The costovertebral joints are paired articulations between each rib head and the thoracic vertebral bodies, with most ribs articulating with two adjacent vertebrae and the disc between them. Together with the costotransverse joints they act as a functional unit, so each rib rotates about an axis running through its neck. Because this axis changes orientation down the thorax, upper ribs move in a pump-handle pattern increasing anteroposterior diameter, and lower ribs in a bucket-handle pattern increasing transverse diameter.
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Costovertebral joint dysfunction produces sharp, well-localised thoracic back pain that worsens with deep breathing and trunk rotation, mimicking pleurisy and cardiac pain in its presentation. It is often confused with thoracic disc or facet joint pain. The diagnosis is supported by reproduction of pain with posterior rib springing, and fluoroscopically guided joint injection can confirm and treat it. Ankylosing spondylitis commonly involves the costovertebral joints, reducing chest expansion. Thoracic spondylosis and osteophyte formation at these joints contribute to thoracic rigidity in older adults.
Restricted painful joint movement producing thoracic pain that worsens with breathing, managed with manual therapy, rib mobilisation, or corticosteroid injection.
Degenerative or inflammatory arthritis of the costovertebral joints causing posterior thoracic pain worsened by deep breathing and rotation, managed with physiotherapy, anti-inflammatories and injection.
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