Mid-Back (Thoracic)

Costotransverse Joint Dysfunction

늑횡돌기관절 기능장애

Dysfunction of rib-vertebra joints causing localized thoracic pain

Written and edited by Dr. Kwang Lee, D.C., L.Ac. · Updated 2026-10-04

How common: Common (underdiagnosed)
Typical age: Ages 30–60

What is it?

Malalignment or synovitis of the costotransverse and costovertebral joints causes localized and respiration-related pain.

Commonly affected: Mid-thoracic (T4-T9) most common

How it develops

Trauma/OverloadLifting/twisting stresses the joint
Joint MalalignmentRib head subluxes slightly
SynovitisCapsular inflammation, muscle guarding
Respiration-related PainRib motion during breathing provokes pain

Symptoms

Unilateral sharp thoracic painPain 2–3 cm lateral to spinous process
Pain with respirationSevere with deep breath/cough/sneeze
Intercostal radiationRadiates anteriorly along intercostal nerve
Rotation painLocal pain with thoracic rotation

How it is examined

Joint tendernessPoint tenderness 2–3 cm lateral to spinous process
Spring testDownward pressure reproduces pain
Restricted rotationWorse with rotation to painful side
Normal neurologicNormal motor/reflex rules out radiculopathy

Imaging

Usually normal; may show degenerative changes.

Often normal
Possible degeneration
Rule out rib fracture

MRI for chronic cases — shows edema/synovitis.

Joint edema
Capsular thickening
Possible marrow edema

Non-surgical care

Manual therapy (HVLA)Mobilization/manipulation often gives immediate relief
NSAIDs/heatPain and muscle tension control
Breathing/thoracic exercisesIntercostal and diaphragmatic mobility
Intra-articular injectionImage-guided injection for refractory cases

Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.

When surgery is considered

Surgery rarely indicated

Procedures that may be discussed

Conservative care only

Outlook

Most resolve within 2–4 weeks with manual therapy and exercise.