Rib and Chest pain: Costovertebral Arthralgia

This article looks at rib and chest pain or costovertebral joint arthralgia to give it its correct title. This article covers:

• Signs and symptoms
• Anatomy of costovertebral joint
• Causes


Signs and symptoms

Sudden onset of chest pain is common but thankfully the majority of times it isn’t anything serious. Obviously if anyone presents at the clinic with a sudden onset of chest pain a number of medical conditions have to be ruled out. Cardiac problems need to be explored with a thorough history and then examination and the lungs need to be listened to. Spontaneous pneumothorax also needs to be excluded.

Most patients with costovertebral joint pain may present with a sudden onset of upper back pain, often between the shoulder blades but anywhere in the thoracic spine is possible. This will often be described as a stabbing pain. This pain is often one sided and often was the result of a particular movement or activity which can aid the diagnosis.

There may be muscle spasm in the paraspinal muscles that run up and down the spine on the affected side and there may be a focal point of tenderness over the affected costovertebral joint. On occasions pain may radiate around to the front of the chest and the sterno-costal joint of the involved rib may also be very tender to touch and it may appear inflamed.


Anatomy of the costovertebral joint

In the posterior aspect of the spine the ribs articulate with the vertebrae at two joints. The costo-transverse joint and the costovertebral joint are the two articulations with the vertebrae and at the front of the spine the ribs articulate with the sterno costal joint. On breathing the ribs move up and down in a bucket handle motion and pivot at the sterno-costal joint. This articulation at the rear of the spine can be damaged or sprained on sudden movement such as from sneezing or through repetitive injury from activity or a sedentary lifestyle.


Causes

Activities that cause this condition may be twisting or lifting and bending activities. From my clinical experience sneezing can also cause this and on examination there may be a reluctance to take a deep breath in as the pain suddenly ‘catches’ at the deepest point of inspiration. A sedentary lifestyle may also contribute to the condition through making the postural muscles lazy and therefore predispose the joints in the spine to injury.


If you have chest pain or pain on breathing in then you may have a costovertebral joint sprain but a thorough examination is required to be certain. If you wish to make an appointment at Islington's Angel Osteopathic Clinic please click below.



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