Inflammatory disease of the costotransverse joints: US evaluation in 15 symptomatic patients

Abstract

The costotransverse joints (CTJs) are small arthrodial joints which articulate with the costal tuberosity on the transverse process of the thoracic vertebrae. CTJs are composed of oval-shaped facets with a major axis, vertical at the upper vertebrae and almost horizontal at the lower vertebrae. This position explains the different movements of the ribs: the cranial ribs move on the sagittal plane and the caudal ribs on the transverse plane. Movements in directions other than these usual CTJ spatial planes can cause inflammation resulting in a stinging pain in the space between the scapula and thoracic spine. We studied 15 subjects with paravertebral pain compatible with CTJ pathology. Mean age was 29 years, 11 females/4 males. In 12 patients, the non-dominant limb was affected. US imaging was carried out using linear 12 MHz and 9 MHz probes. Scanning was performed following the long axis of the rib (transverse plane) and the short axis (sagittal plane). Sagittal scanning is the method of choice for detection of possible joint effusion and comparison with undamaged joints above and below. US identified joint effusion correlating with the site of pain in all patients. Thickening of the posterior costotransverse capsular ligament was detected in six patients mainly affecting the first thoracic vertebrae. Power Doppler showed intraarticular hypervascularization in four patients. US imaging should be performed as a first-line examination in the evaluation of patients with stinging pain in the paravertebral region. US evidence of effusion within the joints is a sure sign of involvement of these structures.

Usefulness of gadolinium‐enhanced magnetic resonance imaging in diagnosing costotransverse joint pain

“…Furthermore, the pattern of costotransverse joint pain is similar to that of thoracic zygapophyseal joint-or costovertebral jointorigin pain. 3 In addition, many imaging tools, such as radiography, computed tomography, and conventional MRI, cannot detect pathology in the paravertebral joints that leads to pain. Therefore, the diagnosis of pain originating from the costotransverse joint is difficult.…”

“…2 The mechanisms underlying the development of costotransverse joint pain have not been clearly elucidated; however, it is thought that the traction exerted by the muscles inserted on the ribs or the thoracic vertebrae causes movements of the costotransverse joints, and thus, repetitive motions could directly affect these joints. 3 The costotransverse joint is typically not considered as a source of pain in daily clinical practice. Furthermore, the pattern of costotransverse joint pain is similar to that of thoracic zygapophyseal joint-or costovertebral jointorigin pain.…”