Thoracic epidural steroid injections are a treatment commonly used in the management of mid-back and shoulder blade pain that is a result of pinched of inflamed nerves in the thoracic spine. There are a number of different conditions that can compress nerves in this region, leading to inflammation and painful symptoms. Some of the more common causes include:
The Thoracic Spine
The thoracic spine refers to the middle and upper back regions. It joins the cervical spine (neck), extending down about 5 inches past the bottom of the shoulder blades, where it connects to the lumbar spine (lower back).
Made up of 12 vertebrae, the thoracic spine is designed for stability and plays an integral role in holding the body upright and protecting vital organs in the chest. The thoracic spine differs from the cervical and lumbar spine in a number of ways, most notably, its limited flexibility. The rib cage is attached to each level of the thoracic spine, providing rigidity and decreasing range of motion. Compared to the higher-mobile cervical and lumbar regions of the spine, problems like disc herniation are actually not as common in the thoracic spine. Though disc problems can occur in this part of the spine, other more common sources of pain may include:
- Muscular problems
- Joint dysfunction
- Vertebral fractures
- Overuse injury
- Nerve injury
- Kyphosis (hunchback)
Nerve Pain in the Thoracic Spine
The thoracic spine is used in many of our day-to-day activities, making it prone to strain and certain types of injuries. Some injuries can put pressure on the spinal nerves, creating pain and other adverse symptoms. Sensations of pain related to a pinched thoracic spine nerve can range from mild to severe, and are typically localized to the middle back, but can also be experienced in the shoulder blade. Sometimes, this pain can radiate from the spinal column to the front of the chest or abdomen, and may be accompanied by numbness or tingling.
Nerve compression in the thoracic spine may also lead to muscle weakness in the legs. Since so many other conditions can potentially cause symptoms to arise in this region of the body, diagnosing a pinched thoracic nerve can be tricky. If your symptoms and medical imaging do confirm a diagnosis of a pinched nerve in the thoracic spine, then treatment will typically begin with non-invasive approaches including heat therapy, cold therapy and pain medications. If conservative treatments do not prove to be effective for you, then a series of thoracic epidural steroid injections may be recommended.
How is a Thoracic Epidural Steroid Injection Performed?
In a thoracic epidural steroid injection procedure, a corticosteroid (anti-inflammatory medication) combined with a local anesthetic, is injected directly into the thoracic epidural space. The epidural space is the area outside the “sack” covering the spinal cord and nerves. This outpatient procedure is performed using x-ray guidance (flouroscopy), to ensure proper placement of the needle.
Once the injection has been administered, you may notice your pain has significantly decreased or is no longer present. This is due to the effect of the local anesthetic and typically lasts for a few hours. Once the anesthetic wears off, your pain may return and you may experience soreness around the injection site for a day or so. Pain relief from the anti-inflammatory medication can take several days to take effect, however, this varies from patient to patient.
In the days and weeks following your procedure, you will periodically be asked to rate your pain. If the first thoracic ESI was successful and well tolerated, subsequent thoracic epidural steroid injections may be recommended to maintain the therapeutic effects.
Schedule a Consultation at the Diagnostic Pain Center in Austin
The best way to find out if thoracic nerve damage is causing your back pain is to schedule an individualized consultation at the Diagnostic Pain Center in Austin, TX. Our providers will perform a physical evaluation alongside other diagnostic testing to determine if you are a candidate for thoracic epidural steroid injections.