[The vertebrogenic factor and thoracalgia.]

Reversible functional joint disorders (joint blockages, somatic dysfunction) of the intervertebral and rib joints can be treated using manual therapy, which improves the related segmental changes in both the dorsal and the ventral area [pseudoradicular syndrome, hyperalgesia zone (HAZ)]. This phenomenon is triggered by a decrease in the heightened nociceptor irritation in the joint capsule and in the surrounding tissues.

The patients were examined lying prone to assess the functional rib and intervertebral joint disorders. The deep, periarticular tender points directly surrounding intervertebral joints displaying functional disorders were infiltrated with 5 ml lidocaine 0.5% in four segments in 35 patients. In a further 48 patients the same local anaesthetic dose was used, but given by intracutaneous infiltration in the area of painful thoracic segments. A third group of 31 patients was treated manually in accordance with current practice.

Ventral HAZ and also pain disappeared in 26 of the patients (74%) who received deep lidocaine infiltration. Comparable results were achieved with manual therapy (in 68%). However, only 8 of 48 patients (17%) became painfree after intracutaneous lidocaine infiltration (p<0.05) Freeing of the rib joint blockages was observed in 15 of 25 patients after deep lidocaine infiltration, in 9 of 31 patients after manual therapy, and in 3 of 8 patients after intracutaneous lidocaine infiltration.

From our results we conclude that blocking of the peripheral nociceptors, rather than of the peripheral nerve bundles, is of primary significance for the effective treatment of anterior thoracalgia.