Patients may present with atypical abdominal and chest pain that may be related to spinal problems. The key features on history that point to spinal referred pain are pain on movement, tenderness and tightness of musculoskeletal structures at a spinal level supplying the painful area, and an absence or paucity of symptoms suggestive of a non-musculoskeletal cause. Harding G. Yelland M. Back, chest and abdominal pain- is it spinal referred pain?. Australian Family Physician. 36(6):422-3, 425, 427-9, 2007 Jun.
In those who have chest/abdominal pain due to musculoskeletal causes, the prevalence of thoracic intervertebral dysfunction could be as high as 65.5%. Intervertebral dysfunction prevalence could be even as high as 72.0% in those with back pain and 79.0% in those with back pain with chest/abdominal pain. Chest pain was more commonly associated thoracic intervertebral dysfunction compared to abdominal pain.
For those with cervical problems having pain in the back, chest and/or abdomen, there was an association with pain on active movements and overpressure at end range and with loss of range of motion. Range of motion restriction was not noted in patients with thoracic intervertebral dysfunction.
The minimum examination for the detection of intervertebral dysfunction is testing for pain with spinal movements and palpation for tenderness. The interpretation of positive signs requires knowledge of their prevalence in pain free controls and in patients with visceral disease. The prevalence of thoracic intervertebral dysfunction was 25.0% in controls. Yelland MJ. Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain?. Australian Family Physician. 30(9):908-12, 2001 Sep.
eToims treatments for atypical chest and abdominal pain involve not only treating paraspinal muscles supplied by cervical and thoracic nerve roots but also the chest and abdominal wall musculature. Treatments must also involve the paraspinal muscles of the lower spine and even the muscles of the upper and lower limbs.