this type of effort and is transmitted to the inside of the discs. Any weakness within the annulus allows more disc material to herniate during increased pressure within the disc. In turn, more pressure may be exerted on a compromised spinal root, causing more pain.

Pain from cervical and lumbar herniations is typically reduced when you bend forward, thus opening the spinal canal and the foramina and thereby relieving the pressure on the root. Pain is worse when you bend forward, thus opening the spinal canal and the foramina and thereby relieving the pressure on the root. Pain is worse when you bend backward. In any disc herniation causing root compression, you may experience throbbing pain like a toothache, pins and needles, or  burning sensation. The pain may be so severe that your back is locked in spasm, or it may be just a dull ache that increases with movement.

Thoracic Discs

The thoracic spine, behind the chest, is relatively safe from disc herniation because it hardly moves and is curved slightly backward, thus placing more pressure on the front of the discs. When these discs herniate, it is due to the weight on the thoracic spine from the body above the level of herniation or from a trauma, such as falling. A thoracic-disc herniation may cause pain radiating under the ribs, in the chest, upper abdomen, or around the thoracic spine and shoulder blades in the back of the body. Symptoms vary from a band of chest pain , deep, dull pain behind  the breastplate or stomach, or pain between the shoulder blades. Disc herniations of this type are not easily recognised by nonspecialists unfamiliar with this problem.

Lumbar Discs

Any lumbar disc can rupture. The ones at the bottom of the spine herniate most frequently because they carry a greater proportion of the body’s weight. Herniated lumbar discs can often be identified by the pattern of pain and nerve loss in the leg. The spinal cord does not extend below L1-2. However, disc herniation in the lumbar spine that primarily affects the foramen – herniating off to the side of the spine – usually damages the exiting root at that level. Those that herniate centrally into the canal may damage the root that exits the spine one level below. This depends on the size of the canal in relation to the disc and the location of the herniation and the roots exiting the dural sac.

At the L3-4 level, a disc herniation may result in damage to the L3 root exiting the spine, on the side of the disc, in the foramen, or the L4 root off to one side in the canal. The same pattern applies to the other lumbar discs. The following patterns of pain, weakness, numbness, and reflex loss exist for various lumbar roots likely to be affected by disc herniations.

  • Damage to the L3 root results in pain to the front of the thigh to the inner part of the knee. Sensory changes, such as numbness and tingling, may occur in this area. Weakness may occur in the quadriceps and the muscle that raises the thigh with the knee bent and the foot on the ground. There may be reduction of the knee reflex.
  • If the L4 root is damaged, it may result in pain along the nerve root that runs down the leg to the front of the ankle. Sensory changes may occur in the same area. Weakness of the quadriceps and reduction of the knee reflex may exist.
  • The L5 root, if damaged, results in pain that radiates down the leg, over the outside of the calf, and over the arch of the foot to the big toe. Muscles controlled by this root raise the foot and curl the big toe upward. Sensory changes may occur in the same area. There is no reflex loss with damage to this root.
  • The S1 nerve root can also be damaged, usually from a disc herniation at L5-S1. This causes pain that radiates down the leg into the back of the calf and the outside of the foot. This root, if damaged, causes weakness of the muscle that allows you to stand on your toes. Sensation may be altered in the same area as the pain. The ankle reflex may be reduced.

Sciatica Pain from Lumbar Discs

Sciatica is a term used to describe pain radiating along the route of the sciatic nerve. Sciatica from disc herniations occurs most commonly from a lumbar disc pressing on the L4, L5, and S1 roots, all of which when compressed may radiate pain to the lower leg and foot. The sciatic nerve consists of the L5, S1, and S2 roots.

Generally, leg pain from lumbar-disc herniations is worse when sitting and possibly standing and walking and less when lying in bed on the back with a pillow under the knees or, possibly, on the side.

Diagnosing Nerve Pain From Disc Herniation

An MRI can obtain images from inside the spinal canal and is the most sensitive test for identifying the location of a disc herniation and nerve compression.

If you cannot have an MRI because of metal implant in your body, a CT scan can be done.

Conservative Treatment

Most people with herniated disc recover with rest and pain medications.

Medications

Anti-inflammatories, muscle relaxants or NSAIDs to reduce the inflammation around the root.

Epidurals

Epidurals are corticosteroids, combined with local anaesthetics, that are injected into the epidural space. It can help to reduce pain from root compression from disc herniations.

Treating Pain from Cervical-Disc Herniations

Most of the time, the pain from a herniated cervical disc can be controlled with medication and nonsurgical treatment. Wearing a soft cervical support collar for several weeks day and night helps rest your neck. However, wearing too long may weaken your neck muscles. Seek medical advice about long-term use.

Physiotherapy

Physiotherapy can help open up the cervical foramen where the nerve root exits the spinal canal.

Treating Pain from Lumbar-Disc Herniations

Relief from pain caused by lumbar-disc herniation calls for conservative treatment, such as medications and physiotherapy. You should get out of bed and ambulate as well as you can. Strict bed rest is not beneficial.

Surgery for Disc Herniation

Discectomy, in the neck, antterior decompression  are all operations may be used to treat problems from a disc’s pressing a nerve root.

Surgery is sometimes indicated to decompress a root pressed between a disc and a piece of bone or ligament or to remove the portion of the disc that is pressing on the nerve.

Certain types of muscle weakness may lead to early surgery. If your foot is in a dropped position and cannot be raised off the floor, early surgical intervention must be considered.

Surgery does help to eliminate the symptoms of sciatica more quickly than conservative – nonsurgical – treatment.

Key Points about Back Pain from Disc Herniations

  • Most disc herniations occur at spinal segments that are maximally bent foward: the lower neck and lumbar spine.
  • A lower lumbar-disc herniation may cause true nerve root pain, called sciatica.
  • An MRI can obtain images from inside the spinal canal and foramen and is the most sensitive test for identifying the location of a disc herniation and nerve compression.
  • Most people with herninated disc recover with rest, pain medications, and, sometimes physiotherapy or epidural injections.
  • Progressive or sudden onset of neurological problems or bowel or bladder problems may require surgical intervention.

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