Upper Back Pain: Causes, Symptoms, and Diagnostic Tests

Frequent upper back pain?

Hello, I would like to ask...
I often experience pain in my upper back and feel the urge to stretch my chest and twist my waist.
The specific area of pain is in the upper back, around the rib cage, similar to the "gāo huāng" point, with a sensation akin to a bruise or internal injury.
Sometimes, the soreness is so intense that it prevents me from sleeping, especially when it's cold or during the premenstrual phase.
Some people have suggested that this could indicate issues with my heart or respiratory tract, which leaves me uncertain about how to proceed with examinations.
Currently, I also feel a slight strain in the upper right side of my chest, which feels tight, possibly due to excessive stretching and twisting.
I want to alleviate the discomfort in my upper back, as I often have to consciously control my breathing to feel like I'm getting enough air.
When I twist my waist today, it feels as if the area above and below my chest is disconnected, and I can hear a sound resembling a gap or hole when I move.
It's quite strange...
If I want to check for any issues with my thoracic cavity, trachea, respiratory tract, heart, or ribs, what examinations should I undergo?

Youzi, 20~29 year old female. Ask Date: 2017/03/03

Dr. Zhang Hongwei reply Family Medicine

It is still necessary to visit a hospital and consult a physician for a physical examination in order to make an accurate differential diagnosis.

Reply Date: 2017/03/03

More Info

Understanding upper back pain can be quite complex, as it can stem from various causes, and the symptoms can vary widely among individuals. Your description of persistent pain in the upper back, particularly around the thoracic region, along with the sensation of tightness and discomfort during breathing, raises several important considerations.

Causes of Upper Back Pain
1. Musculoskeletal Issues: The most common causes of upper back pain are related to muscle strain, ligament sprains, or poor posture. Activities that involve repetitive movements or prolonged sitting can lead to muscle fatigue and discomfort. In your case, the frequent desire to stretch or twist may indicate muscle tightness or strain.

2. Disc Problems: Conditions such as herniated discs or bulging discs in the cervical or thoracic spine can also lead to pain that radiates to the upper back. These conditions can compress nearby nerves, leading to pain and discomfort.

3. Nerve Compression: As noted in your previous MRI results, a bulging disc at C6/7 could potentially contribute to upper back pain. If the nerve roots are compressed, it can lead to referred pain in the upper back and shoulders.

4. Referred Pain: Sometimes, pain in the upper back can be referred from other areas, such as the heart or lungs. Conditions like angina or pulmonary issues can manifest as upper back pain, especially if accompanied by breathing difficulties.

5. Psychosomatic Factors: Stress and anxiety can also contribute to muscle tension in the upper back, leading to pain. This is often exacerbated by poor posture or prolonged periods of inactivity.

Symptoms to Monitor
- Pain Characteristics: Is the pain sharp, dull, or throbbing? Does it radiate to other areas?
- Breathing Difficulties: Any changes in your ability to breathe deeply or comfortably?
- Posture: Are there any positions that relieve or worsen the pain?
- Associated Symptoms: Are there any other symptoms such as numbness, tingling, or weakness in the arms?

Diagnostic Tests
To determine the underlying cause of your upper back pain, several diagnostic tests may be recommended:
1. Physical Examination: A thorough physical exam by a healthcare provider can help assess your posture, range of motion, and areas of tenderness.

2. Imaging Studies:
- X-rays: Useful for identifying fractures, alignment issues, or degenerative changes in the spine.

- MRI or CT Scan: These imaging modalities provide detailed images of soft tissues, including discs and nerves, and can help identify herniations or other abnormalities.

- Bone Scans: If there is suspicion of bone pathology, a bone scan can help identify areas of increased activity that may indicate inflammation or infection.

3. Pulmonary Function Tests: If there are concerns about respiratory issues, tests to evaluate lung function may be warranted.

4. Cardiac Evaluation: Given your mention of potential heart-related issues, an electrocardiogram (ECG) or stress test may be necessary to rule out cardiac causes of pain.

5. Blood Tests: These can help identify underlying conditions such as infections or inflammatory diseases.

Management Strategies
1. Physical Therapy: Engaging in physical therapy can help strengthen the muscles of the back and improve flexibility, which may alleviate pain.

2. Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain. However, consult with a healthcare provider before starting any medication.

3. Posture Correction: Ergonomic adjustments in your workspace and awareness of posture can significantly reduce strain on your back.

4. Breathing Exercises: Techniques such as diaphragmatic breathing can help improve your breathing pattern and reduce tension in the upper back.

5. Stress Management: Incorporating relaxation techniques such as yoga or mindfulness can help manage stress-related muscle tension.

In conclusion, upper back pain can arise from a multitude of causes, and understanding the specific nature of your symptoms is crucial for effective treatment. It is advisable to consult with a healthcare professional who can guide you through the appropriate diagnostic tests and develop a tailored treatment plan based on your individual needs.

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