Abstract

The costovertebral joint is a true joint; it is susceptible to osteoarthritis, rheumatoid arthritis, psoriatic arthritis, Reiter’s syndrome, and, in particular, ankylosing spondylitis. The joint is often traumatized during acceleration-deceleration injuries and blunt trauma to the chest; with severe trauma, the joint may subluxate or dislocate. Overuse or misuse can result in acute inflammation of the costovertebral joint that can be quite debilitating. The joint is also subject to invasion by tumor from primary malignant disease, including lung cancer, or from metastatic disease. Pain emanating from the costovertebral joint can mimic pain of pulmonary or cardiac origin. On physical examination, patients suffering from costovertebral joint syndrome attempt to splint the affected joint or joints by avoiding flexion, extension, and lateral bending of the spine; they may also retract the scapulae in an effort to relieve the pain. The costovertebral joint may be tender to palpation and feel hot and swollen if it is acutely inflamed. Patients may also complain of a “clicking” sensation with movement of the joint. Because ankylosing spondylitis commonly affects both the costovertebral joint and the sacroiliac joint, many patients assume a stooped posture, which should alert the clinician to the possibility of this disease as the cause of costovertebral joint pain.