Skip to Main Content




A perceptive clinician elicits often scant objective signs and interprets them correctly, but the easiest way to the diagnosis is to think of it.

NE Shaw J Bone Joint Surg. 1975;57B:412


Thoracic pain


As with neck pain (Chapter 20) and low back pain (Chapter 26), it is frequently difficult for the clinician to make a precise diagnosis in patients with pain in the region of the thoracic spine, given the interplay between the thorax, upper limb, neck, low back, and the cardiorespiratory and visceral systems. Perhaps the most common musculoskeletal problems are disorders of the thoracic intervertebral joints and the numerous rib articulations, as this region of the spine is primarily required to contribute stability to the axial skeleton. Injury to the intervertebral disk, the facet joints (also named zygapophyseal joints), or other nociceptive structures of the thoracic spine may contribute local or referred pain. Clinical presentation of these, often articular, problems is varied, with combinations of pain and altered motion the dominant feature involving one or more intervertebral segments or rib joints. There may be associated abnormalities of the paraspinal and periscapular muscles, as well as increased neural mechanosensitivity (Chapter 6). Thoracic intervertebral joint problems frequently refer pain to the lateral or anterior chest wall. Prolapse of a thoracic intervertebral disk is rare in sportspeople; however, it may be under-reported given the often diffuse symptoms that arise.1,2 Cross-sectional imaging studies are often necessary to rule out this diagnosis.


In adolescents, the most common cause of pain in the area of the thoracic spine is Scheuermann’s disease, a disorder of the growth plates of the thoracic vertebral end-plates associated with an accentuated lower thoracic kyphosis. A list of the causes of pain in the region of the thoracic spine is shown in Table 25.1. The surface, muscle, and cross-sectional anatomy of this area are shown in Figure 25.1).

Table Graphic Jump Location
Table 25.1

Causes of thoracic pain

Figure 25.1

Anatomy of the thoracic spine region

(a) Surface anatomy

Graphic Jump Location

(c) Axial CT image of the typical motion segment from the lower thoracic region. The most accessible rib articulation for palpation and mobilization is the costotransverse joint (CTJ), with the costovertebral joint (CVJ) attached firmly to the lateral ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Clinical Sports Medicine Collection Full Site: One-Year Subscription

Connect to one of the most renowned references in sports medicine and explore all aspects of diagnosis and management of sports-related injuries and physical activity. Subscription includes access to a library of sports medicine videos.

$65 USD
Buy Now

Pay Per View: Timed Access to all of Clinical Sports Medicine Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.