The assessment of thoracic pain

Patients with thoracic back pain are proportionately far more likely to have serious spinal pathology than in patients with cervical or lumbar back pain. Thoracic back pain should therefore always be thought of as a ‘red-flag’. The symptom of thoracic back pain may be the first presenting feature of spinal infection, thoracic disc prolapse or neoplasm. It is vital that any practicing orthopaedic surgeon is able to make a thorough assessment of this patient group. As in all medical conditions, a good idea of the diagnosis can usually be obtained with a detailed history and examination. In the case of spinal disease further investigations are of vital importance in order to confirm the diagnosis and to demonstrate neural as well as vertebral involvement. Management will vary depending on the aetiology and presentation.This article will outline a safe and thorough approach to the diagnostic pathways and management of these patients.