Question
QUESTION: I have back pain Thoratic T5 area that is a stabbing pain. It radiates to my right side. I've had this now for 4 years. I have migraines that have progressively gotten worse. Tingling and numbness that comes in goes in my arms, hands and legs. My neck also hurts now from the strain of constantly trying to relieve the pain on my upper back. I have gone to physical therapy which helped alleviate my pain somewhat by loosening my back up however, the sharp stabbing pain is still there. My Physical therapist tells me a bone in my spine is out of line and turned to the right side and is referring me back to my primary doctor to pursue further. What do you think?

ANSWER: Get some imaging done (x-rays or MRI) if you haven't already done so. This will help determine whether you have a true subluxation where the rib and vertebra meet, and it will also rule out the possibility of some kind of disc injury. If pain radiates around your ribcage to to front, there is a good chance that you might have a herniated disc in the thoracic region. Tingling and numbness in the arms, hands and legs could mean something more serious than just a vertebra out of place so make sure you follow up with your primary care physician for a full physical evaluation including blood work to rule out other conditions (ie. diabetic neuropathy, shingles, etc). Though a recurrent vertebra/rib out of place can cause sharp pain, it is highly unlikely that it would account for the upper and lower extremity symptoms.

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QUESTION: I've had x-rays done which didn't show anything. I've had the same exact pain, in the same exact area for 4 years. It's sharp and extends to the right side. The area is tender and any activity with my right arm aggreviates the pain. My legs become tingling just out of no where. I could be walking and it happens pretty often. My hands go to sleep easily by gripping something like a phone. They also get tingling and go to sleep quite often. My physical therapist felt 95% sure it was a bone and he speculated that I could have a disc problem or a pinched nerve. If I take a deep breath the sharp pain is even worse. I'm 29 years old and the only way I think I could have done this is almost 4 years ago I had twins and carried heavy baby infant carseat carriers frequently. What can you please tell me to help me, I really would love any help. I will be going back to my primary physican next week. They did do a blood workup and found nothing. (checking for diabetes, thyroid typical physical bloodwork) should they check for anything different?

Answer
Possible cause for the thoracic and rib pain can be costochondritis. If conservative care (spinal manipulation and joint mobilization) does not provide long term relief, you may want to consider getting a cortisone injection if it is indeed costochondritis. I would also recommend you do some type of therapeutic exercises to address any muscle imbalances (stretching for the upper trapezius, strengthening the rhomboids, etc). In any case, I think an MRI of the thoracic region would be appropriate at this point in time. The tingling and numbness in your hands could possibly be carpal tunnel syndrome or thoracic outlet syndrome. An EMG or NCV test could rule out those conditions. You may also have something going in the lumbar spine (lower back) like a disc bulge or herniation causing the tingling in the legs. I would recommend you focus on the thoracic pain first since that has been the most persistent problem. It's good that you had the basic blood work done, but it might be beneficial to have your primary care physician do a screen for Lyme's disease since it can be a cause for a lot of the symptoms you're having.