Sectional Neuroanatomy of the Middle Thoracic Spine (T5-T8) and Chest

Abstract

This is the third in a series of articles on the spine. The first reviewed the anatomy of the neck. The second reviewed the upper thoracic spine and chest (T1-T4). A fourth article is planned for the lower thoracic spine. Procedures in the midthoracic spine include chest tube placement, trigger point injections, chemodenervation with botulinum toxin, video-assisted thoroscopic surgery, and spinal injections. Complications include pneumothorax, hemothorax, diaphragmatic irritation, sympathetic trunk irritation, postthoracotomy pain, and intradural abscesses. This article provides anatomically accurate schematics of innervations of the middle thoracic chest and spine (T5-T8) that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the middle thoracic chest and spine were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the middle thoracic chest and spine allows the physician to increase the accuracy and efficacy of interventional procedures. This could also assist the electromyographer in correlating the clinical and electrophysiologic findings with magnetic resonance images.

Iatrogenic pneumothorax: safety concerns when using acupuncture or dry needling in the thoracic region

“…1,[18][19][20] Iatrogenic pneumothorax has also been reported to occur with medical research utilizing electromyography fine wiring to assess activation of muscles including levator scapulae, trapezius, serratus anterior, rhomboids, the diaphragm, cervical and thoracic paraspinal muscles, intercostals, pectoralis major and minor, supraspinatus, infraspinatus, and subscapularis. [21][22][23] Similarly injections of prolotherapy solutions, botulinum toxin, anaesthetic, or cortisone into ligaments and muscles in the thoracic region have been associated with iatrogenic pneumothoraces. 21,24,25 Acupuncture-and Dry Needling-induced Iatrogenic Pneumothorax Incidence Acupuncture and dry needling has been identified as an additional cause of iatrogenic pneumothorax.…”

“…Additional care should be taken when dry needling or acupuncturing shoulder muscles that have been associated with fine wire electromyography-induced iatrogenic pneumothoraces or acupuncture-induced pneumothoraces such as subscapularis, supraspinatus, infraspinatus, levator scapulae, pectoralis major and minor. [21][22][23]25,65 Due to the possibility of a congenital foramen in the supraspinous or infraspinous fossa acupuncture and dry needling in this region should be directed at an oblique angle along the fossa towards the glenohumeral joint. When dry needling pectoralis major needling may be performed via a pincer grip hold in the anterior axillary region, gripping the pectoralis major between thumb and fingers, and needling performed across the fibres of the muscle.…”