T-spine pain – pain in the thoracic area

What is thoracic spine syndrome?

Thoracic spine syndrome is an umbrella term for pain in the thoracic spine area. In hospital emergency rooms, chest pain is a common clinical picture and the fear is great: one quickly thinks of a heart attack. The sigh of relief is then great when the diagnosis shows that it is not an infarction. It is a chest pain, a so-called BWS syndrome.

The cause of such a thoracic syndrome is usually the onset of wear and tear in the thoracic spine. Patients describe the pain character in a BWS syndrome as dull, pressing, often as stabbing. If you feel the pain between the shoulder blades, which extends over the ribcage to the front, you can assume that you have a BWS syndrome. Usually, the muscles next to the spine are hardened. It may be accompanied by difficult breathing.

Structure of the spine / thoracic spine


The thoracic spine is the section of the spine between the cervical spine and the lumbar spine. In humans, it consists of 12 vertebrae. The vertebral bodies of the thoracic spine are connected to the ribs by small joints and together with them form the rib cage.

Thoracic spine pain is rare disc disease

Pleasing: Thoracic spine pain is rarely a disc disease. The concern of many people about a herniated disc is justified. All-clear to the herniated disc in the thoracic spine: herniated discs in the thoracic spine play a very minimal role compared to those in the cervical spine (C-spine) and lumbar spine (lumbar spine). In numbers: Only 2 percent of all disc-related conditions affect the thoracic spine. The probability that the cause of the thoracic spine syndrome lies in the intervertebral discs or is even a prolapse is therefore very low.

Heart and lungs can also trigger a thoracic spine syndrome

When looking for the causes of the disease, one should always start with oneself, because that is often where the causes lie:

  • Do I have an unhealthy posture?
  • Do I hunch over at my desk every day and thus adopt an incorrect posture?
  • Am I lifting things too heavy and putting too much strain on my thoracic spine?
  • Are my back muscles weak because I don't move enough?
  • Do I lack sufficient exercise? Am I doing specific exercises to combat tension and poor posture?

Many people have to answer yes to these questions. And a yes in this case does not mean anything good. But of course there are other causes: Osteoarthritis of the vertebral joints, osteoporosis possibly with vertebral fractures, injuries, narrowing of the spinal canal and/or neuroforamen (neuroforamina stenosis), disc degeneration, rarely tumors (meningiomas, neurinomas, hemangiomas). In addition, sometimes adjacent organs such as the heart or lungs can also cause pain in the thoracic spine.

The characteristic symptom of the thoracic spine syndrome is back pain

When we talk about the symptoms of thoracic spine syndrome, back pain is always mentioned. When you move, twist, or tap on the pain site, the pain intensifies. It is not uncommon for the thoracic spine symptoms to radiate to the ribs as well. This is because the thoracic vertebrae and ribs are connected by joints. The pain then feels belt-like.

Severe nerve compression can occur, resulting in neurological deficits such as loss of strength or numbness. Deep breathing, especially after prolonged rest (e.g., at night) can cause severe pain under the ribs.

Diagnosis thoracic spine pain

The diagnosis always begins with a personal conversation between the patient and the doctor. In this so-called anamnesis conversation, the patient describes his medical history to the doctor. After all, there are several causes that may have triggered the pain in the thoracic spine.

The causes include osteoarthritis of the vertebral joints, i.e. degenerative changes. Then there are misalignments of the spine, such as scoliosis and Scheuermann's disease. Similarly, rheumatoid arthritis and injuries to the spine, for example a vertebral fracture, can be responsible. During the diagnosis, the doctor should also find out from you whether you have had oncological diseases, such as a slipped disc, or whether you suffer from osteoporosis. In this way, you can provide the doctor with important information for the diagnosis. In addition, you describe your life circumstances to the specialist during the anamnesis and provide decisive information about the type and localization of the pain.

In the second step, the doctor palpates the spine, looks for any misalignment, pays attention to the symmetry of the upper body, looks for changes or injuries.

Are there any inflammatory processes? These questions are usually answered by a blood count. If the doctor suspects that there is more to the symptoms than a syndrome of the thoracic spine, he will order an electrocardiogram (ECG) to be on the safe side. This can confirm or rule out a hidden heart attack. This provides diagnostic certainty, although the pain associated with a heart attack is different from the complaints emanating from the thoracic spine. Basically, one can say: a cardinal problem is indicated if the patient has problems, for example, when climbing stairs or walking quickly. Is it difficult to bend down, lift objects or squat down? Then it can be assumed that the cause is to be found in the thoracic spine.

Last but not least, imaging techniques such as X-rays, MRI scans of the thoracic spine, CT scans or scintigraphy help with the diagnosis. Technology is of course very important, but in hardly any search for causes are the hands of the doctor as important for the diagnosis as in the case of a BWS syndrome. The diagnosis is a domain of so-called manual medicine, gently and expertly all areas of the thoracic spine, ribs, joints, muscles and the tendons are felt, i.e. examined, to detect possible blockages.

This is how a thoracic spine syndrome is treated successfully

The therapy of the thoracic spine syndrome depends on the diagnosis - in other words, there are several therapy options. Normally, complaints in the thoracic spine are treated conservatively. Medication is used to relieve the patient of pain. The medication can be ingested, administered as an infusion, or directly as an injection (facet infiltrations or PRT).

Physiotherapy with heat, cold, massages and physiotherapy can loosen the muscles in the back and relieve the discs. A mixture of physiotherapy and the administration of painkillers has proved very successful. Physiotherapy will not be 08/15 therapy, but a complete individual therapy. The exercises will therefore be coordinated personally with the patient. The treatment will always be based on the given complaints. However, physio therapy with targeted strength-building training may also include reducing your weight.

Minimally invasive thermo-denervation can help against the pain in the thoracic spine. This involves sclerosing the irritated nerve branches using heat.

In the case of tumors of the thoracic spine, vertebral body infections, osteoporotic fractures, herniated discs, cysts or pronounced scoliosis, other procedures (therapies) may be used here.


Prognosis on thoracic vertebrae pain

There is one person who can treat you the very best and provide a positive prognosis for thoracic pain: It's yourself! The magic word is exercise - walking, swimming, cycling. Since thoracic spine syndrome is often caused by lack of exercise and weak back muscles, as well as posture problems, you should do everything you can now to avoid repeating these mistakes.

In fact, you should consider changing a few things in your life. After all, back problems and our modern lifestyles are often clearly related. Sound familiar? Hours upon hours at your desk in the office, popping a frozen pizza in the oven in the evening, and then hitting the couch with a bag of chips. Not without a glass of wine or the obligatory beer, of course. On the surface, this sounds like relaxation, but in the end, stress, psychological tension, anxiety, lack of exercise and being overweight can all contribute to back pain. Tension can lead to inflammatory processes in the body, which in turn promote further small inflammatory processes. Preferably, get advice from a back school. What you learn and implement there will do you good.

Actively work against tension and poor posture by stimulating your back muscles with targeted exercises and stretching. Be sure to avoid incorrect stresses in everyday life and pay attention to your posture.

Dr. med. Munther Sabarini

Dr. med. Munther Sabarini
Specialist in Neurosurgery

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de