Back chest pain
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Understanding Back and Chest Pain: Causes and Diagnostic Approaches
Common Causes of Back and Chest Pain
Serious Pathologies and Physical Examination Tests
Back and chest pain can often be indicative of serious underlying pathologies. A systematic review highlighted the importance of physical examination tests (PETs) in screening for such conditions. The most frequently reported tests include cardiac and pulmonary auscultation, heartbeats, and blood pressure measurements. However, there is a notable variation in the use of these tests among different healthcare professionals, with doctors and nurses less frequently assessing the range of motion of the thoracolumbar spine and hip compared to physiotherapists and chiropractors.
Spondyloarthritis and Anterior Chest Wall Pain
Anterior chest wall (ACW) pain is a significant symptom in patients with inflammatory back pain (IBP) suggestive of spondyloarthritis (SpA). Research from the DESIR cohort found that 44.6% of patients with recent IBP experienced ACW pain. This pain is associated with enthesitis, thoracic spine involvement, radiographic sacroiliitis, and a diagnosis of ankylosing spondylitis (AS), indicating a more severe disease course .
Aortic Dissection
Aortic dissection is a critical condition that presents with severe chest pain radiating to the back. It requires immediate medical attention. Symptoms can include sudden onset chest pain, changes in consciousness, and absent pulses in the limbs. Diagnostic imaging, such as computed tomography (CT), is essential for confirming the diagnosis .
Muscular and Nerve-Related Pain
Back and chest pain can also stem from muscular issues, such as hyperactivity of the dorsal scapular or long thoracic nerves, often due to spasms in the scalenus medius muscle. Treatments like trigger point injections, physical therapy, and NSAIDs can be effective in these cases.
Straight Back Syndrome
Straight back syndrome, though less common, can present with chest and back pain. This condition is characterized by a flattened thoracic spine and can be diagnosed through radiographic findings. Chiropractic therapy has been shown to alleviate symptoms effectively.
Diagnostic Approaches
Physical Examination and Imaging
The initial approach to diagnosing back and chest pain involves a thorough physical examination, including PETs like auscultation and blood pressure measurements. Imaging techniques such as X-rays, CT scans, and MRIs are crucial for identifying structural abnormalities and serious conditions like aortic dissection or SpA .
Multivariate Analysis for Spondyloarthritis
For patients with IBP, multivariate analysis can help identify factors associated with ACW pain, such as enthesitis scores and thoracic spine involvement. This approach aids in diagnosing conditions like AS and assessing disease severity .
Respiratory Function and Thoracic Mobilization
In cases of chronic non-specific low back pain, thoracic mobilization has been shown to improve respiratory parameters and reduce disability. This treatment involves specific techniques to enhance chest wall expansion and respiratory capacity, highlighting the interconnectedness of respiratory and musculoskeletal health.
Conclusion
Back and chest pain can arise from a variety of causes, ranging from serious pathologies like aortic dissection and spondyloarthritis to muscular and nerve-related issues. Accurate diagnosis relies on a combination of physical examinations, imaging, and specialized tests. Understanding the underlying cause is crucial for effective treatment and management, ensuring better patient outcomes.
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