Thoracic Facet Arthropathy Presenting with Pain Abdomen: An Unusual Presentation

Abstract

This case report is about a patient with thoracic facet arthropathy presenting with abdominal pain, who underwent multiple investigations and treatment for abdominal visceral conditions with no relief of his pain. A 29 years male presented to our pain clinic with episodic, severe left chest wall, and upper abdominal pain. In the last 4 years, he had been treated for various abdominal visceral conditions. He was then diagnosed as a case of intercostal neuralgia and 12th rib (the twelfth rib syndrome). He was treated with anticonvulsants and antidepressants, as well as intercostal nerve block, tender point injection and intercostal nerve radiofrequency (RF), but with partial relief. Careful history and clinical examination revealed left lower thoracic facet joint involvement. Diagnostic block of medial branch of left 10, 11 and 12th thoracic dorsal rami was done with 90% pain relief. This case emphasises that in any case of abdominal pain, spine should be examined because referred pain from spine can be an important etiology of pain abdomen. Careful history, examination and appropriate investigations should be done to rule out abdominal pathologies, and to arrive at a diagnosis. A thorough history, meticulous examination, and diagnostic blocks if required are very important to localize the pain generators.