Pinched nerve in the thoracic spine: what to do?

Pinched nerves – depending on their location – can occur in many anatomical areas. The pathological condition that occurs when the spinal nerves of the thoracic spine are compressed is called thoracic nerve entrapment.

Epidemiology

Pinched nerves in the thoracic spine are less common than in the lumbar and cervical spine and are often misdiagnosed.

According to statistics, thoracic radiculopathy – damage to the thoracic nerve roots – accounts for less than 0.15–4% of all radiculopathies and is most often caused by a herniated thoracic disc. [ 1 ]

Causes thoracic nerve entrapment

From the thoracic section (pars thoracicalis) of the spine, which includes 12 vertebrae (ThI – ThXII), from the spinal cord located in the spinal canal through the intervertebral openings, the spinal nerves (12 pairs) emerge, which form the ventral (anterior) and dorsal (posterior) branches. All of them provide the transmission of motor (movement) and sensory (sensitive) signals along the efferent and afferent nerve fibers, distribute cutaneous branches along the thoracic dermatomes and direct other sensory fibers to deeper structures.

The first upper thoracic nerve (T1) enters the lower trunk of the brachial plexus with one branch, and the second runs along the first intercostal space and ends as the first anterior cutaneous branch of the thoracic cage.

Thoracic nerves T2-T6 - the upper intercostal nerves - run in the intercostal spaces, controlling the rib cage, lungs, diaphragm, and muscles involved in breathing. Near the sternum, they pierce the internal intercostal muscles, anterior intercostal membranes, and pectoralis major, innervating the integuments of the anterior chest above the nipple line. In addition, these nerves give off lateral (side) cutaneous branches that provide sensitivity to the skin of the scapula, latissimus dorsi, and the upper half of the middle and back of the arm.

The anterior branches of the lower intercostal nerves (T7-T11), passing into the abdominal wall between the internal oblique and transverse abdominal muscles, are responsible for the innervation of the dermatome of the anterior abdomen.

The T12 thoracic nerve (subcostal) runs along the lower border of the rib, passes in front of the quadratus lumborum muscle, pierces the transverse muscle and passes forward between it and the internal oblique muscle. It communicates with the iliohyoid nerve of the lumbar plexus and, together with T9-T11, innervates the lower abdominal and back muscles. [ 2 ]

Common causes of a pinched nerve in the thoracic spine include:

• osteochondrosis of the thoracic region, as well as the cervicothoracic region of the spinal column;
• thoracic disc protrusion andintervertebral disc herniation;
• spondylolisthesis (lateral displacement) of the vertebral bodies;
• inflammation of the vertebral joint - arthritis;
• spinal deformation – scoliosis of the thoracic spine;
• degenerative-dystrophic diseases of the spine leading to stenosis of the spinal canal, including spondyloarthrosis and spondylosis with the formation of osteophytes;
• spinal tumors.

Pinching can also be associated with hypertonicity (constant overstrain) of the paravertebral muscles during increased physical activity.

Risk factors

Risk factors for thoracic nerve entrapment include:

• age-related changes in the spine of a degenerative-dystrophic nature; [ 3 ]
• injuries (bruises and rib fractures), damage to the spinal column, including its compression fracture;
• postural disorders;
• prolonged and excessive loads on the thoracic vertebrae;
• decreased stability of the thoracic spine in such a pathology of its ligamentous apparatus as ankylosing spondylitis - Bechterew's disease.
• hereditary spinal problems; [ 4 ]
• obesity.

Pathogenesis

Experts explain the pathogenesis of pinched nerves in this group, as well as pinched nerves in any other group, by a disruption of nerve conduction due to direct compression effects on efferent and afferent nerve fibers, with a decrease in their trophism, which causes ischemic neuropathy to develop.

Why pain occurs when a nerve is pinched in the thoracic region, read in detail in the material - Neuropathic pain.

Symptoms thoracic nerve entrapment

When there is a compression effect on the thoracic nerve, the first signs are determined by the zone of its innervation. Compression of the spinal nerve T1 can cause pain in the back or chest at the first rib, in the ring finger.

Symptoms of a pinched nerve range from minor to severe and debilitating. This can depend not only on its location but also on the amount of pressure being applied.

When the T2-T6 nerves are pinched, pain (aching or burning, constant or paroxysmal) appears in the chest near the corresponding rib or in the back, as well as a squeezing sensation in the chest. In this case, one-sided damage is usually observed: pinched nerve in the chest on the right or pinched nerve in the chest on the left. But in any case, pain increases with movement.

Pain in the back, chest (imitating cardialgia) or abdomen (similar to pain in stomach diseases) can be caused by compression of the spinal nerves T7-T11. [ 5 ]

Pinching of the intercostal nerve in the thoracic region with the appearance of intense pain in the rib area, including during deep inhalation, is discussed in detail in the publication - Intercostal neuralgia

And if the T12 nerve is compressed, which, together with the L1 nerve, enters the lumbar plexus and innervates the abdominal muscles and the skin above the buttocks, then patients may feel pain in the corresponding localization.

Also, pinched nerves in the chest lead to paresthesia (numbness and tingling) and impaired skin sensitivity (dysesthesia or hyperesthesia) in the chest area corresponding to a specific nerve of the dermatome; weakness and shortness of breath.

Complications and consequences

In addition to neuropathic pain syndrome of varying intensity, a pinched nerve in the thoracic spine can cause the following consequences and complications:

• development of chronic back pain; [ 6 ]
• weakening of muscle tone of the anterior abdominal wall;
• discomfort in the epigastric region;
• breathing problems.

Pinched nerves can even lead to permanent nerve damage, muscle atrophy and paralysis.

Diagnostics thoracic nerve entrapment

In addition to a physical examination, medical history, and assessment of presenting symptoms, a diagnosis of thoracic nerve impingement is aided by diagnostic imaging, including:

• computed tomography of the spine;
• MRI of the thoracic spine; [ 7 ]
• electromyographic examination (EMG).

In some situations, chest discography may be performed to confirm the discogenic origin of the pain, since most cases of chest discogenic syndrome may be asymptomatic.[ 8 ]

• Read also – Methods of examination of the spine

Differential diagnosis

Differential diagnostics are carried out with cardialgia and ischemic heart disease, ganglionitis and postherpetic neuralgia, compression of the brachial plexus with superior thoracic outlet syndrome (superior thoracic outlet), myofascial pain syndrome, tumors of the mediastinum or spinal cord, etc.

Treatment thoracic nerve entrapment

Treatment can be etiological and symptomatic. In the first case, therapy is aimed at the cause of compression of the thoracic nerve, and then, for example, the following is performed:

• treatment of osteochondrosis,
• treatment of vertebral hernia,
• treatment of thoracic scoliosis.

In most cases, treatment of a pinched thoracic nerve is carried out at home - using medications prescribed by a doctor. The main medications are non-steroidal anti-inflammatory drugs (NSAIDs) with an analgesic effect: Diclofenac (Dikloran), Ibuprofen, Indomethacin, Meloxicam, etc. The tricyclic antidepressant Amitriptyline ( Saroten ) and drugs from the muscle relaxant group can also be used. [ 9 ]

Various ointments for pain are used locally, for example, ointments for radiculitis or ointments for osteochondrosis. Read more:

• Treatment of neuropathic pain
• Pills for neuralgia
• Treatment of intercostal neuralgia

In cases of severe inflammation, spinal steroid injections are used. [ 10 ]

In mild cases, a pinched nerve is treated with time and rest, and the pain will go away in a few days or weeks. And in cases of trauma, herniated discs or scoliosis, treatment may be surgical (through discectomy, spondylodesis and other surgical interventions). [ 11 ]

An integral part of the treatment is physiotherapy, but exercises and gymnastics for a pinched nerve in the thoracic region are prescribed provided that the pain is relieved. More details - Physiotherapy for neuritis and neuralgia of the peripheral nerves

To relax the muscles and improve their trophism, massage is performed when the thoracic nerve is pinched, in particular, point and reflex-segmental.

Radiofrequency ablation is a technique that uses heat passed through the tip of a needle using continuous or pulsed radiofrequency to denervate the damaged disc that is causing pain in a person.[ 12 ]

And by using a needle applicator for pinched thoracic nerves, you can significantly reduce the intensity of pain.

Prevention

Not all pinched nerves can be prevented, but to reduce their risk, it is recommended to maintain a normal weight, monitor posture, do stretching exercises, and promptly treat diseases of the spinal joints.

Forecast

In each specific case, the prognosis of this pathological condition is influenced by the cause, localization and degree of pinching of the thoracic nerve, as well as correct diagnosis and adequate therapy.