Diagnosis and symptoms6 min read
What is a thoracic disc herniation and what are its symptoms?
A thoracic disc herniation is a disc in the upper back protruding outward. It accounts for only a small proportion of spinal herniations, because the rib cage naturally stabilises this region and limits movement.
Why it is rare
The thoracic spine attaches to the sternum via the ribs, forming a natural cage. As movement is limited, shear load on the discs is also low.
In the lower back and neck, movement is free; that freedom loads the discs more and makes herniation easier. In the upper back this mechanism is largely absent.
Herniation is therefore not the first diagnosis considered in upper back pain. Muscle strain, facet joint and rib joint problems are far more common causes.
Typical symptoms
The most distinguishing finding is pain starting in the back and radiating forward around the ribs like a band, following the course of the nerve root.
Pain can increase with deep breathing, coughing and rotating the trunk. That increase helps separate the picture from muscular pain.
Numbness or increased sensitivity can occur along the affected rib line, matching the line of the radiating pain.
Warning findings
In the thoracic region the spinal cord lies far closer to the disc than in the lower back. Signs of cord compression therefore carry particular importance here.
Weakness in the legs, unsteady walking and a sense of stiffness in the legs should be assessed without delay. These suggest thoracic myelopathy.
Changes in bladder or bowel control, and loss of sensation below a particular level on the trunk, are urgent findings and not suitable for waiting.
Key points
- Thoracic herniation is far rarer than lumbar or cervical.
- The rib cage stabilises the region, so disc load is low.
- Band-like pain around the ribs is the most typical finding.
- Increase with deep breathing and coughing separates it from muscular pain.
- The cord lies very close to the disc here; compression signs are urgent.
Frequently asked questions
Is my upper back pain caused by a herniation?
Most likely not. The vast majority of upper back pain comes from muscle strain, facet joints and rib joints. Without band-like radiation around the ribs and neurological findings, herniation is not the leading diagnosis.
Should I have an MRI?
Usually not, absent neurological signs and where the pain is mechanical. Where there is band-like radiation, leg weakness or a change in gait, the imaging decision is taken without delay.
Can it be confused with heart or lung problems?
It can be. Cardiac and pulmonary causes must be excluded first in pain radiating to the chest. Breathlessness, sweating or chest pain increasing with exertion require urgent assessment.
Related articles
- Treatment course· 6 min readNon-surgical treatment and physiotherapy in thoracic disc herniation
- Exercise· 6 min readExercise in thoracic disc herniation: breathing, mobility and endurance
- Treatment decision· 6 min readWhich upper back pain symptoms require urgent assessment?
- Daily living· 6 min readDaily life with thoracic herniation: lifting, sitting and breathing
Other topics in the same region
- Diagnosis and symptoms· 6 min readWhat is scoliosis and how is it noticed?
- Diagnosis and symptoms· 6 min readWhat is kyphosis? Is a hunched back the same as poor posture?
- Diagnosis and symptoms· 6 min readLocking in the upper back and pain on breathing: a facet joint problem
- Diagnosis and symptoms· 6 min readBurning between the shoulder blades: cause and meaning
Articles of a similar kind
- Diagnosis and symptoms· 6 min readLumbar disc herniation symptoms: which pain points to a disc?
- Diagnosis and symptoms· 6 min readCervical disc herniation symptoms: what arm pain means
- Diagnosis and symptoms· 6 min readWhat is cervical flattening and what does it mean on an X-ray?
- Diagnosis and symptoms· 6 min readWhat is scoliosis and how is it noticed?
This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.