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Open Access Highly Accessed Open Badges Research article

Thoracic costotransverse joint pain patterns: a study in normal volunteers

Brian A Young1*, Howard E Gill2, Robert S Wainner3 and Timothy W Flynn4

Author Affiliations

1 Department of Physical Therapy, Sheppard Air Force Base, Texas, USA

2 Physical Medicine and Rehabilitation, Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas, USA

3 Department of Physical Therapy, Texas State University, San Marcos, Texas, USA

4 School of Physical Therapy, Regis University, Denver, Colorado, USA

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BMC Musculoskeletal Disorders 2008, 9:140  doi:10.1186/1471-2474-9-140

Published: 15 October 2008



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.


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.


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.


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.