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Journal of Rheumatic Diseases and Treatment

DOI: 10.23937/2469-5726/1510003

Differential Diagnosis in Upper Back Pain

Nihal Ozaras*

Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University, Istanbul, Turkey

*Corresponding author: Nihal Ozaras, Department of Physical Medicine and Rehabilitation, Bezmialem Vakif University of Istanbul, Turkey, Tel: +90 212 4874145, Fax: +90 212 6217580, E-mail:
J Rheum Dis Treat, JRDT-1-003, (Volume 1, Issue 1), Editorial; ISSN: 2469-5726
Received: February 16, 2015 | Accepted: February 18, 2015 | Published: February 21, 2015
Citation: Ozaras N (2015) Differential Diagnosis in Upper Back Pain. J Rheum Dis Treat 1:003. 10.23937/2469-5726/1510003
Copyright: © 2015 Ozaras N. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Upper back pain (UBP) is the pain experienced at the thoracic spine region. Spinal pain prevalence is 66 per 100 people and15% them is UBP. Although it is so frequent, it is less studied than neck or low back pain.It can be seen at any period of life, from childhood to elderly.This article briefly describes differential diagnosis in UBP.

UBP characteristics

UBP may be acute (< 4 weeks), subacute (4-12 weeks) or chronic (>12 weeks) and it may have mechanical (related to use), inflammatory (stiffness) or neuralgic (paresthesia) pain characteristics. But presence of the red flags (progressive pain, fever, weight loss, malignancy,immunosuppression, drug abuse, serious neurological symptoms) must always be questioned..

Differential Diagnosis

Thoracic spine is connected to the rib cage and less mobile than cevical or lumbar spine. This structure makes the upper back less vulnerable to strains and sprains. But sustained overload to ligaments or muscles, as seen in postural alterations and work- related disorders, may cause UBP frequently. Another common source of UBP is myofascial pain syndrome and the most affected muscles are the trapezius, supraspinatus and rhomboid [1]. Spinal deformities (scoliosis, kyphosis), thoracic spondylosis, stenosis, disc herniations and osteoporosis are the other reasons that can cause mechanical UBP.

Spondyloarthropathies involve upper back besides of the low back region and they produce inflammatory UBP.It has incidious onset and improves with exercise [2]. Infectious diseases also affects thoracic spine and localized pain, tenderness, fever and neurologic deficits maybe found in clinical findings [3]. Primary or metastatic thoracic tumors can cause persistent, progressive UBP that get worse at nights.

Anamnesis is very important in musculoskeletal diseases. Detailed history taking and proper laboratory/ imaging studies usually lead to right diagnosis in patients with UBP.

  1. Chen CK, Nizar AJ (2011) Myofascial pain syndrome in chronic back pain patients. Korean J Pain 24: 100-104.

  2. Burgos-Vargas R, Braun J (2012) Inflammatory back pain. Rheum Dis Clin North Am 38: 487-499.

  3. Mete B, Kurt C, Yilmaz MH, Ertan G, Ozaras R, et al. (2012) Vertebral osteomyelitis: eight years' experience of 100 cases. Rheumatol Int 32: 3591-3597.

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