Isolated Thoracic Paraspinal Myopathy, Axial Myopathy, Cervicothoracic Pain, Postural Dysfunction, Back Pain

Emily Akamine

Western University of Health Sciences, USA

Biography :

Emily Akamine, is a third-year medical student at Western Uni­versity of Health Sciences COMP­Northwest.Originally from Hono­lulu, Hawai‘i, she earned a BS in Public Health from theUniversity of Washington and has a background in public health and environmen­tal advocacy. AtWesternU, she is involved in headache research, in­cluding carotid artery dissections through theparotid gland and de­velopment of an OMT-based head­ache treatment protocol. She plans topursue a career in Physical Med­icine and Rehabilitation. In her free time, she enjoys cooking,running, surfing, and hiking.

Abstract :

Cervical thoracic pain is a common chief complaint that presents to outpatientmusculoskeletal clinics.The differential diagnosis is vast, including trauma, arthritic, muscledysfunction/myofacial pain, central pain syndromes, infectious, radicular, and neuropathic painsyndromes and a multitude of spinal pathologies. This is a case of isolated thoracic paraspinalmyopathy presenting as exertional cervicothoracic pain in an otherwise healthy older adult.A 67-year-old male hiker presented with a two-year history of burning and aching pain in the leftparascapular region, precipitated by prolonged uphill hiking. Neurologic and musculoskeletalphysical exam showed rounded shoulders and a macular rash over the painful area, otherwiseunremarkable. Routine laboratory studies and cervical MRI were normal. Thoracic spine MRIrevealed marked bilateral paraspinal muscle atrophy confined to the thoracic region, with normalappearing cervical and thoracic musculature. Electromyography was consistent with a myopathicprocess.The patient’s pain was attributed to postural fatigue due to reduced thoracic paraspinal support. Hissymptoms were managed with physical therapy focusing on building core musculature and posturalstabilization, which provided partial relief. Pharmacologic treatment with gabapentin wasineffective. Physio-taping helped the patient with postural support as well as activity modificationwith shorter hikes.This is a rare case of isolated thoracic paraspinal myopathy, a condition that should be consideredas a diagnosis of exclusion for axial pain syndromes. MRI and EMG findings are essential fordiagnosis and appropriate conservative management. The localization of atrophy to the thoracicparaspinals suggests a distinct myopathic process that warrants further investigation into itspathophysiology and long-term outcomes.