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Published in: BMC Musculoskeletal Disorders 1/2008

Open Access 01-12-2008 | Research article

Thoracic costotransverse joint pain patterns: a study in normal volunteers

Authors: Brian A Young, Howard E Gill, Robert S Wainner, Timothy W Flynn

Published in: BMC Musculoskeletal Disorders | Issue 1/2008

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Abstract

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.
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Literature
1.
go back to reference Waddell G: The Back Pain Revolution. 1998, New York: Churchill Livingstone Waddell G: The Back Pain Revolution. 1998, New York: Churchill Livingstone
2.
go back to reference Benhamou CL, Roux C, Tourliere D, Gervais T, Viala JF, Amor B: Pseudovisceral pain referred from costovertebral arthropathies. Twenty-eight cases. Spine. 1993, 18: 790-795. 10.1097/00007632-199305000-00024.CrossRefPubMed Benhamou CL, Roux C, Tourliere D, Gervais T, Viala JF, Amor B: Pseudovisceral pain referred from costovertebral arthropathies. Twenty-eight cases. Spine. 1993, 18: 790-795. 10.1097/00007632-199305000-00024.CrossRefPubMed
3.
go back to reference Fruth SJ: Differential diagnosis and treatment in a patient with posterior upper thoracic pain. Phys Ther. 2006, 86 (2): 254-268.PubMed Fruth SJ: Differential diagnosis and treatment in a patient with posterior upper thoracic pain. Phys Ther. 2006, 86 (2): 254-268.PubMed
4.
go back to reference Yelland MJ: Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain?. Aust Fam Physician. 2001, 30: 908-912.PubMed Yelland MJ: Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain?. Aust Fam Physician. 2001, 30: 908-912.PubMed
5.
go back to reference Singer KP, Edmondston SJ: Introduction: The enigma of the thoracic spine. The Clinical Anatomy and Management of Thoracic Spine Pain. Edited by: Giles LGF, Singer KP. 2000, Oxford: Butterworth-Heinemann, 3-13. Singer KP, Edmondston SJ: Introduction: The enigma of the thoracic spine. The Clinical Anatomy and Management of Thoracic Spine Pain. Edited by: Giles LGF, Singer KP. 2000, Oxford: Butterworth-Heinemann, 3-13.
6.
go back to reference Stolker RJ, Groen GJ: Medical and invasive management of thoracic spinal pain. The Clinical Anatomy and Management of Thoracic Spine Pain. Edited by: Giles LGF, Singer KP. 2000, Oxford: Butterworth-Heinemann, 206- Stolker RJ, Groen GJ: Medical and invasive management of thoracic spinal pain. The Clinical Anatomy and Management of Thoracic Spine Pain. Edited by: Giles LGF, Singer KP. 2000, Oxford: Butterworth-Heinemann, 206-
7.
go back to reference Groen GJ, Stolker RJ: Thoracic neural anatomy. The Clinical Anatomy and Management of Thoracic Spine Pain. Edited by: Giles LGF, Singer KP. 2000, Oxford: Butterworth-Heinemann, 114- Groen GJ, Stolker RJ: Thoracic neural anatomy. The Clinical Anatomy and Management of Thoracic Spine Pain. Edited by: Giles LGF, Singer KP. 2000, Oxford: Butterworth-Heinemann, 114-
8.
go back to reference Bogduk N: Innervations and pain patterns of the thoracic spine. Physical Therapy of the Cervical and Thoracic Spine. Edited by: Grant R. 2002, New York: Churchill Livingstone, 77-3 Bogduk N: Innervations and pain patterns of the thoracic spine. Physical Therapy of the Cervical and Thoracic Spine. Edited by: Grant R. 2002, New York: Churchill Livingstone, 77-3
9.
go back to reference Feinstein B, Langton JN, Jameson RM, Schiller F: Experiments on pain referred from deep somatic tissues. J Bone Joint Surg Am. 1954, 36-A: 981-997.PubMed Feinstein B, Langton JN, Jameson RM, Schiller F: Experiments on pain referred from deep somatic tissues. J Bone Joint Surg Am. 1954, 36-A: 981-997.PubMed
10.
go back to reference Aprill C, Dwyer A, Bogduk N: Cervical zygapophyseal joint pain patterns. II: A clinical evaluation. Spine. 1990, 15: 458-461. 10.1097/00007632-199006000-00005.CrossRefPubMed Aprill C, Dwyer A, Bogduk N: Cervical zygapophyseal joint pain patterns. II: A clinical evaluation. Spine. 1990, 15: 458-461. 10.1097/00007632-199006000-00005.CrossRefPubMed
11.
go back to reference Dwyer A, Aprill C, Bogduk N: Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine. 1990, 15: 453-457.CrossRefPubMed Dwyer A, Aprill C, Bogduk N: Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers. Spine. 1990, 15: 453-457.CrossRefPubMed
12.
go back to reference Schwarzer AC, Derby R, Aprill CN, Fortin J, Kine G, Bogduk N: The value of the provocation response in lumbar zygapophyseal joint injections. Clin J Pain. 1994, 10: 309-313.CrossRefPubMed Schwarzer AC, Derby R, Aprill CN, Fortin J, Kine G, Bogduk N: The value of the provocation response in lumbar zygapophyseal joint injections. Clin J Pain. 1994, 10: 309-313.CrossRefPubMed
13.
go back to reference Dreyfuss P, Tibiletti C, Dreyer SJ: Thoracic zygapophyseal joint pain patterns. A study in normal volunteers. Spine. 1994, 19: 807-811.CrossRefPubMed Dreyfuss P, Tibiletti C, Dreyer SJ: Thoracic zygapophyseal joint pain patterns. A study in normal volunteers. Spine. 1994, 19: 807-811.CrossRefPubMed
14.
go back to reference Fukui S, Ohseto K, Shiotani M: Patterns of pain induced by distending the thoracic zygapophyseal joints. Reg Anesth. 1997, 22: 332-336. 10.1016/S1098-7339(97)80007-7.CrossRefPubMed Fukui S, Ohseto K, Shiotani M: Patterns of pain induced by distending the thoracic zygapophyseal joints. Reg Anesth. 1997, 22: 332-336. 10.1016/S1098-7339(97)80007-7.CrossRefPubMed
15.
go back to reference Niemelainen R, Videman T, Battie MC: Prevalence and characteristics of upper or mid-back pain in Finnish men. Spine. 2006, 31: 1846-1849. 10.1097/01.brs.0000226022.05420.1f.CrossRefPubMed Niemelainen R, Videman T, Battie MC: Prevalence and characteristics of upper or mid-back pain in Finnish men. Spine. 2006, 31: 1846-1849. 10.1097/01.brs.0000226022.05420.1f.CrossRefPubMed
16.
go back to reference Occhipinti E, Colombini D, Grieco A: Study of distribution and characteristics of spinal disorders using a validated questionnaire in a group of male subjects not exposed to occupational spinal risk factors. Spine. 1993, 18: 1150-1159. 10.1097/00007632-199307000-00006.CrossRefPubMed Occhipinti E, Colombini D, Grieco A: Study of distribution and characteristics of spinal disorders using a validated questionnaire in a group of male subjects not exposed to occupational spinal risk factors. Spine. 1993, 18: 1150-1159. 10.1097/00007632-199307000-00006.CrossRefPubMed
17.
go back to reference Arroyo JF, Jolliet P, Junod AF: Costovertebral joint dysfunction: another misdiagnosed cause of atypical chest pain. Postgrad Med J. 1992, 68: 655-659.CrossRefPubMedPubMedCentral Arroyo JF, Jolliet P, Junod AF: Costovertebral joint dysfunction: another misdiagnosed cause of atypical chest pain. Postgrad Med J. 1992, 68: 655-659.CrossRefPubMedPubMedCentral
18.
go back to reference Jensen S: Musculoskeletal causes of chest pain. Aust Fam Physician. 2001, 30: 834-839.PubMed Jensen S: Musculoskeletal causes of chest pain. Aust Fam Physician. 2001, 30: 834-839.PubMed
19.
go back to reference Frobert O, Fossgreen J, Sondergaard-Petersen J, Hede J, Bagger JP: Musculo-skeletal pathology in patients with angina pectoris and normal coronary angiograms. J Intern Med. 1999, 245: 237-246. 10.1046/j.1365-2796.1999.0433e.x.CrossRefPubMed Frobert O, Fossgreen J, Sondergaard-Petersen J, Hede J, Bagger JP: Musculo-skeletal pathology in patients with angina pectoris and normal coronary angiograms. J Intern Med. 1999, 245: 237-246. 10.1046/j.1365-2796.1999.0433e.x.CrossRefPubMed
20.
go back to reference Triano JJ, Erwin M, Hansen DT: Costovertebral and costotransverse joint pain: A commonly overlooked pain generator. Top Clin Chiro. 1999, 6: 79-92. Triano JJ, Erwin M, Hansen DT: Costovertebral and costotransverse joint pain: A commonly overlooked pain generator. Top Clin Chiro. 1999, 6: 79-92.
21.
go back to reference DeFranca GG, Levine LJ: The T4 syndrome. J Manipulative Physiol Ther. 1995, 18: 34-37.PubMed DeFranca GG, Levine LJ: The T4 syndrome. J Manipulative Physiol Ther. 1995, 18: 34-37.PubMed
22.
go back to reference Flynn TW: Thoracic spine and ribcage disorders. Orthopaedic Physical Therapy Clinics of North America. 1999, 8: 1-20. Flynn TW: Thoracic spine and ribcage disorders. Orthopaedic Physical Therapy Clinics of North America. 1999, 8: 1-20.
23.
go back to reference McGuckin N: The T4 Syndrome. 1986, London: Churchill Livingstone McGuckin N: The T4 Syndrome. 1986, London: Churchill Livingstone
24.
go back to reference Cohen MJ, Ezekiel J, Persellin RH: Costovertebral and costotransverse joint involvement in rheumatoid arthritis. Ann Rheum Dis. 1978, 37: 473-475. 10.1136/ard.37.5.473.CrossRefPubMedPubMedCentral Cohen MJ, Ezekiel J, Persellin RH: Costovertebral and costotransverse joint involvement in rheumatoid arthritis. Ann Rheum Dis. 1978, 37: 473-475. 10.1136/ard.37.5.473.CrossRefPubMedPubMedCentral
25.
go back to reference Groen GJ, Baljet B, Boekelaar AB, Drukker J: Branches of the thoracic sympathetic trunk in the human fetus. Anat Embryol (Berl). 1987, 176: 401-411. 10.1007/BF00310082.CrossRef Groen GJ, Baljet B, Boekelaar AB, Drukker J: Branches of the thoracic sympathetic trunk in the human fetus. Anat Embryol (Berl). 1987, 176: 401-411. 10.1007/BF00310082.CrossRef
26.
go back to reference Lau LS, Littlejohn GO: Costotransverse joint injection: A description of technique. Australas Radiol. 1987, 31 (1): 47-49. 10.1111/j.1440-1673.1987.tb01781.x.CrossRefPubMed Lau LS, Littlejohn GO: Costotransverse joint injection: A description of technique. Australas Radiol. 1987, 31 (1): 47-49. 10.1111/j.1440-1673.1987.tb01781.x.CrossRefPubMed
27.
go back to reference Jensen MP, Turner JA, Romano JM: What is the maximum number of levels needed in pain intensity measurement?. Pain. 1994, 58: 387-392. 10.1016/0304-3959(94)90133-3.CrossRefPubMed Jensen MP, Turner JA, Romano JM: What is the maximum number of levels needed in pain intensity measurement?. Pain. 1994, 58: 387-392. 10.1016/0304-3959(94)90133-3.CrossRefPubMed
28.
go back to reference McCormack HM, Horne DJ, Sheather S: Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988, 18: 1007-1019.CrossRefPubMed McCormack HM, Horne DJ, Sheather S: Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988, 18: 1007-1019.CrossRefPubMed
29.
go back to reference Price DD, Bush FM, Long S, Harkins SW: A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994, 56: 217-226. 10.1016/0304-3959(94)90097-3.CrossRefPubMed Price DD, Bush FM, Long S, Harkins SW: A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994, 56: 217-226. 10.1016/0304-3959(94)90097-3.CrossRefPubMed
30.
go back to reference Manchikanti L, Manchikanti KN, Manchukonda R, Pampati V, Cash KA: Evaluation of therapeutic thoracic medial branch block effectiveness in chronic thoracic pain: a prospective outcome study with minimum 1-year follow up. Pain Physician. 2006, 9: 97-105.PubMed Manchikanti L, Manchikanti KN, Manchukonda R, Pampati V, Cash KA: Evaluation of therapeutic thoracic medial branch block effectiveness in chronic thoracic pain: a prospective outcome study with minimum 1-year follow up. Pain Physician. 2006, 9: 97-105.PubMed
31.
go back to reference Manchikanti L, Singh V, Pampati V, Beyer CD, Damron KS: Evaluation of the prevalence of facet joint pain in chronic thoracic pain. Pain Physician. 2002, 5: 354-359.PubMed Manchikanti L, Singh V, Pampati V, Beyer CD, Damron KS: Evaluation of the prevalence of facet joint pain in chronic thoracic pain. Pain Physician. 2002, 5: 354-359.PubMed
32.
go back to reference Manchukonda R, Manchikanti KN, Cash KA, Pampati V, Manchikanti L: Facet joint pain in chronic spinal pain: an evaluation of prevalence and false-positive rate of diagnostic blocks. J Spinal Disord Tech. 2007, 20: 539-545. 10.1097/BSD.0b013e3180577812.CrossRefPubMed Manchukonda R, Manchikanti KN, Cash KA, Pampati V, Manchikanti L: Facet joint pain in chronic spinal pain: an evaluation of prevalence and false-positive rate of diagnostic blocks. J Spinal Disord Tech. 2007, 20: 539-545. 10.1097/BSD.0b013e3180577812.CrossRefPubMed
33.
go back to reference Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD: Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord. 2004, 5: 15-10.1186/1471-2474-5-15.CrossRefPubMedPubMedCentral Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD: Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskelet Disord. 2004, 5: 15-10.1186/1471-2474-5-15.CrossRefPubMedPubMedCentral
34.
go back to reference Igarashi A, Kikuchi S, Konno S, Olmarker K: Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders. Spine. 2004, 29: 2091-2095. 10.1097/01.brs.0000141265.55411.30.CrossRefPubMed Igarashi A, Kikuchi S, Konno S, Olmarker K: Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders. Spine. 2004, 29: 2091-2095. 10.1097/01.brs.0000141265.55411.30.CrossRefPubMed
35.
go back to reference Dreyfuss P, Rogers J, Dreyer S, Fletcher D: Atlanto-occipital joint pain. A report of three cases and description of an intraarticular joint block technique. Reg Anesth. 1994, 19: 344-351.PubMed Dreyfuss P, Rogers J, Dreyer S, Fletcher D: Atlanto-occipital joint pain. A report of three cases and description of an intraarticular joint block technique. Reg Anesth. 1994, 19: 344-351.PubMed
36.
go back to reference Moore KL: Clinically Oriented Anatomy. 1992, Baltimore: Williams & Wilkins Moore KL: Clinically Oriented Anatomy. 1992, Baltimore: Williams & Wilkins
37.
go back to reference Hayek R, Henderson CNR, Hayek AFE: Unique features of the thoracic spine: Impact on chiropractic management. Top Clin Chiro. 1999, 6: 69-78. Hayek R, Henderson CNR, Hayek AFE: Unique features of the thoracic spine: Impact on chiropractic management. Top Clin Chiro. 1999, 6: 69-78.
38.
go back to reference Galiano K, Obwegeser AA, Bodner G, Freund MC, Gruber H, Maurer H, Schatzer R, Fiegele T, Ploner F: Ultrasound-guided facet joint injections in the middle to lower cervical spine: a CT-controlled sonoanatomic study. Clin J Pain. 2006, 22: 538-543. 10.1097/01.ajp.0000202977.98420.27.CrossRefPubMed Galiano K, Obwegeser AA, Bodner G, Freund MC, Gruber H, Maurer H, Schatzer R, Fiegele T, Ploner F: Ultrasound-guided facet joint injections in the middle to lower cervical spine: a CT-controlled sonoanatomic study. Clin J Pain. 2006, 22: 538-543. 10.1097/01.ajp.0000202977.98420.27.CrossRefPubMed
39.
go back to reference Galiano K, Obwegeser AA, Bodner G, Freund M, Maurer H, Kamelger FS, Schatzer R, Ploner F: Ultrasound guidance for facet joint injections in the lumbar spine: a computed tomography-controlled feasibility study. Anesth Analg. 2005, 101: 579-83. 10.1213/01.ANE.0000158609.64417.93.CrossRefPubMed Galiano K, Obwegeser AA, Bodner G, Freund M, Maurer H, Kamelger FS, Schatzer R, Ploner F: Ultrasound guidance for facet joint injections in the lumbar spine: a computed tomography-controlled feasibility study. Anesth Analg. 2005, 101: 579-83. 10.1213/01.ANE.0000158609.64417.93.CrossRefPubMed
Metadata
Title
Thoracic costotransverse joint pain patterns: a study in normal volunteers
Authors
Brian A Young
Howard E Gill
Robert S Wainner
Timothy W Flynn
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2008
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-9-140

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