Perth chiropractor Adam Epskamp discusses "What causes mid back pain?" The thoracic spine has been described as the enigma within the vertebral column, with the diagnosis of pain originating from this region being historically problematic for the practitioner. The neural complexity of the thoracic spine, along with referred visceral pain leads to poor pain source localization. Research of thoracic spine pain referral patterns has been relatively sparse when compared to the cervical and lumbar spine regions, despite reports of equally disabling pain from this region.
The costotransverse and costovertebral joints are often suspected as sources of referred thoracic pain only after costly and often unnecessary negative visceral work-ups have been performed. One example is T4 syndrome, a symptom complex originating in the upper thoracic spine and includes glove-like paresthesias of one or both upper limbs, referred pain into the neck and scapular regions, and a dull, aching generalized headache. Successful treatment has been reported in case studies using manipulation and exercise intervention , despite the unknown cause of T4 syndrome. Both the thoracic intervertebral disks and thoracic zygapophyseal joints are thought to be primary pain generators in T4 syndrome based on their pain patterns, suggesting that dysfunction of the costotransverse joint may be implicated as well.
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