Healthy Life: Thoracic Costotransverse Joint Pain (573)

Healthy Life: Thoracic Spine – Costotransverse Joint Pain

蘇鎮邦 (Christopher So)：
舒整物理治療師 (Manipulative Physiotherapist) 人類工程師 (Ergonomist)

This is one of the commonest conditions especially in cold wintry weather. In the morning when the costotransverse joints tighten or stiffen after a long rest at night, it happens if the patient moves too quickly. If the patient sit for a long time during work the day before, it will precipitate such condition. Usually, it is very painful on one side especially during turning movements or rotations. Even if it is painful on both sides, one side is more painful than the other. This joint links the transverse process of the thoracic spine with the ribs. Therefore, breathing, sneezing and coughing are very painful. The patient should realize the seriousness of the condition and go for consultation straight away. On account of this, recovery is quick, usually within one or two treatments.

It is common for the patient to feel pain on rotations or turning – one side being more painful than the other. Bending to the sides may be painful too. If forward and backward bending are painful then this indicates its severity. Palpation on the costotransverse joint in question will cause severe, sharp pain. It is important for the physiotherapist to be patient and increase the mobilisation slowly and gradually according to the pain tolerance of each individual patient. Then the stiffened joint can be released.

Manipulative therapy consists of two main categories: (1) Mobilisation is slow, gradual and repetitive movements and classified into Grade I to IV. This will release the stiffness of the joints. (2) Manipulation is Grade V. It is a very quick thrust. This opens and closes the joint very quickly so as to allow the impinged tissue between the articular joint to be released. This is a condition that responds more favourably to manipulation than mobilisation. Usually, it is dramatic and immediate. However, the same cannot be said for neck or cervical and back or lumbar spinal joints. Manipulation is particularly effective on articular facet joints but for disc problems it can have adverse effect. That is why it must be carefully chosen according to individual cases. If there is suspicion of nerve root compression – more likely on cervical and lumbar spine than thoracic spine – manipulation is contraindicated.

First, the therapist needs to ascertain which level of the thoracic spine is affected by applying palpation. Then, the therapist decides which technique is appropriate – mobilisation or manipulation. The key to manipulative therapy is that after each treatment technique the therapist repeats the test that reproduces the symptoms so as to compare the effect before and after treatments.

Finally, adjunct therapy such as ultrasound and interferential can be used to reduce pain and spasm. This will increase the rate of recovery. Appropriate exercises are given for full recovery to be achieved and should be reinforced as long term management.

Every level has intercostal nerve under the rib. It can cause pain under the ribs. If it is disc problem, patient may experience pain from the back to the front of the chest.