Thoracic costotransverse joint pain patterns: a study in normal volunteers

BMC Musculoskelet Disord. 2008 Oct 15;9:140. doi: 10.1186/1471-2474-9-140.


Background: Pain referral patterns of asymptomatic costotransverse joints have not been established. The objective of this study was to determine the pain referral patterns of asymptomatic costotransverse joints via provocative intra-articular injection.

Methods: Eight asymptomatic male volunteers received a combined total of 21 intra-articular costotransverse joint injections. Fluoroscopic imaging was used to identify and isolate each costotransverse joint and guide placement of a 25 gauge, 2.5 inch spinal needle into the costotransverse joint. Following contrast medium injection, the quality, intensity, and distribution of the resultant pain produced were recorded.

Results: Of the 21 costotransverse joint injections, 16 (76%) were classified as being intra-articular via arthrograms taken at the time of injection, and 14 of these injections produced a pain sensation distinctly different from that of needle placement. Average pain produced was 3.3/10 on a 0-10 verbal pain scale. Pain was described generally as a deep, dull ache, and pressure sensation. Pain patterns were located superficial to the injected joint, with only the right T2 injections showing referred pain 2 segments cranially and caudally. No chest wall, upper extremity or pseudovisceral pains were reported.

Conclusion: This study provides preliminary data of the pain referral patterns of costotransverse joints. Further research is needed to compare these findings with those elicited from symptomatic subjects.

MeSH terms

  • Adult
  • Arthralgia / etiology
  • Arthralgia / physiopathology*
  • Arthrography
  • Fluoroscopy
  • Humans
  • Injections, Intra-Articular / adverse effects*
  • Male
  • Outcome Assessment, Health Care
  • Pain, Referred / etiology
  • Pain, Referred / physiopathology*
  • Thoracic Vertebrae / innervation*
  • Thoracic Vertebrae / physiopathology*