Costotransverse Disorders

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Clinically Relevant Anatomy

The costotransverse joint is an articulation between the articular tubercle of a typical rib with the costal facet of a transverse process of a thoracic vertebra.¹

The following costotransverse ligaments connect the costotransverse joint²:

• ligamentum costotransversarium superius.

• ligamentum costotransversarium.

• ligamentum costotransversarium laterale.

• A study on human cadavers has also found what were referred to as “inferior and posterior costotransverse ligaments”, the latter identified on the fifth to tenth ribs.³

These ligaments limit movement in the costotransverse joint to slight gliding.

Mechanism of Injury / Pathological Process

• The costotransverse joint, when subjected to severe trauma, may be subluxed or dislocated. Due to being at the top of the rib cage, the first costotransverse joint is most vulnerable.³

• Though distinctly unusual at the costotransverse and costovertebral joint, a case study has been found, describing a patient suffering from rheumatoid artritis in said joints.⁴

• The results of a study on normal volunteers have provided preliminary data on the involvement of dysfunction at the costotransverse joint as a source of referred pain at the thoracic spine, and a referred study was stated to suggest involvement of the costotransverse joint concerning T4 syndrome⁵ 

• The costotransverse joint is known to be involved in patients with ankylosing spondylitis, which, combined with involvement of the costovertebral, sternoclavicular and sternomanubrial joints would result in increased rigidity of the thorax and increased dorsal kyphosis. A 2002 study has shown that this does not result in decreased pulmonary function, possibly due to an increase in diaphragmatic breathing. ⁷ 

• Cases have indicated that, due to positive response to manual therapy directed towards posterior spinal structures, conditions diagnosed as costochondritis might actually be caused by neurogenic inflammation. The specific role of the costotransverse joint itself has not yet been found in literature.^8,9

• A case study has been found, depicting a grade I central chondrosarcoma with myxoid change and focal areas of grade II chondrosarcoma on the transverse process of T5 with extension into the ipsilateral rib.¹⁰

Clinical Presentation

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Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

A case study was found concerning a patient with posterior upper thoracic pain attributed to the costovertebral and costotransverse joints, as well as active trigger points, with a clear description of the differential diagnosis used, as well as the clinical signs that were paid attention to¹¹:

• Musculoskeletal

• • Vertebral/rib fracture

• • Intervertebral disc protrusion/herniation

• • Spinal stenosis

• • Diffuse idiopathic skeletal hyperostosis

• • Intercostal neuralgia

• • T4 syndrome

• • Ankylosing spondylitis

• • Muscle strain

• Visceral

• • Cancer

• • Cardiac

• • Renal

• • Pulmonary

• • Esophageal

• • Gall bladder

• • Hepatobiliary

• Remaining options

• • Zygapophyseal joint arthropathy

• • Costovertebral/costotransverse joint dysfunction

• • Active trigger points

The specific signs for CV/CT joint disfunction used were “pain localized to the posterior thorax; pain may radiate to the anterior chest wall; symptoms unilateral; pain with deep breathing, coughing/sneezing; increased pain with flexion, rotation and ipsilateral side bending; palpable pain at costotransverse joint and rib angle”

Key Evidence

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Resources

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Case Studies

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References

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