Costotransverse Disorders
Original Editors - Yves Hubar
Lead Editors
Search Strategy[edit | edit source]
Searched databases: Pubmed, PEDRo, ScienceDirect, spine journal
Searching for the term "costotransverse" yielded few results, but searching for conditions affecting the costovertebral joints in general supplied more information.
It is to be noted that most of the information found are case studies.
Definition/Description[edit | edit source]
This page contains a list of disorders and pathologies affecting or involving the costotransverse joint.
Clinically Relevant Anatomy[edit | edit source]
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 joint[2]:
- 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.
Epidemiology /Etiology[edit | edit source]
- 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.[4]
- 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.[5]
- 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 syndrome[6]
- 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]
Characteristics/Clinical Presentation[edit | edit source]
The case study used for the differential diagnosis described the following specific signs for CV/CT joint disfunction: “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” [11]
Differential Diagnosis
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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 to[11]:
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
Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
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Physical Therapy Management
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The case study involving a patient with costochondritis exhibited improvement when High-velocity, low amplitude manipulations directed at the costovertebral, costotransverse and intervertebral zygapophyseal thoracic joints were used. Pain was measured with a numeric pain scale, while function was measured with Dallas Pain Questionnaire and Functional Rating Index. [9]
The patiënt suffering from posterior upper thoracic pain was treated with mobilizations at the costovertebral and costosternal joints as well as slow, large amplitude P/A oscillations at the ribs in prone position and trigger point release. As a result, the patient was able to resume all normal activities, had improved on the visual analogue scale, and had a normal active ROM at the cervical, upper extremity and trunk regions.
This treatment, however, also included a training program directed at the m. rhomboidei and m.trapezius, but it was stated that the patient had received both active and passive treatments in the 4 months before the study treatment, and experienced no lasting benefit. [11]
Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ Neumann DA. Kinesiology of the Musculoskeletal System: Foundations for Physical Rehabilitation. Mosby Inc, 2002
- ↑ A. M. R. Agur, Grant's Atlas of Anatomy. 10th ed., Williams & Wilkins, Baltimore, 1999.
- ↑ A F Ibrahim, H H Darwish. The costotransverse ligaments in human: a detailed anatomical study. Clinical Anatomy 18:340-345 (2008) level C
- ↑ Christensen EE, Dietz GW. Injuries of the costovertebral articulation. Radiology 1980. Jan; 134(1): 41-3 level C
- ↑ MJ Cohen, J Ezekiel, RH Persellin. Costovertebral and costotransverse joint involvement in rheumatoid artritis. Ann Rheum Dis 1978 October; 37(5): 473-475 level C
- ↑ B A Young, H E Gill, R S Wainner, T W Flynn. Thoracic costotransverse joint pain patterns: a study in normal volunteers. BMC Musculoskelet disord. 2008; 9: 140 level C
- ↑ L Cerrahoglu, Z Unlu, M can, C Goktan, P Celik. Lumbar stuffness but not thoracic radiographic changes relate to alteration of lung function tests in ankylosing spondylitis. Clin Rheumatol (2002) 21(4):275-279 level C
- ↑ M I Rabey. Costochondritis: are the symptoms and signs due to neurogenic inflammation. Two cases that responded to manual therapy directed towards posterior spinal structures. Manual therapy (2008) 13(1): 82-86 level C
- ↑ 9.0 9.1 D Aspegren, T Hyde, M Miller. Conservative treatment of a female collegiate volleybal player with costochondritis. Journal of manipulative and physiological therapeutics (2007) 30(4): 321-325 level C
- ↑ T Bartalena, E Rimondi, G Rossie, G Bianchi, M Alberghini. Low grade central chondrosarcoma of the fifth costotransverse joint. Australian radiology (2007) 51(s1): B112-125 level C
- ↑ 11.0 11.1 11.2 S J Fruth. Differential diagnosis and treatment in a patient with posterior upper thoracic pain. Physical therapy (2006) 86(2): 254-268 level C
To summarize: all sources from #3 are non comparative studies, therefore level C is applicaple.
