The costovertebral joints move with every breath-approximately 20,000 times per day. This constant motion makes them susceptible to repetitive microtrauma, particularly when posture, thoracic mobility, or respiratory mechanics are compromised. Injury to these joints is common after trauma (falls onto the chest or back, motor vehicle accidents) and in individuals with chronic thoracic hypomobility or chronic cough.
Symptoms: A Commonly Misdiagnosed Condition
Costovertebral pain presents as thoracic spine pain-often described as a deep ache between the shoulder blades or along the rib cage-that worsens with deep breathing, twisting, coughing, or sneezing. The pain can wrap around the chest wall along the intercostal nerve, mimicking cardiac pain, pleurisy, or intercostal neuralgia. Many patients undergo cardiac workups, chest CT scans, and gastroenterological evaluations before the costovertebral joints are identified as the source.
Commonly misdiagnosed condition. Tenderness on palpation of the costovertebral and costotransverse joints is the most reliable clinical finding. Spring testing-applying anteroposterior pressure to the rib at the spine junction-reproduces the patient's familiar pain pattern. In my experience, costovertebral joint pain is one of the most commonly missed diagnoses in spine medicine. The fact that we have a dedicated page for this condition reflects the frequency with which we see patients who have searched for years for a diagnosis and treatment.
Dr. Crane's Regenerative Approach
Costovertebral joint dysfunction is fundamentally a ligamentous instability problem - the stabilizing ligaments have become lax or damaged, allowing excessive joint motion that produces pain and inflammation. Regenerative injection therapy delivers biological repair signals to the ligament attachment sites, initiating a controlled healing cascade that recruits fibrocytes and promotes collagen deposition. Over a series of treatments, the ligaments thicken and strengthen, restoring the precise stability these joints require.
I target the radiate ligament, costotransverse ligaments, and the posterior periosteum of the rib-vertebral junction under fluoroscopic or ultrasound guidance. Multiple levels can be treated in a single session.
Individualized approach. The specific regenerative approach is tailored to each patient based on the severity of joint inflammation, the degree of ligamentous laxity, and response to initial treatment. We may combine or adjust therapies to achieve optimal results.
What to Expect
Treatment involves regenerative injections to the costovertebral joints. Deep breathing exercises and thoracic mobility work complement the regenerative treatment by restoring normal joint mechanics. We track progress through pain assessment and functional measures.