Differential Diagnosis for Intense Intermittent Upper Back Spasm with Associated Chest Pain
Single Most Likely Diagnosis
- Musculoskeletal Strain or Sprain: This is often the most common cause of upper back pain and spasms, especially if the patient has recently engaged in heavy lifting, bending, or other strenuous activities. The pain can radiate to the chest, mimicking more serious conditions.
Other Likely Diagnoses
- Costochondritis: Inflammation of the cartilage that connects the ribs to the breastbone can cause sharp pains in the chest and upper back, which may worsen with movement or deep breathing.
- Thoracic Outlet Syndrome: Compression of the nerves and/or blood vessels that pass into the thoracic outlet (the space between your collarbone and first rib) can cause pain in the upper back, chest, and arms, along with muscle spasms.
- Scoliosis or Kyphosis: Abnormal curvatures of the spine can lead to uneven muscle strain, resulting in spasms and pain, especially if the condition is severe or has progressed significantly.
Do Not Miss Diagnoses
- Myocardial Infarction (Heart Attack): Although less common in younger individuals, chest pain associated with back spasms could be a sign of a heart attack, especially if accompanied by other symptoms like shortness of breath, nausea, or arm pain.
- Pulmonary Embolism: A blood clot in the lungs can cause sudden, severe chest pain that may radiate to the back, along with shortness of breath and possibly coughing.
- Aortic Dissection: A tear in the aorta's inner layer can cause severe, tearing chest pain that radiates to the back, which is a medical emergency.
- Pneumothorax: Air in the space between the lungs and chest cavity can cause sudden chest pain and shortness of breath, which may be associated with back pain if the condition affects the upper lobes of the lungs.
Rare Diagnoses
- Osteoporotic Compression Fracture: Weakened bones can lead to fractures with minimal trauma, causing sudden back pain that may radiate to the chest.
- Spinal Tumors: Although rare, tumors on the spine can cause back pain and muscle spasms, especially if they compress nerves or the spinal cord.
- Infectious Spondylitis or Discitis: Infections of the spine can cause severe back pain, muscle spasms, and systemic symptoms like fever, which may be referred to the chest if the upper thoracic spine is involved.