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Back and scapular pain

Back pain (or dorsal) can be felt from the base of the neck to the last rib, is not as frequent as pain in the neck or spine .

It can be light, excruciating, constant or occurring only during movement. The most common back pain is joint or muscle type , but can not be ignored because lung cancercan also cause symptoms in this area.


Anatomy of the spine and ribs

The backs are commonly known as ribs, the bones of the chest, flat and ribbons, (we have 12 pairs) serve to protect and contain the vital organs of the thoracic cavity.
They originate from the 12 dorsal vertebrae and extend to the sternum.

The ribcage consists of the ribs, the thoracic vertebrae and the sternum and plays an important role in protecting the heart and lungs. 
From the first to the seventh ribs are called “true ribs” because they articulate with the sternum through the interposition of a cartilage, this means that the rib cage is less rigid.

Chest cavity seen later. © Sebastian Kaulitzki-Fotolia.com

The eighth, ninth, and tenth ribs are not articulated with the sternum, but with the preceding one. 
The eleventh and twelfth ribs are atypical, ending before and are called floating ribs. 
The interposition of costal cartilage leaves the rib cage more elastic. 
The costal cartilages progressively lengthen from the first to the seventh, then decrease. 
Freedom of movement is essential if it is to expand the rib cage during inspiration and narrow during breathing.


Dorsal pain or back pain

 What does it mean?

Almost everyone thinks that the pain in the back to the sternum is caused by a cold or by cold weather, this is an erroneous belief if we perceive that the discomfort tends to remain even after a week. 
It is essential to seek a doctor because the symptoms in this area of ​​the body can also be caused by serious diseases such as tumors, ulcers , pleurisy etc. 
If the strong pain originates in the musculoskeletal system or the nerves, it is necessary to be sure that there is no fracture , muscular injury , distraction of the cartilage of the ribs, etc. through evaluation of the patient’s medical history.
The pain may be bilateral, but it almost always feels only on the right or left side of the chest. 
Generally occurs in patients who do any type of work, a very high percentage of the population regardless of the work suffers from this pathology, I see workers, employees, technicians, professionals, athletes,  etc. daily . 
Lumbar pain is more frequent than back pain, although we treat many patients who suffer from the central part of the blocked spine because the symptoms are usually very strong. 
Patients with back pain may be any age, adults are most affected. This untreated disease can properly become chronic, there are patients suffering from it for 20/30 years.
The scapular pain is located between the two shoulders and between the center of the rib cage and neck. 
Who suffers from back pain often also suffers from low back pain, neck pain  or a diffuse rachialgia. 
Often, doctors believe that pain is caused by a  contracture , in fact the contracture is a consequence of pain in the spine and scapular. 
Scapular pain is very common, especially in the movements of the shoulders. People who suffer from this pain can not lift their arm or put their hands behind their head or back.


What are the causes of  back pain?

Back pain affects almost half of the population, patients perform all kinds of work and sports activities. It is difficult to identify the cause, there are certainly people who wake up in the morning with pain or symptoms of low intensity (mild pain) that grows over time. 
Pain is almost always caused by a set of causes, it is rare that the origin is of a single structure. 
The elderly may suffer from spondylosis ( vertebral arthrosis ). 
There is no equivalent of torticollis or low back pain in the dorsal spine. 
The patient’s weight can not be the source of the symptoms because it also affects very lean people. 
Autoimmune diseases such as ankylosing spondylitis orrheumatoid arthritis attack the back, in the first case, the spine takes a form of firm and hard bamboo cane.

What are the symptoms  of  back pain?

The symptoms of back pain are not just in the back, the question to ask the patient is: if the back pain disappears, would it feel healthy? 
The answer may be negative because the patient may feel, for example, tiredness in the arms. 
The pain in the spine is very strong, it is usually located on only one side of the back and can occur even at rest. 
The pain occurs by rotating the thorax or by rotating the neck. 
The symptoms are usually located in the upper region of the back, behind the shoulders and shoulder blades, it is more rare a low back pain. 
The patient says he feels pain when he coughs and when he breathes deeply. 
Symptoms may be caused during return movement or immediately upon return to rest position. There are patients who wake up at four in the morning with the pain and have to get up because the intensity is too high, but during the day the spine is completely painless. 
Pain can also occur when breathing deeply. A patient should not feel stupid just because he feels strange symptoms, it is not correct to consider psychosomatic pain without evidence.


How to get the diagnosis of back pain?

Dorsal magnetic resonance

“A friend of mine says the pain is due to the shoes, another thinks it’s the mattress’s fault  , maybe she has a herniated disc , but she remembers carrying a heavy object and maybe has a muscle injury.” 
These are some hypotheses that the patient usually presents; sometimes they are correct. The doctor conducts a consultation to rule out more serious conditions, and based on the patient’s medical history, exams, and information provided, he or she diagnoses the type of back pain. 
The exams you may prescribe are: MRI and CT scan if you suspect a herniated disc, or an X-ray for any fracture or congenital anomalies at the level of the bones.
It is possible that the patient will suffer from nonspecific back pain, without a cause and with diagnostic tests (magnetic resonance imaging, CT scans, etc.) that do not show any lesion or inflammation . 
These symptoms can be anywhere on the vertical bands that propagate down or up.


Myofascial manipulation


What to do? What is the treatment for back pain ?

All patients should improve posture to avoid incorrect positions, especially when seated. Anti-inflammatory
medications (NSAIDs, cortisone, analgesics, etc.) may provide relief, but the improvement is temporary because they generally do not act on the cause of the problem. 
Muscle injury is a rare event, the treatment is only instrumental, some sessions of Laser or TECR® ( capacitive and resistive energy transfer ) provide healing of the lesion. 
The neuromuscular taping (or kinesio taping) can be associated with the treatment, serves to relax the muscle and stimulate the healthy side, thus homogenous tension of the shoulders and interscapular muscles.

In the case of disc herniation, which is very rare at the dorsal level, the most appropriate treatment is the mckenzie method that pushes the nucleus pulposus of the intervertebral disc to its anatomical location, so that the disc to press on the nerve and cause symptoms . 
For arthritis or back pain by inflammation, instrumental physiotherapy that has a local anti-inflammatory effect is used. 
Patients who suffer from pain during certain movements (usually when they spin) benefit from the technique of joint repositioning and osteopathy . 
For non-specific pain in people who do not have anatomical defects the treatment that gives me the best results is the myofascial manipulation, which dissolves the small adhesions that can cause pain radiating. 
If the patient feels pain especially at night or when he wakes up in the morning, it will be necessary to check if the mattress is adequate.


Pain or intercostal neuralgia. Which is?

 Is it possible to feel shocks in the chest from the shoulder to the sternum?

Dorsal rotation exercise

The sharp pain between the ribs is very strong, it originates in the spine and radiates along the course of the rib to the sternum. It is possible that you do not feel in the middle of the spine, but at the level of the shoulder blade, in certain cases the pain does not rise until the sternum, but ends in the chest at the level of the ribs. 
If the pain in the ribs starts laterally to the vertebra and spreads to the sternum it is of nervous origin and can be caused by a disorder of bone or muscle. 
Patients experience persistent and persistent pain in the middle of the back that may worsen during the execution of certain movements or in some positions. 
Medical examination is essential because thoracic symptoms can be caused by severe visceral diseases, however, it is not always necessary to seek a specialist or do some tests.
This disorder affects all types of patients, often adults who perform heavy or sedentary work.

What are the causes of intercostal euralgia ?

The most likely cause is herniated or disc protruding , although this part of the spine is rare because the disc has a reduced thickness. 
It can be another cause of joint pain , pain can originate in the joints of the vertebrae. 
The reason the hernia or vertebral misalignment appears is posture , trauma or lifting weights in the wrong position. 
The cold wind does not appear to be a case of intercostal neuralgia, although it may harden the muscles and favor the onset of pain.


What are the symptoms of intercostal neuralgia?

The pain is very strong or resembles a very strong and unbearable whipping. 
It is possible to feel it at rest, but it is usually related to the movements of the arm or back . 
The pain can be like a blaze and is located as a half-brace over the rib cage. Deep breathing can exacerbate the symptoms in severe cases even in normal breathing. 
The patient suffers when he keeps his arm raised for a long time (for example, brushing his teeth), especially if the arm is extended forward with the elbow at shoulder height (such as stretching the arm to remove a distant object). 
The movements of the thorax and spine are painful, especially the rotation of one side and folding forward.
If the pain is in the upper back, the rotation or tilting of the side of the neck can cause discomfort. 
Among the rarer symptoms are tingling and loss of sensation in the chest. The pain increases when you stay in the same position for a minimum of 5/10 minutes, sitting, standing or lying in certain postures. 
In severe cases, the patient remains crooked to one side of the spine, sometimes does not notice the disorder until he sees his posture in front of a mirror.  


How to get the diagnosis  of intercostal neuralgia ?

Medical examination is sufficient in most cases and it is necessary to exclude visceral diseases . If your doctor believes that you need further evaluation, you will prescribe an instrumental examination. 
The  MRI or CT show some protrusion or herniated disc that can be the cause of the patient’s symptoms. 
The radiograph shows only the bones, so it is useful to diagnose a fracture or spondylosis, osteoarthritis and scoliosis of the spine. 
The  ultrasound  did not run because it can not provide information on the intervertebral disc. It is difficult to discriminate the muscles of the back because they are arranged in 4 layers.
Blood tests with antinuclear antibodies that may indicate a rheumatic disease such as ankylosing spondylitis, to be confirmed by magnetic resonance imaging in which the spine is seen as a bamboo cane and straight. 
If your doctor thinks it is necessary, you can recommend an appointment with a specialist, a rheumatologist, or an orthopedist. 
It is almost impossible to find a muscle injury at the level of the back, chest and abdominal muscles because the trunk movements are not fast and the presence of many ligaments and joint capsules does not allow the muscles to extend beyond the physiological flexibility.


How to read reports of MRI, computed tomography, radiography, etc.

Can scoliosis cause intercostal pain? 
Not in most cases, if the scoliotic curve is too severe may result in an intercostal nerve compression, but are extremely rare cases.

Can arthrosis be the cause of back pain? 
It is seldom ever to find older people with arthrosis that compresses the nerve because that part of the spine is less flexible and therefore less subject to joint degeneration.

Can a herniated disc cause radiated pain from the dorsal spine to the sternum? 
That ‘s the most likely cause.

The dorsal spine is  rectilinear , does it cause pain in the back and ribs?
No, not the cause.


What is the most appropriate therapy?

The doctor prescribes the treatment according to the cause of the back pain. 
Generally the pain that originates in the spine has a postural cause or is caused by incorrect movements, so the first thing to do is correct the posture to reduce the pain. 
If you suspect that the protrusion, bulging or herniated disc causes symptoms, the most appropriate therapy is manual, with the exercises of the Mckenzie method that gives excellent results. 
Instrumental therapy may be helpful in suppressing inflammation , but it does not cure the patient forever. 
If the nucleus pulposus of the intervertebral disc presses the nerve, no anti-inflammatory therapy can resolve the disorder because the cause is not inflammation.


Back and back pain in the arm


Image of symptoms of back and arm pain 
© Sebastian Kaulitzki – Fotolia.com

Which is?

Spinal pain may also  radiate to the arm, but only to the back. The symptoms are terrible, the patient is comfortable when lying in bed, but sitting and standing can not find a position that relieves the symptoms. If the patient is standing with his hands along the hips and stretches the palm of the hand forward, the pain is in the back of the arm, in the triceps and at the level of the extensors of the wrist and fingers. 
The patient comes to the clinic with the forearm over his head or supported by the other arm because it gives relief and calms the symptoms. Usually occurs associated with neck pain, the patient can not move the neck without feeling pain in any direction. This painful syndrome is often accompanied by a joint or disc disorder at the level of the neck.


What causes the back and back of the arm ?

Like any musculoskeletal type back pain, pain is caused by incorrect posture, trauma, spondylosis (osteoarthritis), improper weight lifting or congenital malformations. 
The onset is acute and often the pain is constant.

Patients tell me that the pain is caused by the work chair that is too high because they spend too much time with an incorrect posture or workouts in the gym. 
The pain may be caused by an abnormal position of the vertebrae that are slightly misaligned and cause friction in the movement, by a muscle contraction, a protrusion or bulging of the disc . 
Some patients arrive with MRI and think that the problem is the intervertebral disc consumed. 
Usually this is not so because the intervertebral disc is very narrow, cartilage and disc wear is generally asymptomatic and young people (and adults) are much more affected than the elderly.


What are the symptoms?

The person suffering from this syndrome seeks to maintain a non-painful position with his hand above his head or by holding his arm with a scarf around his neck. 
During the day, the patient does not know which position to hold because he feels a constant and unbearable pain that increases in the execution of certain movements. 
In this case, the symptoms that originate in the part of the scapular region and terminate in the fingers are caused by a compression of the cervical nerve root C6, but often the patient states that the neck is asymptomatic and healthy. 
This is possible because often the pain of the neurological type does not give an exact match between the affected region and the symptoms.

There are many patients who present in clinic with disorders that affect only the shoulder or elbow caused by a cervical problem. Unlike intercostal or scapular pain, the patient does not feel pain by lifting his arm forward, but may experience chest pain on the painful side. 
Symptoms include tingling in the index and middle finger, constant pain in the arm, the patient also feels pain in the side of the spine near the scapula. This syndrome may involve the neck because the movements are very limited, but the pain is felt in the region of the scapula, the patient feels more pain when:

  • Leans forward
  • Look up
  • Turns the neck to the painful side.

At night the patient does not suffer, but during the day feels the need to lie down to feel better. 
Usually during the movement the pain decreases, but remaining firm in the same position exacerbates the symptoms, as well as deep breathing. 
There is another type of disorder that can be felt in the first dorsal vertebra and continues through the middle of the posterior forearm. Dorsal pain can also affect athletes, especially volleyball players, as this sport involves many jumps, barrier traumas and stroke attacks.  


What is the treatment?

The first thing to do is correct the posture, for example:

  • Adjust the height of the office chair
  • When a breastfeeding mother should put a cushion over her thigh
  • Bend your knees to lift an object off the floor instead of flexing the spine

It is important to place the lumbar roller on the chair to maintain the correct position of the spine. 
Any therapy will have little effect if the patient maintains incorrect habits. 
The most effective therapy is manual because the disorder is not an inflammation. Laser therapy, Tecar therapy® and  massage serve to eliminate contractures in the neck region and between the ribs. 

For disc disease, the most appropriate therapy at the joint level is Mckenzie therapy associated with joint repositioning. 
If the patient does not have a herniated disc, the best manual therapy is the manipulation of the fascial tissue to loosen the adhesions in the connective tissue that interfere with the nerves.

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