The costotransverse and costovertebral joints are susceptible to injury from acute blunt trauma of both the anterior chest wall and the dorsal spine from motor vehicle accidents and contact sports such as football and rugby as well as repetitive microtrauma from chronic coughing and activities that require repeated flexion, extension, and lateral bending. Left untreated, the acute inflammation associated with the injury may result in arthritis with its associated pain and functional disability.

Patients suffering from costotransverse and costovertebral joint dysfunction or inflammation will complain of a pain when flexing, extending, or lateral bending of the dorsal spine. The patient will often attempt to splint the painful area by retracting the scapula. Sleep disturbance is common with the patient awakening when rolling from side to side. Palpation of the area of the affected costovertebral joint will often elicit pain and paraspinous muscle spasm.

Plain radiographs are indicated for all patients who present with pain thought to be emanating from the costotransverse or costovertebral joints to rule out occult bony pathology, including tumor. Based on the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, prostate-specific antigen, sedimentation rate, and antinuclear antibody testing. Magnetic resonance, computerized tomographic, and/or ultrasonographic imaging of the joint is indicated if primary joint pathology is suspected (Fig. 86.1). The injection technique presented below serves as both a diagnostic and a therapeutic maneuver.

The first through tenth ribs articulate with the thoracic vertebra at two places. The first is the point at which the facet of the tubercle of the rib articulates with the transverse process of the vertebral body. This articulation is known as the costotransverse joint (Figs. 86.2 and 86.3). The second, more proximal articulation of the rib is the point at which the head of the rib articulates with the vertebral body and is known as the costovertebral joint (although many authors refer to both joints as simple “costovertebral joints”) (see Figs. 86.2 and 86.3). Both the costotransverse and costovertebral joints function to facilitate a coordinated movement of the ribs during respiration and activity. Both the costotransverse and costovertebral joints are innervated by the ventral rami rather than the medial branch. The costotransverse joint is a synovial plane-type joint and is strengthened by the costotransverse and lateral costotransverse
ligaments. The costovertebral joint is a trochoid joint and is reinforced by the superficial radiate and radiate ligaments. The 11th and 12th ribs lack a true costotransverse joint, and both have a larger single articulation at the head of the rib.