What should I do about chest pain and back pain? One of the persistent diseases of thoracic back pain, thoracic spine small joint misalignment The small joint misalignment of the thoracic spine caused by the external force of rotation, resulting in back and chest pain and functional limitation. It is traditionally called “bone misalignment” and “back brawn tendon injury”. The 12 pairs of thoracic spinal nerves pass through the intervertebral foramen in the same order, and the anterior branch, except for the first thoracic nerve which is involved in the brachial plexus, travels in the intercostal sulcus; that is, the intercostal nerve, and the posterior branch enters the back and innervates part of the muscles and skin of the neck and back, waist and abdomen. . The thoracic sympathetic nerve (attached near the small head of the rib cage) is replaced with fibers that innervate the heart muscle, cardiovascular, gastrointestinal tract, pelvic organs, etc., thus producing a series of symptoms similar to those of visceral lesions when the lesion is present. Although the specific pathological mechanism of thoracic spondylolisthesis is still controversial, its etiology is the same as that of other common rib injury diseases, and trauma, strain and degeneration are the main pathogenic factors of thoracic spondylolisthesis. Combined with modern medical research on physiological anatomy, biochemistry and biomechanics, it is generally believed that when the small joints of the thoracic spine are subjected to sudden violence, such as super-limited rotational activities, or long-term adverse stresses such as improper posture, acute tears, congestion, edema and chronic adhesions, thickening and calcification changes occur in the joint capsule and ligaments of the small joints of the thoracic spine, resulting in small head joints of the ribs, transverse rib joints and posterior thoracic spine The joints cannot be stabilized and are slightly displaced, disrupting the overall biomechanical balance of the spine. The thoracic intervertebral disc is thin, and after degeneration, it not only causes narrowing of the intervertebral space, relaxation of the joint capsule ligaments and compression of the spinal nerve roots, but also displaces the small head of the ribs and the rib nodes outward, resulting in disruption of the joint structure. As the sensory nerve endings on the synovial membrane are sensitive to pain, and the spinal nerve roots and sympathetic nerves are mechanically and chemically stimulated, the local tissues or organs innervated by the nerves become dysfunctional, and intercostal neuralgia, restricted movement, a combination of symptoms related to autonomic involvement and reactive visceral symptoms occur. Diagnosis】 1. History of back trauma or poor postural habits. 2, Recurrent, long-standing pain and discomfort in the thoracic back, intercostal neuralgia and associated autonomic dysfunction of the thoracoabdominal organs. 3, physical examination of the thoracic spine with percussion pain, pressure pain or disorder of alignment, deviation of the spine from the median line, and positive reactive material in the surrounding soft tissues. 4.Frontal and lateral radiographs of the thoracic vertebrae can show injurious changes or degenerative changes in the relevant vertebrae. In addition, tuberculosis, tumor, rheumatoid and fracture of the thoracic spine can be excluded. 5.Physical and chemical examination of the relevant organs can assess the degree of organ damage as well as exclude infectious diseases, stones, tuberculosis and tumors of the organs. 6.Small joint disorders of the thoracic spine often have a history of lifting, carrying, carrying, lifting and body twisting or strain, and the clinical manifestations vary according to the damaged areas and the tissues affected by inflammation. (1) Local inflammatory symptoms of the joint: raised or depressed spinous process at the damaged site, percussion pain and pressure pain, tension and pressure pain of the paraspinal muscles, restricted movement, and sometimes painful nodules or cords can be palpated. (2) Intercostal neuralgia: In mild cases, it only shows discomfort or pain in the innervation range of intercostal nerves, sometimes showing radiating burning pain, in severe cases, it causes ligament tearing and subluxation of the cribriform joints, manifesting as forked breath, severe pain in the quarter rib area, chest pressure, and even aggravating symptoms due to chest lifting, loud talking or deep breathing, showing painful face. (3) Thoracoabdominal organ dysfunction: Vertebral small joint disorder can cause symptoms of autonomic dysfunction of the corresponding internal organs. Clinical manifestations are specific pain syndrome (intractable pain, diffuse pain and abnormal sensation to stimuli), vasomotor and sweat gland secretion derangement and visceral dysfunction in the damaged sympathetic innervation area. For example, T1-T4 injury is characterized by chest tightness, irritability, chest blockage and pressure, coughing and asthma, as well as respiratory and cardiovascular symptoms such as palpitations, heart rhythm disorders, premature beats, etc. T5-T12 injury is characterized by gastric distension, excessive or excessive gastric acid, loss of appetite, abdominal distension and pain, dyspepsia, gastrointestinal weakness or hyperactive gastrointestinal motility, and even induced cholecystitis, gastric ulcer bleeding and other symptoms of the digestive system. symptoms. In the chronic phase, various visceral organic lesions may occur due to visceral nutritional disorders. X-ray examination The front and side views of the thoracic vertebrae occasionally show increased density of the corresponding vertebral margins, osteophytes, calcification of the ligaments, and compensatory scoliosis or kyphosis of the spine. Fracture and bone disease can be excluded. 【Treatment】 1, the lighter thoracic vertebral joint stitching, local local arthritis and intercostal neuralgia heavy with nerve block, for longer duration, hunchback deformity, poor mobility, local soft tissue scar adhesions heavier can be used arc blade needle knife closed soft tissue release combined with ozone water, restore the normal anatomical position of the joint, reshape the back mechanical balance, restore the deformity. 2.Medication treatment is supplementary. 3, functional rehabilitation exercises for the thoracic and back muscles, avoiding large movements for 1-2 weeks.