Thoracic (Mid Back) Pain Facet Joint Pain

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Is The Cause of Your Thoracic Back Pain Your Facet Joints?

Facet joint pain is one of the least reported conditions that can afflict the mid-back (thoracic) region accounting for only 2% of spine disease reporting.  If you are among those who have it, it can manifest as a very aggravating chronic mid-back ache that may also radiate along a rib. The pain may also manifest as a radiating tingling. To complicate diagnosis, thoracic facet joint pain can also manifest as a head ache or even stranger, as a sensation of having a useless or heavy limb.

Understanding How Thoracic Facet Joints Can Cause Pain

While the mid-back or thoracic region of the spine is less prone to injury than the neck (cervical) and lower back (lumbar) regions, it can still fall prey to major back ailments like degenerative disc disease, osteophytes, shifted vertebrae, facet joint pain, bulging and herniated discs and more.  In general the thoracic back accounts for approximately 15% of all spine complaints.

The thoracic region of the spine consists of 12 vertebrae with each vertebra connecting to two ribs. There are 12 pairs of spinal nerve roots. Each rib is connected to the spine with two facet joints that articulate slightly to provide very limited movement for the ribs. Problems with facet joints usually occur between the T9 and T12 vertebrae.

A car crash, a fall, a bike accident, any traumatic event that places stress on the rib cage can damage the ligaments and nerves in the facet joints resulting in pain. Individuals with arthritis (rheumatoid arthritis and spondyloarthritis) in the facet joints will experience a localized chronic pain. Thoracic facet joints, small as they are, have nerves that can also become inflamed resulting in swelling and pain (neurogenic inflammation).

It is important to understand the basic structure of the thoracic spine. The middle back supports our ribs which curve around connecting to the sternum, the strong bony structure in the middle of our chest. The thoracic spine’s curve is kyphotic which is Greek for ‘hump’. This “C”-shaped curve with the opening of the “C” in the front is a clever design that allows room for our lungs, heart and other essential organs in our rib cage. This part of the spine has very narrow, thin intervertebral discs. Rib connections and smaller discs in the thoracic spine limit the amount of spinal movement in the mid back compared to the lumbar or cervical parts of the spine. The vertebrae in this region are smaller than in the lumbar spine because they need to support less weight. There is also less space inside the spinal canal in this region.

Through gradual wear and tear, the spinal discs and facet joints begin to lose some of their water content. In doing so, they become less flexible, and more prone to damage with even the most basic of movements. As the discs and facet joints dehydrate they become weaker, and lose the ability to serve as a shock absorbers that can absorb the stress of an impact. The plump discs that helped facilitate easy, fluid movement become thin and dried out. The decrease in flexibility and elasticity of the discs no longer allows them to support fluid movement. The resulting stiff discs and damaged facet joints can result in localized pain in the middle back region, plus we can experience pain that radiates from the vertebra across our ribs to the sternum.

While gradual degeneration of the discs and facet joints is an expected part of aging, it should be closely monitored by a spine expert. There are several non-surgical solutions that can relieve facet joint pain such as chiropractic adjustments, physical therapy, yoga, acupuncture and medications. For some patients, minimally invasive surgery may prove to be the optimal strategy to reduce pain. Basic Spine provides the full spectrum of minimally invasive outpatient options with many surgeries taking less than an hour to perform, and with patients returning home on the same day.
Sources:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382964/

http://www.physio-pedia.com/Costotransverse_Disorders

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