Cervical-thoracic interstitial bursitis

The interdigital ligaments of the lower cervical and upper thoracic spine can cause acute and chronic pain that occurs after their overload. It is believed that this pain causes bursitis. Often, patients develop median pain after prolonged operation requiring hyperextension of the cervical region, for example, colorizing the ceiling or prolonged use of a computer monitor with a highly placed focal point.

[1], [2]

Symptoms of the cervical-thoracic interstitial bursitis

The pain is localized in the interstitial region between C7 and Th1 and does not irradiate. She is constant, stupid, aching. The patient can try to reduce the pain by adopting a pose of kyphosis with the neck extended forward. Pain with cervicothoracic interstitial bursitis often decreases during movement and increases at rest. The examination reveals soreness with deep palpation of the C7-Th1 region, often with a reflex spasm of paravertebral muscles. There is always a restriction of movement and increased pain when flexing in the lower cervical and upper thoracic areas.

Examination

There is no specific method for the detection of cervical-thoracic interstitial bursitis. The examination, first of all, is aimed at revealing the hidden pathology or other diseases that can mimic the cervical-thoracic interstitial bursitis. X-ray examination can reveal any change in the bones of the cervical region, including arthritis, fracture, congenital pathology (Arnold-Chiari malformation), and a tumor. All patients with a recent onset of cervical-thoracic interstitial bursitis should undergo MRI of the cervical spine and brain if symptoms of significant occipital and headaches are present. To exclude hidden inflammatory arthritis, infection and tumor, laboratory screening should be performed, including a general blood test, an ESR, an antinuclear antibody test, and a biochemical blood test.

Differential diagnosis

Cervical interstitial bursitis is a clinical diagnosis of an exception, supported by a combination of history, physical examination, radiography and MRI. Pain syndromes capable of simulating cervical-thoracic interstitial bursitis include neck trauma, cervical myositis, inflammatory arthritis and pathology of the cervical spinal cord, roots, plexus , nerves. Congenital anomalies, such as Arnold-Chiari malformation or Klippel-Feil syndrome, can also manifest as cervicothoracic interstitial bursitis.

Clinical signs of cervicothoracic interstitial bursitis

If it is necessary to achieve long-term relief, correction of functional disorders that caused the development of cervico-thoracic bursitis is required. Physiotherapy procedures such as local thermal, soft stretching exercises and deep relaxing massage are effective and can be applied simultaneously with NSAIDs. Injections of local anesthetics and steroids are very effective in the treatment of pain in cervicothoracic bursitis, which could not be alleviated by other conservative measures. Strong exercises should be avoided, as they can aggravate the symptoms.

[3], [4], [5], [6]

Treatment of cervicothoracic interstitial bursitis

In the treatment of cervical-thoracic interstitial bursitis, a multi-level approach is most effective. Physiotherapy, consisting of correction of functional abnormalities (incorrect posture, improper stool or computer height), thermal procedures and deep relaxing 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 relief of pain, the next step is to inject the local anesthetic and steroid into the area between the interstitial and yellow ligaments. For symptomatic relief, cervical epidural blockades, blockages of the medial branch of the dorsal nerve or intraarticular injection into the facet joint of local anesthetics and steroids can be used. With the persistence of symptoms, it is advisable to use tizanidine. With depression, tricyclic antidepressants are advisable.