All About Upper Back Pain

thoracic spine
Fig. 1 Side view of the thoracic spine with ribs attached (larger view)

Although upper back pain is not a very common spinal disorder, it can cause significant discomfort and pain when it does occur. The most common causes of upper back pain are muscular irritation (myofascial pain) and joint dysfunction.

There can be an injury to a disc in the upper back (such as a thoracic herniated disc or degenerated disc) that causes upper back pain, but such injuries are very rare.

It is important to note that the thoracic spine (also called upper back, middle back, or mid-back) is very different in form and function than the cervical spine (neck) or the lumbar spine (lower back). While the neck and lower back are designed to provide us with mobility, the thoracic spine is designed to be very strong and stable to allow us to stand upright and to protect the vital internal organs in the chest. Because this section of the spinal column has a great deal of stability and only limited movement, there is generally little risk of injury or degeneration over time in the upper back.

Anatomy of the Upper Back

The word "thoracic" means pertaining to the chest, and the thoracic spine (also called the upper back or mid-back) is the portion of the spinal column that corresponds to the chest area (Figure 1).

  • Twelve vertebrae in the middle of the spine with ribs attached make up the thoracic spine. When viewed from the side, this section of the spine is slightly concave.
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  • Each vertebra in the thoracic spine is connected to a rib on both sides at every level and these in turn meet in the front and attach to the sternum (the breastbone). This creates a cage (the thoracic cage) that provides structural protection for the vital organs of the heart, lungs, and liver, and also creates a cavity for the lungs to expand and contract.
  • The upper nine ribs start at the spine, curve around and are joined at the front of the chest. Because the ribs are firmly attached at the back (the spine) and the front (the sternum), they allow for very limited motion in the spine.
  • The lower three ribs do not join together at the front, but do function to protect the vital organs while allowing for slightly more motion.
  • The joints between the bottom thoracic vertebra (T12) and the top lumber vertebra (L1 in the lower back) allow twisting movement from side to side.

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Because there is little motion and a great deal of stability throughout the upper back (thoracic spine), this section of the spine does not tend to develop common spinal disorders, such as a herniated disc, spinal stenosis, degenerative disc disease, or spinal instability. These conditions can cause upper back pain but are exceedingly rare in the upper back.

Because of this stability and lack of motion, in most cases anatomic causes of upper back pain cannot be found, and an MRI scan or CT scan will rarely image an anatomic problem that is amenable to any sort of surgical solution for the upper back pain.

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