Pinched nerve in the thoracic spine: what to do?

Pinched nerves - depending on their location - can occur in many anatomical areas. The pathological condition resulting from compression of the spinal nerves of the thoracic spine is defined as a pinched thoracic nerve.

Epidemiology

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

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

Causes of the pinching of the thoracic nerve

From the thoracic region (pars thoracicalis) of the spine, which includes 12 vertebrae (ThI - ThXII),  spinal nerves  (12 pairs) exit from the spinal cord located in the spinal canal through the intervertebral foramina, which form the ventral (anterior) and dorsal (posterior) branches. All of them ensure the transmission of motor (motor) and sensory (sensory) signals along efferent and afferent nerve fibers, spread skin branches along the thoracic dermatomes, and direct other sensory fibers to deeper structures.

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

Thoracic nerves T2-T6 - superior  intercostal nerves  - run in the intercostal spaces, controlling the chest, lungs, diaphragm, and breathing muscles. Near the sternum, they pierce the internal intercostal muscles, the anterior intercostal membranes and the pectoralis major muscle, innervating the integument of the anterior part of the chest above the line of the nipples. In addition, these nerves give lateral (lateral) cutaneous branches that provide sensitivity to the skin of the scapula, the latissimus dorsi, 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 anterior abdominal dermatome.

The T12 thoracic nerve (hypocostal) runs along the inferior border of the rib, passes anterior to the quadratus lumborum, pierces the transverse muscle, and passes anteriorly 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 spine;
• protrusion of the  thoracic disc and  herniated disc ;
• spondylolisthesis (lateral displacement) of the vertebral bodies;
• inflammation of the spinal joint - arthritis;
• spinal deformity -  scoliosis of the thoracic spine ;
• degenerative-dystrophic diseases of the spine leading to stenosis of the spinal canal  , including spondylarthosis and spondylosis with the formation of osteophytes;
• spinal tumors.

Also, pinching can be associated with hypertonicity (constant overstrain) of the paravertebral muscles during increased physical exertion.

Risk factors

Risk factors for a pinched thoracic nerve include:

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

Pathogenesis

Experts explain the pathogenesis of a pinched nerve in this group, as well as pinched any nerve, by a violation of nerve conduction due to a direct compression effect on efferent and afferent nerve fibers - with a decrease in their trophism, due to which  ischemic neuropathy develops .

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

Symptoms of the pinching of the thoracic nerve

With a compression effect on the thoracic nerve, the first signs are due to the zone of its innervation. Compression of the T1 spinal nerve can cause back or chest pain at the first rib, in the ring finger.

Pinched nerve symptoms range from minor to severe and debilitating. This may depend not only on its location, but also on the degree of pressure exerted.

When the nerves T2-T6 are pinched, pain (aching or burning, constant or paroxysmal) appears in the chest at the corresponding rib or in the back, as well as squeezing sensations in the chest. In this case, a unilateral lesion is usually observed: a pinched nerve in the chest on the right or a pinched nerve in the chest on the left. But in any case, when moving, there is an increase in pain.

Pain in the back, chest (mimicking cardialgia), or abdomen (similar to stomach pain) can cause compression of the T7-T11 spinal nerves. [5]

Pinching of the intercostal nerve in the thoracic region with the appearance of intense  pain in the region of the ribs , including during a deep breath, are 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 skin over the buttocks, then patients may feel pain of the corresponding localization.

Also, pinched nerves in the chest lead to paresthesia (numbness and tingling) and impaired skin sensitivity (dysesthesia or hyperesthesia) in the area of the chest corresponding to a particular 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 such consequences and complications as:

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

A pinched nerve can even lead to permanent nerve damage, muscle atrophy, and paralysis.

Diagnostics of the pinching of the thoracic nerve

In addition to the physical examination, history, and evaluation of symptoms, the diagnosis of thoracic nerve entrapment helps establish instrumental diagnosis, including:

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

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

• Read also -  Methods of examination of the spine

Differential diagnosis

Differential diagnosis is carried out with cardialgia and coronary heart disease, ganglioneuritis and postherpetic neuralgia, compression of the brachial plexus with the syndrome of the upper thoracic outlet (upper chest aperture), myofascial pain syndrome, tumors of the mediastinum or spinal cord, etc.

Treatment of the pinching of the thoracic nerve

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 occurs:

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

In most cases, a pinched thoracic nerve is treated at home - with the use of medicines prescribed by a doctor. The main drugs are non-steroidal anti-inflammatory drugs (NSAIDs) with analgesic effects:  Diclofenac  (Dicloran),  Ibuprofen , Indomethacin, Meloxicam, etc. The tricyclic antidepressant Amitriptyline ( Saroten ) and drugs of the  muscle relaxant group can also be used . [9]

Various ointments for pain are applied locally, for example,  ointments for sciatica  or  ointments for osteochondrosis . Read more:

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

For severe inflammation, injections of spinal steroids are used. [10]

In mild cases, the pinched nerve heals with time and rest, and the pain will go away in a few days or weeks. And in case of injuries, a herniated disc or scoliosis, treatment can be surgical (by discectomy, spinal fusion, 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 subject to pain relief. Read more -  Physiotherapy for neuritis and neuralgia of 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 a damaged disc that causes pain in a person. [12]

And using a needle applicator for pinching the nerve of the thoracic region, 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 normal weight, monitor posture, perform stretching exercises and treat diseases of the vertebral joints in a timely manner.

Forecast

In each 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.