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Chapter 16: Posterior Thorax Pain

Kathy Doubleday

Description of the Symptom

This chapter describes pathology that may lead to posterior thorax pain. Local causes are defined as pathology occurring within the spine and posterior chest wall structures. Remote causes are defined as occurring outside this region, most notably deep to the parietal pleura.

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Special Concerns

  • Acute chest pain with nausea, pallor, anxiety, vomiting, or diaphoresis

  • Coughing up blood, blood in stool

  • Fainting, dizziness, or vertigo

  • Pain unresolved by rest or change in position, or worse at night

  • Pain that worsens following meals or while inhaling

  • Severe fatigue or shortness of breath

CHAPTER PREVIEW: Conditions That May Lead to Posterior Thorax Pain
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CHAPTER PREVIEW: Conditions That May Lead to Posterior Thorax Pain
T Trauma
REMOTE LOCAL
COMMON
Cervical facet joint dysfunction 274

Costovertebral or costotransverse joint dysfunction 277

Fractures:

  • Compression fracture 279

  • Rib fracture 279

Thoracic facet joint dysfunction 281
UNCOMMON
Not applicable T4 syndrome 281
RARE
Pneumothorax 276

Fractures:

  • Vertebral fracture/dislocation 279
I Inflammation
REMOTE LOCAL
COMMON

Aseptic

Gastroesophageal reflux disease 274

Septic

Peptic ulcer disease 275

Aseptic

Delayed-onset muscle soreness 278

Myofascial pain disorder 280

Septic

Not applicable
UNCOMMON

Aseptic

Not applicable

Septic

Gallstones and biliary disease 274

Pancreatitis 275

Pneumonia 276

Aseptic

Ankylosing spondylitis 277

Fibromyalgia 278

Septic

Discitis 278

Herpes zoster 279

Meningitis 280

Vertebral osteomyelitis 284
RARE
Aseptic

Not applicable

Septic

Pleurisy/empyema 275

Pyelonephritis 276

Aseptic

Transverse myelitis 282

Septic

Epidural abscess 278

Tuberculosis of the spine (Pott's disease) 282
M Metabolic
REMOTE LOCAL
COMMON
Not applicable Osteoporosis 280
UNCOMMON
Not applicable Paget's disease 281
RARE
Not applicable

Cushing's syndrome 277

Osteomalacia 280
Va Vascular
REMOTE LOCAL
COMMON

Angina:

  • Stable angina 273

  • Unstable angina/acute coronary insufficiency 273

  • Variant angina 273

Not applicable
UNCOMMON
Myocardial infarction/acute coronary insufficiency 275 Dissecting aortic aneurysm 278
RARE
Not applicable Not applicable
De Degenerative
REMOTE LOCAL
COMMON
Cervical degenerative disk disease 274 Not applicable
UNCOMMON
Not applicable

Thoracic degenerative disk disease 281

Thoracic osteoarthrosis/osteoarthritis 282
RARE
Not applicable Not applicable
Tu Tumor
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable

Malignant Primary:

Not applicable

Malignant Metastatic, such as:

  • Metastases, including from primary breast, kidney, lung, prostate, and thyroid disease 283

Benign:

Not applicable
RARE

Malignant Primary, such as:

  • Esophageal adenocarcinoma 276

  • Gastric adenocarcinoma 277

  • Pancreatic carcinoma 277

Malignant Metastatic:

Not applicable

Benign:

Not applicable

Malignant Primary, such as:

  • Leukemias 282

  • Multiple myeloma 283

  • Primary bone tumors 284

Malignant Metastatic:

Not applicable

Benign, such as:

  • Neurogenic tumors 283

  • Osteoblastoma 283

  • Osteoid osteoma 283
Co Congenital
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable
Ne Neurogenic/Psychogenic
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable

Note: These are estimates of relative incidence because few data are available for the less common conditions.

Overview of Posterior Thorax Pain

Physical therapists commonly ...

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