Thoracic & Chest Pain

Thoracic Intervertebral Joints
There are relatively few disorders of the thoracic spine (upper back). Disorders may involve damage to the disks or joints between vertebrae. The small joints between the spine and the ribs can also be a cause of pain in this region.

Sternoclavicular Joint
The sternoclavicular joint is where the collar bone (clavicle) joins with your sternum. A disorder with this joint can cause chest pain and is often injured in conjunction with the acromioclavicular (AC) joint of the shoulder. This joint can be sprained, subluxed and dislocated. Treatment varies dependent upon the severity of the injury.

Referred Pain
The most common cause of chest pain in those under 35 is referred pain from the thoracic spine. Referred pain may or may not be associated with thoracic pain. A thorough examination is required in these cases to diagnose the cause of the pain.

Blunt Trauma
The ribs may be fractured or bruised as a result of a direct blow. X-rays will confirm a fracture. These injuries will be tender for at least three weeks. Recovery from these injuries can be speeded up by physiotherapists.

Scheuermann's Disease
The most common cause of thoracic pain in adolescents is Scheuermann's Disease, a disorder of the growth plates of the thoracic vertebra. Pain is often felt between or around the shoulder blades. The pain may have commenced suddenly as a result of a sudden movement or may have been of a more gradual onset.

Treatment
Treatment aims to restore full mobility by mobilisation and manipulation of the joints and massage to the spinal muscles. It is important to follow this up with a rehabilitation programme involving stretching and strengthening exercises. Chest pain occurs frequently in athletes, usually due to musculoskeletal causes.

Non-Musculoskeletal Chest Pain
There is usually no obvious method of injury or trauma with non-musculoskeletal chest pain.

Chest pain (often described as central and crushing) associated with symptoms such as arm pain, palpitations, shortness of breath and sweating may indicate that the pain is cardiac in nature i.e. heart or angina attack. An ambulance should be called as urgent hospital treatment is required in the case of a heart attack.

A history of chest pain combined with a productive cough may point more in the way of a respiratory origin.

Symptoms that show relief with antacid medication are most likely gastrointestinal
i.e. stomach ulcer or gastrointestinal reflux.