Vertebrogenic muscle-tonic, neurodystrophic and vasomotor syndromes are associated with the functional and anatomical specifics of the thoracic spine. The support function of the thoracic intervertebral joints increases with rotational movements. In this case, the main load falls on the anterior sections of the discs, where degenerative lesions occur more often, which are closer to spondylosis in the picture; than to osteochondrosis. With various deformities of the spine, first of all, with spondylosis, the joints of the rib heads and tubercles of the ribs suffer. Diseases of the chest organs also contribute to the formation of arthrosis.
Clinical manifestations in dystrophic lesions of the thoracic spine are associated with sympathetic spinal and ganglionic formations, as well as with lesions of the chest cavity organs. This explains the richness of the clinic in sensory manifestations from the skin and subcutaneous tissue (zones of hyperalgesia of Zakharyin-Ged and Mackenzie). Sometimes it can be clinically decided which of the reflex and sensory manifestations in the chest area are associated with the spine or chest, and which are with internal organs. These difficulties arise with any vertebral pathology of the thoracic region, especially with degenerative lesions.
For a differential diagnosis, it is necessary to distinguish between vertebrogenic reflex muscular-tonic, dystrophic and vascular reflex syndromes of the thoracic region. When these syndromes are detected in the back, they are defined as dorsalgia, and in the anterior chest wall as pectalgia.
The main symptom of the disease is pain, which is most intense at night, aggravated by vibration, cooling, torso rotation, less often when bending to the side. Straightening the trunk is accompanied by a feeling of back fatigue. The pain in the joints of the heads and tubercles of the ribs increases with a deep breath. It is localized in the intercostal spaces, sometimes accompanied by difficulty breathing, especially inhalation. The pain can last for a day or more. The provoking tests for its occurrence are percussion along the spinous processes, zones of the capsule joints of the rib tubercles and rotation of the trunk.
In half of the observations with dorsalgia, reflex, more often asymmetric, tension of the paravertebral muscles is revealed. It is known, in particular, that with the pathology of the spinal-locomotor apparatus TII – TXI, there is a tension in the rhomboid muscles, the lower part of the pectoralis major muscle and 3-5 intercostal muscles.
From vegetative disorders, hyperalgesia, local temperature increase, increased sweating are detected. In the pathology of the thoracic region, a number of visceral disorders are observed,
first of all, reflex coronary pathology. Coronary vasomotor changes, as well as dystrophic changes in the region of the heart, can arise as a reflex response to irritation of the receptors of the cervical and thoracic spine and associated sympathetic formations. Thoracogenic impulses mimic cardiac pathology, but they can modify the true coronary pain, which is very important to consider in clinical practice. Vertebral pseudo-coronary pain is called pectalgia or anterior chest wall syndrome. The main source of pathological impulses is in the thoracic and cervical spine. The pain intensifies with exertion, turning the body sometimes has a burning character. Against the background of diffuse soreness of the tissues of the chest wall, trigger zones are revealed, more often in the places of muscle attachment. The syndrome of soreness of the sternum is characteristic – the zone of the beginning of the sternocleidomastoid muscle. Pain from the zone of the xiphoid process extends to both subclavian regions and along the anterior-inner surfaces of the hands.
With the pathology of synchondrosis of the VII-X ribs, the mobility of the end of one cartilage increases, leading to its sliding and traumatizing the nerve formations. Sometimes pain in this pathology mimics the clinical picture of angina pectoris, epigastric hernia. The diagnosis is established by detecting increased mobility and soreness of the false ribs. These are the symptoms accompanied by reflected or local pain in the anterior chest area.
Compression syndromes develop with protruding discs and prolapsed disc herniation. The compression of the root that occurs during these processes is manifested by girdle pain and hypalgesia in the corresponding dermatomes.
Compression at the Tv-Tx level, where the sympathetic fibers of the splanchnic nerves begin, can cause abdominal dysfunction. In addition to compression-ischemic radiculopathies, intercostal neuropathies are even more common. This is facilitated by some topographic-anatomical relationships of the intercostal nerves. The latter are the anterior branches of the thoracic mixed nerves, directed along the lower edge of the rib along its groove between the external and internal intercostal muscles. In the lower parts of the chest, the intercostal nerves at their origin pass directly at the capsule and the head of the underlying rib. Here, in connection with frequent arthrosis and periarthrosis of the joints of the rib head, the conditions for neuropathy of the intercostal nerves develop. The depth of analgesia in pathology is less than in compression radiculopathy. With girdle pain, paresthesia, intercostal neuralgia is often diagnosed. However, you should know that only acute herpetic ganglioneuritis (herpes zoster or herpes zoster) is the true intercostal neuralgia.
It is an infectious disease caused by a neurotropic virus close to the causative agent of chickenpox. Shingles sometimes occurs with chronic infections, cerebrospinal meningitis, and other conditions. It is based on inflammation of one or more spinal ganglia, roots and nerve.
The clinical picture usually proceeds as an infectious disease with fever, a change in the blood count, sometimes with somatic disorders. This period lasts 2-3 days, then very sharp symptoms of radicular neuralgia appear. Burning pains, constant and radiating from the spine to the zone of innervation of one or more roots. The skin in the area of the corresponding dermatomes turns red and after 1-2 days a group of inflammatory papules appears in this zone, surrounded by a reddish corolla. Then they become serous and a little later purulent, turning into yellow-brown crusts. In older people, herpes zoster can leave behind persistent, excruciating pain.
When the disc herniation of radiculomedullary arteries or their branches is compressed, spondylogenic radiculomyeloischemia develops. Symptoms of lesions of the thoracic segments of the spinal cord appear acutely, slowly progressing over several weeks. The appearance of symptoms of spinal cord injury requires in-depth clinical, neurological and paraclinical research. Manual therapy in such cases is contraindicated.
