The rib tubercle is a bony prominence on the posterior rib between the rib neck and the rib angle, projecting posteriorly and slightly inferiorly. It articulates with the transverse process of the corresponding thoracic vertebra at the costotransverse joint. The lateral surface of the tubercle is roughened for ligamentous attachment; the medial surface carries the articular facet.
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| Ossification | The articular part ossifies from a secondary centre appearing at about 15-16 years and fusing at about 20-25 years (ribs 1-10). |
The rib tubercle and costotransverse joint are relevant in thoracic approaches requiring rib resection: the costotransverse joint is disarticulated to allow rib removal in costotransversectomy approaches. Paravertebral nerve block placement targets the costotransverse space adjacent to the rib tubercle, anesthetising the intercostal nerve and paravertebral structures. The rib tubercle may be exostotic in hereditary multiple exostoses, causing pain and occasionally neural compression at the costotransverse level.
Degenerative arthrosis of the costotransverse joint at the rib tubercle level produces a focal thoracic posterior pain worse with rotation, reproduced by costotransverse joint palpation, managed by corticosteroid injection under CT or fluoroscopic guidance into the small joint space.
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