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Cervicothoracic interosseous bursitis.
Last reviewed: 04.07.2025
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The interspinous ligaments of the lower cervical and upper thoracic spine can cause acute and chronic pain after they are overloaded. Bursitis is thought to cause this pain. Often, patients develop midline pain after prolonged activities that require hyperextension of the cervical spine, such as painting the ceiling or using a computer monitor with the focal point too high for long periods of time.
[ Symptoms of cervicothoracic interspinous bursitis
The pain is localized in the interspinous region between C7 and Th1 and does not radiate. It is constant, dull, aching. The patient may try to reduce the pain by assuming a kyphosis pose with the neck extended forward. Pain in cervicothoracic interspinous bursitis often decreases during movement and increases at rest. Examination reveals pain with deep palpation of the C7-Th1 region, often with reflex spasm of the paravertebral muscles. There is always a limitation of movement and increased pain with flexion in the lower cervical and upper thoracic regions.
Survey
There is no specific test to detect cervicothoracic interspinous bursitis. The investigation is primarily aimed at detecting occult pathology or other diseases that can mimic cervicothoracic interspinous bursitis. Plain radiography can reveal any change in the bones of the cervical spine, including arthritis, fracture, congenital pathology (Arnold-Chiari malformation), and tumor. All patients with recent onset of cervicothoracic interspinous bursitis should undergo MRI of the cervical spine and brain if there are symptoms of significant occipital and headache pain. Laboratory screening should be performed to exclude occult inflammatory arthritis, infection, and tumor, including a complete blood count, ESR, antinuclear antibodies, and blood chemistry.
Differential diagnosis
Cervicothoracic interspinous bursitis is a clinical diagnosis of exclusion, supported by a combination of history, physical examination, radiography, and MRI. Pain syndromes that can mimic cervicothoracic interspinous bursitis include neck trauma, cervical myositis, inflammatory arthritis, and pathology of the cervical spinal cord, roots, plexus, or nerves. Congenital anomalies such as Arnold-Chiari malformation or Klippel-Feil syndrome may also present as cervicothoracic interspinous bursitis.
Clinical features of cervicothoracic interspinous bursitis
If long-term relief is desired, the underlying functional disorders that caused the cervicothoracic bursitis must be corrected. Physical therapy such as local heat, gentle stretching exercises, and deep relaxation massage are effective and can be used in conjunction with NSAIDs. Local anesthetic and steroid injections are very effective in treating cervicothoracic bursitis pain that has not been relieved by other conservative measures. Vigorous exercise should be avoided as it may worsen symptoms.
Treatment of cervicothoracic interspinous bursitis
A multilevel approach is most effective in treating cervicothoracic interspinous bursitis. Physical therapy consisting of correction of functional abnormalities (poor posture, inappropriate chair or computer height), heat treatments, and deep relaxation massage in combination with NSAIDs (eg, diclofenac or lornoxicam) and muscle relaxants (eg, tizanidine) are appropriate at the beginning of treatment. If this treatment does not provide rapid pain relief, the next step is an injection of a local anesthetic and steroid into the area between the interspinous and yellow ligaments. Symptomatic relief can be achieved with cervical epidural blocks, medial branch dorsal nerve blocks, or intra-articular facet joint injections of local anesthetics and steroids. If symptoms persist, tizanidine may be appropriate. Tricyclic antidepressants may be appropriate for depression.