Thoracic pain of lower cervical origin

The clinical association between injury to the lower cervical region and upper thoracic pain is well known, especially with 'whiplash' injuries. It should be noted that the C4 dermatome is in close proximity to the T2 dermatome.

The T2 dermatome appears to represent the cutaneous areas of the lower cervical segments, as the posterior primary rami of C5,6,7,8 and T1 innervate musculature and have no significant cutaneous innervation.

The pain from the lower cervical spine can also refer pain to the anterior chest, and mimic coronary ischaemic pain. The associated autonomic nervous system disturbance can cause considerable confusion in making the diagnosis.

The medical profession tends to have a blind spot about various pain syndromes in the chest, especially the anterior chest and upper abdomen, caused by the common problem of dysfunction of the thoracic spine. Doctors who gain this insight are amazed at how often they diagnose the cause that previously did not enter their 'programmed' medical minds.

Physical therapy to the spine can be dramatically effective when used appropriately. Unfortunately, many of us associate it with quackery. It is devastating for patients to create doubts in their minds about having a 'heart problem' or an 'anxiety neurosis' when the problem is spinal and it can be remedied simply ( Chapter 34 ).

Lumbar spinal dysfunction

The association between lumbar dysfunction and pain syndromes is generally easier to correlate. The pain is usually located in the low back and referred to the buttocks or the backs of the lower limbs. Problems arise with referred pain to the pelvic area, groin and anterior aspects of the leg. Such patients may be diagnosed as suffering from inguinal or obturator hernial and nerve entrapment syndromes.

Typical examples of referral and radicular pain patterns from various segments of the spine are presented in Figure 21.1 .

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