Thoracic Radiculopathy

Original Editors - Van der Hoeven Rik, Henau Laurien, Derick Glenn and Kafkot Nick

Top Contributors - Haegeman Nicolas, Rik Van der Hoeven, Kim Jackson, Lucinda hampton, 127.0.0.1, Admin, WikiSysop and Amanda Ager 

Definition/Description

Thoracic radiculopathy refers to a compressed nerve root in the thoracic area of the spine. This is the least common location for radiculopathy. The symptoms often follow a dermatomal distribution, and can cause pain and numbness that wraps around to the front of your body..

• The pinched nerve can occur at different areas along the thoracic spine
• Symptoms of radiculopathy vary by location but frequently include pain, weakness, numbness and tingling.
• A common cause of radiculopathy is narrowing of the space where nerve roots exit the spine, which can be a result of stenosis, bone spurs, disc herniation or other conditions.
• Radiculopathy symptoms can often be managed with nonsurgical treatments, but minimally invasive surgery can also help some patients.

The most important structures which are involved with a thoracic radiculopathy are the:

• Thoracic vertebrae (T1-T12)
• Intervertebral disc of the thoracic vertebrae,
• 12 pairs of spinal nerve roots,
• 12 rami - posterior rami innervate the regional muscles of the back, ventral rami innervate the skin and muscles of the chest and abdominal area.
  

Epidemiology /Etiology

Unknown, the diagnosis of thoracic radiculopathy is overlooked. 

Thoracic radiculopathy has been infrequently reported and described as uncommon.

Radiculopathy typically is a mechanical root compression , most commonly caused by:

• Diabetes mellitus - 15% insulin-dependent and 13% non-insulin-dependent have diabetic thoracic polyradiculopathy.
• Degenerative spine changes such as disc herniation and spondylosis.

Other possible causes of mechanical root compression are a metastatic tumor, trauma, scoliosis, viral infection/inflammation, connective tissue disease and tuberculosis.

Characteristics/Clinical Presentation

• A person may experience pain in the chest and torso when the nerve compression or irritation occurs in the mid back region.
• Thoracic radiculopathy is an uncommon condition that may be misdiagnosed as shingles, heart, abdominal, or gallbladder complications.

Symptoms associated with thoracic radiculopathy include:

• Burning or shooting pain in the rib, side, or abdomennumbness and tingling

The symptoms of thoracic radiculopathy, regardless of the cause, are often not recognized, as there is typically no associated motor deficit.

• When the etiology is disc herniation or trauma, motor deficit or myelopathy may be observed in the advanced stages.
• The typical presentation of band-like thoracic or abdominal pain can mimic a myriad of conditions .
• With many differential diagnoses to consider, it is not surprising that thoracic radiculopathy is often not discovered for months, or years, after symptoms arise

Diagnosis

In addition to a physical exam and symptom review, doctors may diagnose radiculopathy using:

• radiologic imaging with X-ray, MRI, and CT scans
• electrical impulse testing called electromyography or EMG, to test nerve function
• The exclusion of other causes of pain is the most important step in the diagnostic procedure as there are a lot of generators of thoracic pain and differentiating these differential diagnoses will be difficult

Differential Diagnosis

• Postherpetic neuralgia
• Chronic abdominal wall pain
• Malignancy
• Other spinal disorders (e.g. spinal cord tumors, compression by intervertebral discs)
• Spinal: Infectious, neoplastic (primary, metastatic), degenerative (spondylosis, spinal stenosis, facet syndrome, disc disease/HNP), metabolic (osteoporosis, osteomalacia), deformity (kyphosis, scoliosis, compression fracture, somatic dysfunction), neurogenic (radiculopathy, Herpes Zoster, anteriovenous malformation)
• Extraspinal: Intrathoracic (cardiovascular, pulmonary, mediastinal), Intra abdominal (Hepatobiliary, gastrointestinal, retroperitoneal), Musculoskeletal (Post-thoracotomy syndrome, polymyalgia rheumatica, myofascial pain syndrome, somatic dysfunction, rib fractures, costochondritis), Neurogenic (Intercostal neuralgia, peripheral polyneuropathy, RSD/CRPS)
  

Outcome Measures

VAS

Oswestry Disability Index.

Examination

Includes

• Symptoms (already discussed earlier).
• Due to non-universal tenderness and the sensory changes, it is not reliable to do a sensory examination.
• Physical examination is not the best way to evaluate thoracic radiculopathy, unlike the lumbosacral and cervical radiculopathies the affected muscles cannot be tested isolated.
• The examination will rather be used to exclude other diagnoses then to determine a thoracic radiculopathy.

Thus the examination will be done with more medical strategies and therefore we can use: EMG, MRI, CT, radiographs

Medical Management

• non-steroidal drugs, such as ibuprofen, aspirin or naproxen
• oral corticosteroids or injectable steroids
• narcotic pain medications
• physical therapy
• ice and heat application

Physical Therapy Management

Physical modalities of the therapy include:

• heat,
• ultrasound
• TENS.
• Spinal extension exercises..
• Rest Education: avoid the activities that produce the pain (bending, lifting, twisting, turning, bending backwards, etc).
• Apply ice in acute cases to the thoracic spine to help reduce pain and associated muscle spasm.
• An exercise regiment designed specifically to address the cause of the symptoms associated with pinched nerve and improve joint mobility, spinal alignment, posture, and range of motion.
• Restore joint function ( eg Spinal manipulations or mobilisations)
• Improve motion
• Help the return of full function.

Clinical Bottom Line

Mild Cases

• In mild cases many patients found that rest, ice and medication were enough to reduce the pain. Physical therapy is recommended to develop a series of postural, stretching and strengthening exercises to prevent re-occurrence of the injury. Return to activity should be gradual to prevent a return of symptoms.

Moderate to Severe Cases

• If the problem consultation with your health care provider. Your physician should perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.

References

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