Differential Diagnosis for Neck Flexion Causing Sharp Midline Midthoracic Pain
- Single Most Likely Diagnosis
- Thoracic spine strain or sprain: This is the most likely diagnosis due to the mechanical nature of the pain (sharp pain with specific movement) and its location (midline midthoracic). The thoracic spine is less mobile than the cervical or lumbar spine, but it can still be strained or sprained, especially with sudden or forceful movements like neck flexion.
- Other Likely Diagnoses
- Thoracic disc herniation: Herniation of a thoracic disc can cause sharp midline pain, especially if the herniation is central and compresses the spinal cord or if it affects a nerve root that refers pain to the thoracic region. The pain can be exacerbated by movements that increase pressure on the disc, such as neck flexion.
- Costochondritis or Tietze's syndrome: Although more commonly associated with chest pain, costochondritis (inflammation of the cartilage that connects the ribs to the sternum) or Tietze's syndrome (a similar condition that can also involve the muscles) can sometimes cause pain that is perceived in the thoracic spine area, especially if the upper thoracic segments are involved.
- Do Not Miss Diagnoses
- Aortic dissection: This is a medical emergency that can present with sudden, severe, tearing chest or back pain. Although the pain is often more lateral, it can be midline and can radiate to the back. The association with neck flexion might be coincidental, but any severe, acute onset of thoracic pain warrants consideration of aortic dissection.
- Spinal epidural abscess: An abscess in the spinal epidural space can cause severe back pain, fever, and neurological deficits. The pain can be exacerbated by movement, including neck flexion, and is a medical emergency due to the risk of spinal cord compression.
- Rare Diagnoses
- Osteoporotic vertebral fracture: Although more common in the elderly or those with known osteoporosis, a vertebral fracture can cause acute onset of back pain. The pain can be sharp and exacerbated by movement, including neck flexion, especially if the fracture is in the thoracic region.
- Spinal tumor: Tumors of the spine (primary or metastatic) can cause back pain that may be exacerbated by movement. The pain is often constant but can be worsened by specific movements, including neck flexion, depending on the tumor's location and effect on the spine.