Thoracic Back Pain Differential Diagnosis

The following is a differential diagnosis for thoracic back pain, categorized for clarity and emphasis on potential severity.

• Single Most Likely Diagnosis
  • Musculoskeletal strain: This is often the most common cause of thoracic back pain due to the high prevalence of muscle and ligament injuries in the thoracic region, which can result from poor posture, lifting heavy objects, or sudden movements.
• Other Likely Diagnoses
  • Herniated disc: Disc herniation in the thoracic spine can cause pain, numbness, and weakness, although it is less common than in the lumbar or cervical regions.
  • Osteoporotic compression fracture: Especially in older adults or those with osteoporosis, compression fractures can cause sudden onset of thoracic back pain.
  • Scoliosis: Abnormal curvature of the spine can lead to uneven muscle strain and pain in the thoracic region.
  • Thoracic spondylosis: Wear and tear on the spine can cause pain and stiffness in the thoracic area.
• Do Not Miss Diagnoses
  • Aortic dissection: A medical emergency where the inner layer of the aorta tears, causing severe, tearing chest pain that can radiate to the back.
  • Pulmonary embolism: A blockage in one of the arteries in the lungs, which can cause sudden chest pain and shortness of breath.
  • Pneumonia: Infection in the lungs that can cause chest pain, especially when coughing or taking deep breaths.
  • Spinal infection (e.g., osteomyelitis, discitis): Infections of the spine that can cause severe back pain, fever, and other systemic symptoms.
• Rare Diagnoses
  • Thoracic spine tumors: Both benign and malignant tumors can cause thoracic back pain, although they are less common.
  • Cauda equina syndrome: A condition where the nerves in the spinal canal are compressed, causing pain, numbness, and potentially severe neurological deficits.
  • Multiple myeloma: A type of blood cancer that can cause bone pain, including in the thoracic spine.
  • Scheuermann's kyphosis: A condition that causes an abnormal curvature of the thoracic spine, leading to back pain and poor posture, typically in adolescents.

Each of these diagnoses has distinct characteristics and risk factors, and a thorough medical history, physical examination, and sometimes imaging studies are necessary to determine the underlying cause of thoracic back pain.