Dr Sunil Rama
The patient typically calls it “a sharp pain beneath my wings” or a pain that is centred to the thoracic spine (mid to upper back) often having pain with deep breathing.
The essential diagnosis must be made as the cause may be multifactorial depending on age, activity and lifestyle of patient. History of trauma or a motor vehicle accident can typically make the symptoms persist even with the use of anti inflammatories (NSAIDs). Simple tests like palpation and getting the patient to move to assess where and when pain is felt can assist in making a diagnosis.
Cardiovascular causes must be ruled out too as heart disease is rife in South Africans and now in an increasingly younger population. I check blood pressure on all my patients, to ensure the ticker box is functioning well. I frequently request a fasting cholesterol test to rule out any lipid plaque formation in the blood vessels.
Organs like the pancreas and gall bladder can also refer pain to this area. This can be ruled out with a thorough history taking and abdominal examination from your healthcare provider
Night pain between the shoulder blades or at the thoracic spine accompanied with sweating or fever can be something a bit more sinister which warrants xrays.
A change in office furniture, bed, pillow and motor vehicle can cause a postural change that allows the muscles around the area to spasm and the joints of the spinal column at the affected area to become fixated or restricted. This is typically treated succcessfully by spinal manipulation to the thoracic segments (this allows the joint to move fluently). I also treat the associated muscle spasm with electromodalities and dry needling. The symptoms resolve well after three sessions, provided the patient is compliant with chiro care and eliminating the probable cause.
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