Upper Back Pain : Anatomy, Symptoms, Causes & Diagnosis

Anatomy of the Upper Back

Your thoracic spine—the upper back or mid-back region—is the most stable part of your spine. It is very stiff, and the thoracic spine has a limited range of motion. It is like that for several reasons, all of which you can understand by looking at the anatomy of the thoracic spine.

Vertebrae

There are 12 vertebrae in the thoracic spine. They are labeled T1 through T12; the T stands for thoracic. You have more vertebrae in your thoracic spine than you do in any other spinal region. (The cervical spine—the neck—has 7 vertebrae, and the lumbar spine—the low back—has 5 vertebrae. There's also the sacrum and coccyx, which are 5 fused vertebrae and your tailbone.) The thoracic spine extends from your shoulders to your waist.

Vertebrae are the building blocks of your spine, and they stack one on top of each other, getting progressively larger from the cervical spine to the lumbar spine. Vertebrae help your body carry its weight efficiently, in addition to protecting the spinal cord and internal organs.

Thoracic vertebrae have a few unique characteristics, as demonstrated in the illustration below

The spinous processes are very long in the thoracic spine. They also point downwards, as opposed to cervical and lumbar spinous processes, which point more horizontally. The thoracic spinous processes may even overlap each other, and because of that, it's difficult to arch your thoracic spine very much. The long spinous processes limit movement in the thoracic spine.

The intervertebral foramen in the thoracic vertebrae are where the spinal nerve roots exits the spinal canal and go out to the rest of the body. In the thoracic spine, though, the nerve roots don't take up much room in the foramen, so that's why you're less likely to have nerve compression problems in the thoracic spine: there's more space for the nerves to travel through.

The ribs attach to the thoracic vertebrae at the costovertebral joints, another unique characteristic of thoracic vertebrae. Everybody usually has 12 pairs of ribs—one for each thoracic vertebrae. The ribs attach in two places on the vertebrae: at the costal facet, which is on the "block" part of the vertebra, and at the costotransverse facet, which is on the transverse process.

Because the thoracic vertebrae are part of the rib cage, the thoracic spine doesn't move as much as the other spinal regions.

Intervertebral Discs

In between your vertebrae, you have intervertebral discs. These act like pads or shock absorbers for your spine as it moves. Each disc is made up of a tire-like outer band called the annulus fibrosus and a gel-like inner substance called the nucleus pulposus.

The proportion of annulus fibrosus to nucleus pulposus is greatest in the thoracic intervertebral discs. So—relative to the other intervertebral discs, thoracic discs have more of the tire-like outer band. This also adds to the limited mobility of the thoracic spine. Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. These nerves run down the center of the vertebrae and exit to various parts of the body, where they help you feel and move.

Muscles, Ligaments, and Tendons

Your thoracic spine has a lot of soft tissues that support it. Muscles, ligaments, and tendons help your body move: twist, lift, throw, etc. Muscles are strands of tissues that power your movement. Ligaments are the strong, flexible bands of tissue that link bones, and tendons connect muscles to bones. Muscles, ligaments, and tendons all work to control your movements so that you don't hyperextend (bend backwards too much), hyperflex (bend forwards too much), or over-twist your spine.

Symptoms of Upper Back Pain

Many cases of upper back pain are caused by muscle or soft tissue problems, such as sprain, strain, or tension. Many symptoms, then, relate to the muscles:

• stiffness
• spasm
• pain
• tightness
• tenderness when the injured area is touched

Sometimes, you can also feel upper back pain when you take a deep breath because the vertebrae (the spinal bones) in your thoracic spine are connected to the ribs. Sneezing or coughing may also be painful.

With upper back pain (or mid-back pain), you may also have pain in your shoulders and neck (cervical spine). That's because all your muscles are connected, so if it's a muscle problem causing your upper back pain, the other muscles in your shoulders and neck can be affected.

Causes of Upper Back Pain

In order to get the best, most effective treatment for your upper back pain (also known as mid-back pain), you should know what's causing it. Your doctor can help you figure that out, but here are some common causes:

• muscle or soft tissue problem: Muscles, tendons, and ligaments—the soft tissues that support the spine—can be sprained or strained by misuse or overuse. It's possible to get an upper back muscle sprain or a strain through:

1. poor posture: Sitting with a rounded back, shoulders hunched forward, can put too much stress on the back muscles. Poor posture is one of the leading causes of upper back pain because so many office workers spend their work days at the computer. It's easy to fall into bad habits of not sitting properly, especially when you're at your desk for so many hours a day.
2. improper lifting: When picking something up, you should also use good body mechanics so that you protect your spine. Not using the proper form can cause injury and pain.
3. carrying a heavy backpack: Kids are obviously more in danger of getting an upper back injury because of a backpack. An overly loaded backpack is dangerous to the spine, but so is not wearing the backpack correctly (eg, just using one strap).

• trauma/injury: Traumatic events, such as car accidents, can cause upper back pain for various reasons. It's possible to fracture a vertebra (spinal bone). Or part of your vertebra(e) can press on a spinal nerve, which can cause pain.
• other spinal conditions: Upper back pain can be a symptom associated with other spinal conditions. For example:

1. infections: A spinal epidural abscess or a paraspinal abscess can compress the spinal cord or spinal nerves in the thoracic spine, causing pain and other symptoms.
2. osteoporosis: This is a condition affecting the bones. It weakens them, making them more likely to fracture and less likely to carry your weight well. If you have osteoporosis in your thoracic spine, you may develop upper back pain. Weakened vertebrae don't support your body's weight as well, so your muscles, ligaments, and tendons have to work harder to make up for the vertebrae. That can lead to sprain, strain, or muscle fatigue.If you have a vertebral fracture or fractures because of osteoporosis, you will probably develop a rounded back—that's poor posture, which can lead to upper back pain.
3. problematic kyphosis: When looked at from the side, your spine is supposed to curve outwards in your upper back (thoracic spine) region; that curve is called kyphosis or a kyphotic curve. However, it can start to curve outward too much, and that's problematic kyphosis. Various conditions, such as osteoporosis, can cause problematic kyphosis in the thoracic spine, leading to upper back pain.
4. scoliosis: Scoliosis causes an unusual curve or curves in the spine. It can make your spine look like an "S"or a "C" when viewed from the back. If your spine is curving to the left or to the right in the upper back (thoracic spine), you may have pain because of how the curve affects spinal nerves, muscles, and other soft tissues.
5. other conditions: Upper back pain can develop in conjunction with other medical conditions not related to the spine. For example:

• acid reflux (GERD)
• ulcers
• cardiac conditions, such as angina

The upper back (thoracic spine) is much more stable than the neck (cervical spine) and low back (lumbar spine). It doesn't move as much as they do because one of its main jobs is to protect the internal organs in the chest. It does this in conjunction with the ribs, which are attached to the thoracic vertebrae.

Because the thoracic spine doesn't move as much, it's less prone to the joint and disc problems that more commonly affect the neck and low back. That doesn't mean that you can't have a herniated disc causing your upper back pain, but it is much less common.

It's also less common to have degenerative problems in the thoracic spine. The neck and low back move more, so the joints and discs may wear out sooner from use, overuse, and misuse.

Exams and Tests to Diagnose Upper Back Pain

Upper back pain can become so severe that it limits your daily life. If it gets to that point, or if your pain lasts more than a week, you should make an appointment to see a doctor.

During your visit, the doctor will ask you basic questions and perform some exams. All that will help him or her diagnose the cause of your upper back pain and develop a treatment plan for you—a way to manage your pain and other symptoms and heal your body.

Questions to Help the Doctor Understand Your Upper Back Pain

The doctor will probably ask you questions such as:

• When did you first notice the pain?
• Does the pain seem to travel from your upper back to any other part of your body?
• Have you noticed other symptoms besides pain?
• What activities did you recently do?
• What have you done to treat your upper back pain?
• Does anything reduce the pain or make it worse?

Physical Exam

The doctor will also do a physical exam. In that exam, your doctor will observe your posture, range of motion (how well and how far you can move certain joints), and physical condition, noting any movement that causes you pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasms and tenderness. Upper back pain is often caused by muscle problems, so a thorough physical exam is important.

Neurological Exam

You may also have a neurological exam. The doctor will test your reflexes, muscle strength, other nerve changes, and pain spread (that is—does your pain travel from your back and into other parts of your body?). The neurological exam checks to see if your spinal nerves have been affected.

Imaging Tests

You may have to have imaging tests done if the doctor suspects that your upper back pain is caused by a mechanical problem in the thoracic spine (as opposed to a muscle problem such as a strain).

You may have an x-ray, which can help your doctor "see" the bones in your spine. X-rays are effective at showing vertebral fractures or osteoarthritis.

A Computerized Axial Tomography scan (a CT or CAT scan) is the best imaging test to show the bones and joints.

If your doctor thinks there is a nerve problem, you may have to have another test called a Magnetic Resonance Imaging test (an MRI) performed. The pictures produced by an MRI machine are very detailed, so the doctor can see all of the structures in your spine. On an MRI, the discs show up better than on a CT scan.

Other Possible Tests

Osteoporosis is a possible cause of upper back pain, so if your doctor suspects that you have that bone-weakening condition, he or she may have you do a bone mineral density (BMD) test. It will help the doctor understand how strong and healthy your bones are. For more information on how a BMD test helps doctor diagnose osteoporosis, read the article Exams and Tests for Osteoporosis.

Diagnosis

Through the physical and neurological exams—and with any needed imaging tests—the doctor should be able to diagnose the cause of your upper back pain and get you on your way to feeling better.

Read more about :  Neck pain diagnosis & treatment

Source : http://www.spineuniverse.com/conditions/back-pain/upper-back-pain/anatomy-upper-back