The costotransverse joints connect the rib tubercle to the transverse process at each thoracic level (ribs 1-10), working with the costovertebral joints to produce the coupled rotation of rib elevation during breathing. Their joint orientation determines the direction of rib motion — upper ribs move in a pump handle (anteroposterior) direction and lower ribs in a bucket handle (lateral) direction.
Costotransverse joint dysfunction from thoracic spine injury or overuse produces a characteristic posterolateral rib pain worsened by deep breathing and reproduced by direct joint palpation. It is treated with thoracic manipulation targeting the costotransverse joint. Costotransverse joint injections under fluoroscopic or CT guidance provide diagnostic confirmation and therapeutic relief.
Rib-transverse process joint dysfunction producing posterolateral chest pain worsened by breathing managed with manipulation and targeted injection.
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