Symptoms
- Mid-back pain between shoulder blades
- Pain that wraps around chest (rib pain)
- Stiffness or limited rotation of upper body
- Pain with deep breathing
- Burning or aching sensation in mid-back
- Pain radiating to chest wall
Common Causes
Thoracic spine problems are less common but treatable. Causes include:
- Compression fractures: Especially in osteoporosis or from falls
- Disc herniation: Rare in thoracic spine but can occur
- Arthritis: Facet joint degeneration
- Spinal curvature: Scoliosis or kyphosis
- Muscular strain: Poor posture, repetitive activities
- Trauma: Falls, accidents
- Rib dysfunction: Rib-spine joint problems
How We Diagnose
Thoracic spine conditions require careful evaluation:
- Physical examination: Range of motion, rib mobility, neurological assessment
- MRI: Evaluates discs, spinal cord, and soft tissues
- X-rays: Standing views to assess alignment and detect compression fractures
- CT scan: Better visualization of fractures and bone detail
- Bone density scan (DEXA): If osteoporosis suspected
Important: Thoracic pain can sometimes be related to organs (heart, lungs, digestive system). Chest pain with shortness of breath, fever, or other concerning symptoms requires immediate medical evaluation.
Treatment Options
Good News for Most Patients
The majority of spine conditions improve with conservative (non-surgical) treatment. Surgery is typically considered only when non-surgical approaches haven't provided adequate relief after an appropriate trial period, or when there are progressive neurological symptoms.
Non-Surgical Treatment (First-Line Approach)
- Physical therapy focusing on posture and thoracic mobility
- Anti-inflammatory medications
- Osteoporosis treatment if applicable
- Bracing for compression fractures
- Facet joint or epidural injections
- Manual therapy and mobilization
- Core strengthening exercises
Surgical Options
- Vertebroplasty or kyphoplasty for compression fractures
- Thoracic decompression for disc herniation or stenosis
- Spinal fusion for instability or deformity
- Minimally invasive approaches when appropriate
When Surgery Is Considered
- Severe pain from compression fracture not healing with bracing
- Progressive kyphosis (forward curve) causing disability
- Thoracic disc herniation with spinal cord compression
- Severe stenosis with myelopathy (spinal cord symptoms)
- Failed conservative treatment for appropriate conditions
Recovery & What to Expect
Acute Phase (Weeks 1-6)
Pain management, activity modification, bracing if indicated, gentle range of motion
Rehabilitation (Weeks 6-12)
Progressive physical therapy, postural training, strengthening program, return to light activities
Long-Term Recovery (Months 3-6)
Continued strengthening, full activity resumption, prevention strategies
If Surgery Performed
Recovery depends on procedure; kyphoplasty recovery is rapid (days), fusion procedures require 3-6 months
Frequently Asked Questions
For Referring Providers
Evaluation Approach
Thorough assessment including examination of thoracic mobility, rib function, neurological status, and review of imaging to distinguish between mechanical pain, fracture, and other pathology.
What to Send
Thoracic X-rays (AP and lateral), MRI if neurological symptoms present, DEXA scan if osteoporosis concern, and any prior treatment records.