The lateral costotransverse ligament is a short, strong band connecting the tip of the transverse process to the posterior surface of the tubercle of the same-numbered rib. It is the thickest and strongest of the costotransverse ligaments and is the primary stabiliser of the costotransverse joint, resisting anterior displacement of the rib tubercle and guiding the rotation of the rib during breathing.
The primary stabiliser of the costotransverse joint, resisting anterior translation of the rib tubercle on the articular surface of the transverse process and directing the rotational arc of rib movement during inspiration and expiration.
The lateral costotransverse ligament must be divided during costotransversectomy, the surgical approach used to reach the posterolateral thoracic disc and thoracic vertebral bodies. It is the key ligament to protect during posterior thoracic facet joint and costovertebral joint injections. Progressive ossification as part of DISH or ankylosing spondylitis restricts thoracic cage expansion, contributing to reduced respiratory reserve.
Forced rib rotation or direct posterior impact can disrupt the lateral costotransverse ligament, allowing rib tubercle subluxation with a painful click or catching sensation during breathing or trunk rotation, managed with manipulation, physiotherapy, and occasionally joint injection.
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