Thoracic Costo-Transverse Joint (posterior rib) Pain - Fact Sheet

What is thoracic costo-transverse joint?

Thoracic costo-transverse joints (CTJ) are joints in the thoracic spine (upper to mid back), where the ribs meet the vertebrae of the spine. These joints allow for certain movements, particularly rotation of the upper/mid back.

AC joint injury

What causes CTJ Pain?​

The facet joints can be damaged or irritated by a sudden excessive movement or by activities that repetitively load them. For example, sitting in a slumped position at work for long periods, or repeated side-to-side or reaching movements (such as using a mouse).

Signs and Symptoms

• Unilateral back pain or ache, particularly during work or at the end of a working day.
• Pain with activities involving reaching in front of you (i.e. using a computer mouse, cooking, cleaning).
• Pain from the thoracic CTJs can often refer along the ribs, under the shoulder blades (pictured)
• Pain may also be present with deep breathing, as the ribs expand with these breaths.

Shoulder Assessment

Treatment of Thoracic Costo-Transverse Joint Pain ?

Hands on treatment: involves mobilisations of the CTJ to reduce irritation and promote smooth movement of the joints. This should not be solely relied upon, as evidence suggests this works mainly in the short term, giving 2-3days relief.

Stretching and mobility exercises: Exercises/stretching involving thoracic rotation movements often help improve the movement of the CTJ.

Strengthening exercises: particularly of the muscles between the shoulder blades and shoulders, helps support the CTJ and improve postural control.

Moving around: Sitting at a desk, driving for long periods and other prolonged postures can put stress on the costo-transverse joints. Every 20-30 or so minutes, try to get up and move around. Get a drink, do some stretches, take a few deep breaths, then sit back down. These joints are designed to move!

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