Upper back injury includes damage to the thoracic region of the vertebral column and/or the surrounding joints, ligaments, muscles, tendons, cartilage, and nerves. Severity ranges from mild and self-limiting to potentially life-threatening or disabling. A common site of fracture is at the thoracolumbar junction where the rigid thoracic spine meets the moveable lumbar spine (T10 to L2). Mild and chronic back pain is commonly related to repetitive overuse or muscle strain from twisting and lifting. Patients may present with upper back pain and muscle spasm, tenderness, or stiffness.
Etiology includes acute trauma, poor posture (especially associated with computer use), degenerative condition, overuse, and falls. Risk factors include a sedentary lifestyle, large breast size, obesity, sporting activities, and strenuous work.
Management may include rest, physical therapy, massage, anti-inflammatory or analgesic medication (resources for opioid prescribing guidelines, as well as nonopioid alternatives, can be found here), or surgery. Some injuries are self-limited and resolve within weeks to months, but other cases may result in chronic pain and neurologic injury (lasting longer than 3 months).
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