The superior costotransverse ligament connects the crest of the neck of each rib to the transverse process of the vertebra above, forming the strong superior boundary of the costotransverse foramen. It has anterior and posterior lamellae. The anterior lamella is a distinct thickening of the anterior joint capsule running from the upper border of the rib neck to the lower border of the transverse process above it.
Limits downward and forward displacement of the rib relative to the transverse process, guides the gliding motion at the costotransverse joint during rib cage elevation in inspiration, and provides the primary superior restraint to costotransverse joint distraction.
The superior costotransverse ligament defines the superior boundary of the costotransverse foramen through which the posterior ramus of the spinal nerve and its accompanying vessels pass. Knowledge of this ligament is essential during posterior thoracic approaches and costotransverse resection for access to the thoracic spine and posterolateral disc herniations. Pathological calcification or ossification of this ligament contributes to thoracic cage rigidity in diffuse idiopathic skeletal hyperostosis (DISH).
Acute or repetitive stress at the posterior thoracic cage disrupts the superior costotransverse ligament, producing unilateral posterior thoracic pain worsened by deep breathing and rotation, often misidentified as pleuritis or musculoskeletal strain.
