A periosteal bursa at the outer rib surface where overlying muscles (serratus anterior, external oblique) attach via muscular slips, developing from repetitive contractile forces at the bone-muscle interface.
Costal periosteal bursitis is a cause of localised lateral chest wall pain reproduced by deep palpation of the rib surface and resisted trunk rotation. It contributes to the lateral chest wall pain syndrome in rowers and racquet sport athletes. Ultrasound guides injection at the rib periosteum-muscle interface.
Bursal inflammation at the rib periosteum from repetitive serratus or oblique loading, producing lateral chest wall pain worsened by trunk rotation and managed with injection and biomechanical modification.
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