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Thoracic Facet Dysfunction/Costotransverse Joint Pathology 

Thoracic Facet Dysfunction/Costotransverse Joint Pathology
Chapter:
Thoracic Facet Dysfunction/Costotransverse Joint Pathology
Author(s):

Brian A. Young

, Phillip S. Sizer

, and Miles Day

DOI:
10.1093/med/9780199350940.003.0010
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date: 13 August 2020

The thoracic facet and costotransverse joints are often implicated as the source of thoracic pain, yet definitive diagnostic and treatment guidance is significantly limited. This chapter reviews the anatomy, innervation, and biomechanics of these joints, as well as associated pathology. Definitive innervation of the posterior primary rami has yet to be established, and significant pain pattern overlap between the thoracic facet joint, costotransverse joints, and visceral referral patterns, as well as the limitations of current biomechanics, challenge the clinician’s ability to examine pain of suspected thoracic origin. The use of clinical reasoning in the absence of definitive diagnostic and treatment approaches is necessary to optimize outcomes in patients with pain of suspected thoracic musculoskeletal origin. A progression from noninvasive to minimally invasive to interventional techniques may be warranted based on the patient’s response to treatment.

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