Each rib articulates with the spine through two joints: the costovertebral joint at the rib head and the costotransverse joint at the rib tubercle. These two joints move together, producing the rotation that elevates the anterior end of the rib during inspiration (pump handle) or the lateral end (bucket handle). Their dysfunction produces the thoracic joint pain of rib dysfunction — the most common cause of acute thoracic pain in clinical practice.
Rib dysfunction (costovertebral joint restriction) produces acute thoracic pain worsened by deep inspiration and a palpable rib angle tenderness posteriorly. Manual therapy (high-velocity rib manipulation) or dry needling resolves most acute episodes. Slipping rib syndrome (hypermobile costochondral junction) produces a different anterior presentation.
Costovertebral joint restriction producing acute thoracic pain on inspiration managed with manual therapy or dry needling.
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