Dr. Amod Manocha - Pain Specialist In Delhi
Thoracic spine and Chest wall Pain treatment in Delhi
Thoracic spine treatment in Delhi, Chest wall pain treatment in Delhi

Thoracic spine and Chest wall Pain

March 25, 2018

This section covers pain anywhere between shoulders to the bottom of ribs. It can arise from

  • Inside the thoracic cavity (inside chest)
  • From the chest wall including the thoracic spine
  • Be referred from the neighbouring areas and structures such as abdomen, cervical spine.

Chest wall pain can originate from any of the chest wall structures including bones, joints, muscles, cartilage, ligaments, tendons, nerves, skin and soft tissue. It generally increases with arm movement and is accompanied by localised tenderness.

Some common conditions/situations leading to chest wall pain are

  • Prolonged unaccustomed physical activity. This may cause muscle soreness which can persist
  • Trauma/fall with fracture of ribs or vertebrae. In presence of osteoporosis even trivial trauma can lead to fractures. The event may be difficult to remember specially when the onset of pain is delayed
  • Spine can be a source of posterior chest pain. Pain may arise from joints including those between the vertebrae (facet joints), between the ribs and vertebrae (costovertebral joints, costotransverse joints), discs, spinal ligaments, muscles (paravertebral muscles) and the nerves. The pain can radiate towards the side of chest and as far as the front of chest and abdomen
  • Other joints such as the one between the collar bone and sternum or the ones between the ribs and sternum can also be a source of chest wall pain. Inflammation of the cartilage connecting the ribs to the sternum is known as chostrochondritis
  • Infections such as Shingles commonly affect the thoracic area (Post Herpetic Neuralgia)
  • Rheumatological disorders such as rheumatoid arthritis, ankylosing spondylitis
  • Post surgical pain arising after surgeries such as heart, lung, breast surgery
  • Nerve injury or damage as a result of surgery, trauma or otherwise.
  • Cancer which has spread to chest wall or bones


The treatment will depend on the cause of pain. A multi disciplinary approach using a combination of medications, physiotherapy, psychology and injections is the preferred approach. Please follow the links to read more about these.

Details of some of the treatments available via the pain clinic are given below

Nerve Root Block/ Epidural
Facet joint injection

Spine has many vertebrae and these are linked to each other by small joints called facet joints. The main function of these joints is to provide stability while allowing some degree of movement. These joint commonly become painful and stiff as a result of wear and tear, inflammation or injury. The resulting pain is generally described as a dull ache, heaviness that may radiate along the chest wall.

Investigations such as x-rays and MRI may or may not show joint changes. It is important to understand that even if these investigations show wear and tear/arthritis, not every arthritic joint is painful so MRI alone cannot be relied on to make the diagnosis. A more reliable test, to determine if these joints are responsible for your pain, is accurately placed injections and if the pain reduced significantly then these joints are the likely source of pain.

Injections for facet joints can be done under x- ray or ultrasound guidance as a day care procedure. The procedure involves placing needles at precise location under x-ray guidance followed by injection of a mixture of local anaesthetic and steroid. Most people tolerate this procedure well under local anaesthesia. It may take a few days and sometimes weeks for the full effects of the injections to become apparent.

Medial branch Blocks

These injections are used as tests to diagnose facet joint pain and assess whether the radiofrequency treatment will be beneficial or not. The targets in these injections are the nerve carrying the pain sensation from the facet joints (compared with the joints themselves in the facet joint injections). The procedure involves placing small amount of local anaesthetic at specific locations under x-ray guidance. The resulting nerve block temporarily abolishes the pain if the source of pain is the facet joints. Decision to proceed with radiofrequency is taken based on the degree and duration and of pain relief obtained from these diagnostic injections. 

Costochondral, Sternochondral & Manubriosternal joint injection

These are performed under ultrasound/ x-ray guidance as an outpatient or day care procedure. The procedure involves injecting a mixture of local anaesthetics and a small dose of steroids. The steroid acts around the area it is injected and does not have the same side-effects as taking oral steroid tablets. Ultrasound helps to visualise the spread of drugs and reduce the chances of complications as the needle can be kept away from important structures such as lungs.

Intercostal Nerve Blocks & Radiofrequency
Cryoablation: Freezing Of Nerves
Dorsal Scapular Nerve Block
Pectoral Nerve block, PECS and Serratus Plane block
Trigger Point Injections


Dr. Amod Manocha - Pain specialist doctor in Delhi

Dr. Amod Manocha

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