Matt Ross Physiotherapy

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Costovertebral Joint Dysfunction

The thoracic spine consists of 12 vertebrae and are the main attachment points for the ribs, hence it is naturally more stiff than the lumbar and cervical spine with limited movement. The costovertebral joint is an articulation between the vertebrae and the rib, connected by a synovial joint which allows some small degree of movement, mainly medial and lateral rotation, which is mainly utilised during respiration. Due to the complexities of the thoracic neural network, costovertebral joint dysfunction can sometimes be overlooked as a source of posterior chest wall pain.

Symptoms

People report possible symptoms which may include:

• Pain localised to posterior chest wall, which may sometimes radiate to the anterior chest wall along the rib

• Symptoms mainly one sided

• Symptoms with a deep breath in / coughing / sneezing / laughing

• Pain with passive or passive flexion, rotation or bending to the side

• Reduced movement of the joint

• Tenderness on palpation

• Increased muscle tension in paraspinal muscles, rhomboids, trapezius and levator scapulae.

Diagnosis

Following a thorough history of how the symptoms developed, it is important to perform a thorough physical assessment to rule out another cause for the onset of symptoms, such as those from the lungs, gallbladder or kidneys. Once ruled out, the physical inspection will include:

• Active and passive range of movement of the thoracic spine

• Manual muscle testing of the upper extremities

• Sensory examination of the posterior chest wall to identify any nerve root involvement

• Palpation of the costovertebral joint

• Palpation of the surrounding musculature

How can Physiotherapy help?

Physiotherapy interventions has been shown to be helpful for thoracic pain by offering the following interventions:

• Advice and education

• Mobilisation and manipulation

• Soft tissue massage

• Pain management

• Acupuncture