The costotransverse ligaments connect the neck and tubercle of each rib to the transverse process of the corresponding thoracic vertebra at the costotransverse joint. Three components are described: the posterior costotransverse ligament (from the rib neck to the transverse process), the lateral costotransverse ligament (from the rib tubercle to the transverse process tip), and the superior costotransverse ligament (from the rib crest to the transverse process above). Together they stabilise the costotransverse joint.
Stabilise the costotransverse joint by limiting gliding and rotation of the rib head on the transverse process, allowing only coupled rotational motion of the rib during respiratory excursion.
The costotransverse joint and its ligaments are relevant in costotransversectomy surgical approaches to the thoracic spine, where the joint is disarticulated by dividing the lateral and posterior costotransverse ligaments to allow rib head and neck resection for access to the anterior vertebral body. Costotransverse joint arthropathy produces posterior thoracic pain at the costotransverse level, managed by targeted costotransverse joint injection. The superior costotransverse ligament also supports the intercostal neurovascular bundle as it exits the foramen.
Costotransverse joint pain from facet arthropathy or post-fracture degeneration produces posterior rib-level thoracic pain reproduced by palpation at the costotransverse junction; fluoroscopy or CT-guided injection of local anaesthetic and corticosteroid into the joint provides diagnostic confirmation and therapeutic relief.
