The intercostal muscles taper into tendinous fibres at their costal attachments anteriorly and posteriorly, blending with the periosteum of the costal groove superiorly and the inferior rib edge inferiorly. These tendinous ends are the primary attachment points transmitting respiratory force between adjacent ribs.
Intercostal tendinous end injuries occur in rib stress fractures and direct thoracic trauma, producing point tenderness at the costal groove level. Intercostal nerve blocks target the groove where the nerve runs alongside the artery and vein beneath the tendinous inferior rib edge. Rib plating for flail chest stabilisation must account for the tendinous attachments of the intercostal muscles to avoid stripping and devascularisation.
Traction injury at the costal tendinous ends from coughing, rowing, or direct trauma producing localised rib margin pain reproduced by deep inspiration and rib compression.
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