Small bursae along the inferior margins of the lower ribs, between the rib periosteum and the overlying intercostal or abdominal muscle fascia. They reduce friction where the abdominal muscles attach to and slide against the costal margin during breathing and trunk movement.
Subcostal bursitis produces lower chest and upper abdominal pain at the costal margin that worsens with trunk flexion and deep inspiration. It is commonly mistaken for a slipping rib syndrome, hepatic pathology, or referred thoracic disc pain. Ultrasound-guided injection at the costal margin confirms the diagnosis and provides relief. It is seen in rowers, gymnasts, and manual workers with repetitive trunk loading.
Hypermobility and bursitis at the costal margin producing a painful click or pop at the lower chest with trunk movement, often affecting ribs 8-10 where the cartilage tips are least supported.
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