Pinched Thoracic Nerve – Radiculopathy, Compression

Nerve compression at the level of the thoracic vertebrae, or thoracic radiculopathy, is less common than in the cervical radiculopathy or lumbar nerve compression because of the lower amount of pressure and movement that the thoracic vertebrae are subjected to. However a pinched nerve at the thoracic level may cause symptoms that just as severe, usually presenting as pain, tingling, and numbness in the arms, chest, abdomen or pelvis.

Anatomy of the Thoracic Spine

The parts of the spine at the mid-back region is made up of 12 thoracic vertebrae, each being separated, as in other regions, by an intervertebral disc which acts as a cushion between the vertebrae and also allow movement and flexibility of the spine. Symptoms of nerve compression or entrapment neuropathy may occur when a nerve is compressed or pinched as it traverses a closed space, such as the spinal cord through the spinal canal, and depending upon the site of compression, varying symptoms may be produced. The mid-back or thoracic region is not involved with much bending or flexing movements, hence spinal problems at this level is comparatively rare, resulting in less chance of nerve compression.

Types of Nerve Compression in the Thoracic or Mid Back Region

1. Herniated thoracic intervertebral disc

A herniation or bulging disc occurs when there is a rupture of the outer layer of the disc causing the inner disc contends to protrude and impinge on the nerves within the spinal canal or exiting the canal.

2. Degenerative thoracic intervertebral disc

The intervertebral disc has a hard outer covering supporting a soft gelatinous center and due to gradual wear and tear as a result of age, the outer layer of the disc degenerates. This allows the soft inner portion to protrude out and may put pressure on a nerve root, causing pain, tingling and numbness. This phenomenon is rare in the thoracic region and when it does occur, it is a slowly progressing condition that takes years to develop.

3. Trauma to the thoracic region of the back

A traumatic injury to the thoracic region of the back may give rise to herniated intervertebral disc as a result of the sudden severe force to the mid back.

4. Thoracic outlet syndrome

Nerves or blood vessels may become compressed in the thoracic outlet, the space between the clavicle (collar bone) and first rib,  giving rise to symptoms such as pain and numbness in the shoulders, neck and fingers.

Causes of Thoracic Outlet Syndrome

  • Trauma due to car accident injuries or severe falls.
  • Job related repetitive injuries, like carrying heavy loads.
  • Repetitive injuries due to sports related activities or old injuries.
  • Idiopathic meaning that the cause is unknown.
  • Congenital defect, such as cervical rib, where an extra rib occurs above the first rib.
  • Poor posture.

Symptoms of Thoracic Outlet Syndrome

The symptoms due to nerve compression, or neurogenic thoracic outlet syndrome, are caused by compression of the brachial plexus, a bundle of nerves that come out from the spinal cord. The brachial plexus controls muscle movements and sensation of the shoulder, arm and hand, hence the symptoms produced on compression of the brachial plexus may be associated with its innervation. These include :

  • Neck and shoulder pain
  • Tingling or numbness in the fingers
  • Aches or pains in the arm or hand
  • Muscle weakness often noticed as a weakening grip.

Diagnosis

Apart from the case history and clinical findings upon the physical examination of the patient, certain tests may be done to confirm the diagnosis, such as :

  • X-ray – cervical rib can be seen on x-ray
  • Magnetic resonance imaging or MRI scan
  • Electromyography or EMG
  • Nerve conduction study or nerve conduction velocity test

Treatment

Conservative management is the treatment of choice and may include :

  • Exercises to strengthen the shoulder muscles
  • Relaxation techniques
  • Maintaining good posture

In more severe cases, with persistent symptoms, other therapeutic measures may have to be considered.

  • Medications to relieve pain and reduce inflammation, such as ibuprofen, and muscle relaxants are helpful.
  • Surgery may be considered if conservative treatment is not effective in giving relief from symptoms or if there is significant nerve damage,  although there remains a risk of injury to the brachial plexus during the operation.

5. Spinal Stenosis

Narrowing of the spinal canal, as a result of degenerative changes associated with normal wear and tear due to aging, may cause compression on the spinal cord and nerves, but this condition is rare in the thoracic region.

6. Long Thoracic Nerve Compression

Compression of the long thoracic nerve may occur as a result of carrying heavy packs, such as in army recruits or backpackers, or the nerve may be stretched following heavy labor. Pain is negligible, but there may be impairment of movement in overhead arm extension and winging of the scapula or shoulder blade. This condition may resolve spontaneously in six to twelve months if further compression of the nerve is avoided, such as carrying a heavy object or bag across the shoulder. Exercises to strengthen the muscles are recommended, with surgery being the last option for treatment.

  • Dr. Chris

    Hi James

    I assume that you have not had any severe injury or trauma in the past which could be a contributing factor although not directly related to you condition at the moment. The fact that you have been to reputable health care facility and have not received any positive feedback, I think it would be naive of me to assume that i could help you via this online platform. I do not know your case, I have not seen your test results (although you claim that it is all normal) and from experience, I have learned that readers often choose to give bits and pieces of a story (either because they do not know all the information that the doctor knows or that they prefer to hide certain points).

    Considering that you are so unresponsive to treatment, I am surprised that none of the doctors have considered a psychosomatic component to your condition and advised on counseling. I am sure that your doctors have been doing their best and if you are unhappy, seek advice from another practitioner after he/she has gone through all your previous test results, concluded a complete physical examination and thorough case history.

    That is the best advice that I can give you at this point in time.

    Please note that this free question and answer service is only intended to guide a reader on health related issues and should not replace a medical consultation with a doctor. Please refer to the terms of use above for further terms and conditions regarding this service.

  • Yvonne Lenger

    Am 65 female, can a nerve compression in thoracic spine cause excuciating chest pain that goes into the back and into the jaw. was a hard type of pain.lasted around four minuets, eased off by the time ECG was done that was ok. Have history of lumber back problems and did have a type of angina two years ago.

  • Dr. Chris

    Hi YvonneLenger

    I am sorry but I do not understand what exactly you are asking so I will cover this generally.

    Given that you were previously diagnosed with a “type of angina” and considering your age, I would advise that you do not attribute the pain to a pinched thoracic nerve only. Always keep a possible cardiac condition in mind and if your are feeling the pain along with other signs and symptoms like dizziness, nausea, fatigue and sweating, then see your doctor immediately. This may occur episodically and while it may indicate angina, one of these episodes could end up being a heart attack.

    In terms of your pinched thoracic nerve, it really depends on the cause. A bulging disc or deterioration of the disc is not uncommon in your age and if it has not resolved by this time, along with the help of physical therapy, the chances are that surgery may be the only option. However this is not usually a successful option and once again your age may be a factor to consider here as it may not be advisable.

    If you have not as yet seen an orthopedist / orthopedic surgeon, then do so as soon as you can. Specialist attention can make a big difference in living with this condition. As for your inconclusive ECG, do not become complacent about your chest pain. Follow up consultations with your doctor as well as a stress ECG and full cardiovascular examination by a cardiologist may be advisable. Speak to your doctor about your options and the need for this.

  • parussell

    For the past ?10 years or so I have been battling with something. The closest I can find that is similar is thoracic rediculopathy. I don’t have any “pain” but I do have symptoms that drive me crazy. When I get in certain positions (right side lying is one) I can feel tingling sensations all over my trunk, up into my face and down to my toes. If I do not move (and even if I do) I begin to purspire heavily. I cannot tolerate the sweating so I must move. Now back to the “pain” as I said there really isn’t any but I do have lots of neck and shoulder muscle soreness and an ache between my shoulders more to the left side. I had MRI and EMG done and nothing was found. I am currently going to a chriopractor and he has so far not been about the get the thoracic region to move. What do you think might be the cause and what can I do to finally get rid of this?

  • Crystal B.

    I am a 32 yr old female. I fell in 2005 and severely injured my back from tailbone to cervical spine. My main problem is the 3 herniated discs at T7-8, T8-9 and T10-11 and the severe pain that radiates around my ribcage.The newest problem it osteoarthritis of the thorascic spine. Ive seen many drs, pain specialists and a neurosurgeon all of whom say there is nothing that can be done to help the pain. I take fentanyl,dilauded, nuerontin, muscle relaxers and a combo of other meds. Nothing seems to help even remotely alleviate the pain. I have 7 yr old twins and a 1 yr old. I cant live in this much pain or be on this much narcotics for the rest of my life. I dont know what else to do. If you have any suggestions it would be greatly appreciated. Thankyou

  • Dr. Chris

    Answer by Dr. Alison :
    Hi Parussel,
    Keeping in mind your symptoms, you could be suffering from nerve compression. Sometimes, certain nerve fibers of the sympathetic or parasympathetic system, which control sweat and other secretions of the body, could be compressed too. However it would be best for you to consult a specialist, like a neurophysician/neurologist, who would be able to diagnose your condition better. A nerve conduction test may be advised and other tests to check for autonomic nerve function. A blood sugar test for diabetes may also be necessary.

  • Dr. Chris

    Answer by Dr. Alison :
    Hi Crystal B,
    Since you have tried all forms of medical treatment, perhaps you need to consult with your neurologist again. He might advise epidural steroid injections between the bones of the spine, which may help with the pain. As a last resort, you may have to go for surgery. However, your neurophysician will be the best judge of that, after examining you and doing all relevant tests.

  • Suzi K

    Hi! Just turned 46 in April. Have had low back issues for 10 years. L5-S1 & L4-5 herniated disks with degeneration & some spinal stenosis. Had a rhizotomy 1 year ago. In JAN 2010 I hurt myself @ work with a forward bend twist & herniated T6-7 & T8-9 with Mod. spinal cord compression in both area & EMG showing radiculopathy. Did Physical Therapy which makes it worse, had 2 epidural injections which helped minimally. Pain is right side chest, shoulder blade & mid back. Also have Bilat. thigh soreness like I worked out too long which stays with me most of the day. Dont know what to do now? Saw an Orthapedic spine Dr. who said surgery is dangerous!!!

  • Dr. Chris

    From Dr. Alison :
    Hi Suzi K
    I see that you have tried most of the options available for your back problem. Considering that you are still in a lot of pain, I am afraid you might have to consider surgery as an option now. But before you do so, you also have to realize that in many cases even after surgery the pain does not go away altogether. As to whether surgery will benefit you in any way and to learn about the risks associated with surgery, you really need to consult a neurosurgeon who will be the
    correct person to advise you. Taking a second opinion from another orthopedic spine surgeon may be a good idea too.

  • Dr. Chris

    James, it has been removed. However it will still appear on Google for anywhere between 30 to 90 days. This is not in our control.

    Glad to hear that you are finding some satisfaction with your current health care provider. Good luck.

  • 3TxCats

    29 Y/O female, history of power-weightlifting and unusually large muscle mass for a woman; constant muscular spasms and pain for nearly 3 years in upper back, neck, and shoulders. Followed aggressive treatment plan to release muscles for past six months and as muscles have relaxed, pain has intensified (dramatically) and become more isolated to one spot in the neck and two in the upper back (one between shoulder blades and one about three inches lower), all places have pain that radiates, neck in a band around the back of the neck, top of back down back of upper arms and mid back around right side of ribcage. Periodic numbness in hands, mostly right thumb and index finger since three months after a right distal radius fracture in 2000. Also, have episodes where heart races, even if pain isn’t terribly bad; seems to be related to “pinch” in spots on back. Finally got cervical MRI, have annular tear at C3/4 and something that looks worse near T2/3. Ortho surg not convinced tear at C3/4 is source of pain and has ordered MRI of thoracic spine. Is it possible for muscles to have “guarded” an injury to thoracic column for nearly a decade? I have had muscle pain for three years and the last 5-6 weeks the pain has become so bad, it is hard to move most days and the only comfortable position is standing! Also, wondering if nerve compression could cause increase in heart rate? It feels like it wants to pound out of my chest at times. Thanks!!!

  • 3TxCats

    To parussell: see my post about my “muscular” problems – had physical therapist amazed that my back muscles had immobilized front/back movement of T3, T4, and T5 (which now move and are between two remarkably painful areas); in addition have two knots/trigger points in muscles under scapula that very, very aggressive massage therapist cannot move or break up after almost 6 months of weekly deep tissue work! Would make doctors keep looking!

  • Dr. Chris

    Hi 3TXCats

    Your question was missed as you had submitted two posts. A bit confused about the relevance of your muscle having guarded against the thoracic column injury. Muscles do have a protective function for many of the internal structures and offer support to sensitive areas to prevent abnormal flexibility of the bones and joints and related structures which could result in damage. Nerve root compression could affect heart rate but this is often related to pain. From what you say, you are experiencing palpitations and it needs to be investigated as you may only be focusing on your musculoskeletal condition and may be missing more serious underlying disorders. Please speak to your doctor or seek a second opinion if you are still concerned.

  • 3TxCats

    Dr. Chris, regarding the muscles my question was if they could have protected an actual injury, not protected from injury (if the spasms could be the result of injury to the spine/discs); I did get checked out by cardio – normal EKG, just high pulse rate. I also had a thoracic MRI and there are three discs (T2/3 and 3/4 substantial bulges, and T6/7 is a mini-bulge). There isn’t any severe nerve compression and now wondering if my muscles are the bigger problem – which still makes me wonder if the instability in the spine is triggering the spasms.

  • Dr. Chris

    Hi 3TXCats

    I see what you are asking – muscles attach to bones and while muscles are integral for moving bones at joints, an unstable bone, will prevent the muscle from acting properly. It is possible that your muscles attempted to stabilize the spine for a period of time and ultimately went into severe spasm. This could happen after a few days, or weeks, even months but not over a prolonged period of time. Secondly, you may be looking at two separate issues and attempting to draw your own conclusions here. We cannot comment because we have not seen your actual results.

  • Tkn2hvn

    I am so sick of being in pain! 2 1/2 months ago I was involved in a innertube boating accident. I had a compression fracture to my L2 and underwent kyphoplasty a month and a half ago. I am 32 with no previous back injuries/problems. I am taking Soma and using Volteran Gel for the sciatica and lower back pain. The problem that I an still having is in my thoracic area. It feels as if an elephant stepped on my T4-7 area and that something is wedged deep within that area. I only had all the X-ray, CT scans, MRI’s of my Lumbar area. I am going to have an X-ray of the thoracic area tomorrow. My question is will this show what’s truly causing the pain or do I need an MRI to help diagnose the problem. I think finding my compressed fractured vertabra at L2 kind of through all the doctors for a loop so they didn’t think about looking at the other areas. I am hoping you can help.

  • Dr. Chris

    Hi TKN2HVN

    It is unlikely that they did not check the entire spine at the time of the accident. That would have just been negligent of them. An x-ray is a very effective tool but seems to given little merit these days (by the general public) due to CT scans and MRIs. If is related to the vertebrae, then an X-ray may detect abnormalities. For soft tissue injuries, an MRI will be more effective.

  • kmrwab

    17 yr old injured during football drills (no contact)on August 23rd – sustained a small tear of the labrum. Gradually over 3 days, he lost all feeling in his right arm from just above the elbow down. He also had extreme sensitivity in his right shoulder and shoulder blade area. After several drs, including 2 that thought he was faking, he’s had 12 sessions of physical therapy including 1- 1/2 hrs of exercises and ultrasound of the shoulder blade area each session. The sensitivity of that area has greatly reduced as has shoulder pain; however, there has been no return of sensation to the arm. My questions are: Do we seek another medical opinion, and if so, what medical specialty? Is patience the key – we need to give physical therapy more time to show more results? The numbness is in his dominant arm. Schoolwork has been challenging as he has to write w/ his left hand since he can’t feel a pencil in the right hand. Also, being high school, people are constantly “testing” the lack of feeling with hits, pinches, pencil stabs, etc. Just a frustrated mom.

  • Dr. Chris

    Hi kmrwab

    Yes, a second (or third) opinion is advisable. You need to see a neurologist.

    While with nerve injuries there can be a significant improvement after many months (sometimes longer than 6 months), it is nevertheless prudent to have it evaluated and managed by a medical specialist like a neurologist. Given the age of the person and that his dominant hand is affected, every measure should be taken to ensure that he is receiving proper care and advice during the recovery and rehabilitation period as this can significantly affect his life.

    Constant interfering with the affected limb can be problematic. The extent of an injury cannot be evaluated since he cannot report pain and if there are no visible signs, the repeated trauma may complicate into an infection. Some restraint has to be shown by the school mates.

  • Kellyann

    Hi. I’m a 28 yr old female with DDD and bulges at L4, L5, and S1. I have also lost over 200 lbs in the past 2 yrs; this was accomplished with extreme dieting and ALOT of exercise.
    On New Years Eve I slipped on ice and fell onto brick steps. As a result, I have problems with my left SI joint and I had a fracture at the L1
    transverse process. Anyway, for years I’ve been having a pinching sensation in my mid back in
    the left hand side right under/in my rib area. It used to be once in a while sitting (primarily while driving), but since the fall is more constant. Also, since my fall I have a pain/tingling(it varies) in the exact location as the “pinching”, but around front in my abdomen. It is starting to become more and more frequent.
    I went to my PCP and she sent me to a gastro, who is running a battery of tests on me with negative results for everything. My sports med physiatrist had mentioned this can be caused by thoracic spine injury, but we’re not focusing on it since I currently have so many other injuries due to excessive working out/losing weight.
    My question: what could that “pinching” pain in my back be, and do you think the ab pain/tingling sounds like thoracic injury? Should I pursue this more agressively?
    Thanks!

  • AnneMarie

    Hi I have just come across this website and was hoping I could receive some advice.

    I am a 35 yr old female and about 2 months ago I woke up one morning with a pain on one side of my scalp, over the days the pain in my scalp got worse to the point I couldn’t brush my hair, over several weeks the pain remained I went my dr and was told that she had no answer other than stress and she Prescribed nortriptyline which I didn’t take, over the weeks after that the pain has travelled down my neck to my middle back and ribs, I have had an X-ray which showed no damage to my neck but did show muscle spasm, I am now awaiting an MRI, but as my condition is not priority that is a long wait. Meanwhile I am on ibruprofen and codeine for the pain. I would just like to hear your thoughts any information or advice would be appreciated because up to 2 months ago I was completely fine

    Thanks