Chest, Rib and Shoulder Disharmonies and Discomforts

Have you ever experienced pain and discomfort around your chest, ribs, sternum and upper back?  If yes, you could be suffering from one or more of the following conditions:

Patients with extreme and rigorous physical activities like sports, yoga, and gymnastics; or had injuries, accidents and infections usually experience these conditions. The conditions may appear related, but affect different areas of the chest, ribs, sternum, shoulders and spine.

Costovertebral Joint Dysfunction

The costovertebral joint is the section where the head of a rib articulates with a vertebra of the thoracic spine. Costovertebral Joint Dysfunction could occur when there is damage to the connective tissue that surrounds the joint due to sudden movement involving bending, lifting or twisting through the thoracic spine; or due to a fall, accident or injury.  It may also happen when the upper thoracic region is provoked by ‘pump handle’ movements like reaching, bending or carrying loads on the shoulder, while mid and lower costovertebral problems are provoked by ‘bucket handle’ motions of bending, lateral flexion, and rotation. Usually, the sudden impact will cause muscle spasm, pain and stiffness the following day(s). The disorders cause a dull ache in the upper back. Deep breathing, coughing, or rotation of the trunk and rib cage could worsen the pain. Costovertebral and rib cage pain is a common complaint during pregnancy.

Complaints of costovertebral joint dysfunction range from focal and burning to sharp, stabbing, and radiating pain.  Patients sometimes describe concurrent costovertebral and costosternal pain as if they were “shot by an arrow.” Costovertebral joint dysfunction presents clinically as localised pain, 3-4 cm lateral to the spine with possible radiation of symptoms along the associated rib.  The pain usually occurs between the shoulder blades and one side of the spine. Radiating complaints may include hyperalgesia or paraesthesia.

Costotransverse Disorders

The Costotransverse Disorders occur at juncture where the neck and tubercle (small rounded point) of a rib is ‘joined’ with the transverse process of its corresponding vertebra.  Ligaments connect the costovertebral and costotransverse joints. The juncture between the costotransverse and costovertebral joints must fall in place together so that the rotational axis passes both joints, mostly as ‘coupled’ motions. For example, during respiration, as the ribs rises, the neck gets depressed. This movement is akin to a ‘pump handle’ elevation for the upper ribs, while the lower ribs move in an anterior to posterior manner like a ‘buckle handle’ movement.

Disorders in these joints account for pain in the thorax or functional impairments. When subjected to severe trauma, these joints can subluxate or dislocate. Being located at the top of the rib cage, the first costotransverse joint is the most vulnerable. Persons with spondylitis usually have costotransverse joint disorders. 

Costochondritis and Tietze Syndrome

 Costochondritis, sometimes called chest wall pain or Costosternal Syndrome, is a condition where there is inflammation of the cartilage that joins your ribs to your sternum (breastbone). It could mimic an experience of a fracture for younger adults. Tietze Syndrome is less common, but also involves inflammation of the costochondral joint, with chest swelling which may last even after any pain and tenderness is gone.  Costochondritis tends to affect those above 40, while tietze syndrome usually affects younger adults below 40.

The causes of costochondritis and tietze syndrome could be due to injury to your chest from sudden or prolonged physical exertion. The inflammation may create moderate localised chest pain to sharp and severe stabbing pain that radiates to your shoulder and upper back. Often, the pain is on the left of the sternum; hence, some may think that they have a heart attack. Symptoms of costochondritis may begin following sudden, unguarded, or explosive movements like coughing or sneezing.  Patients will often report a history that includes twisting, reaching, pushing, or pulling; repeated strenuous exercises like yoga and gymnastics; or bacterial, fungal, viral or respiratory tract infections.

Persons involved in wrestling, rugby, football, golf, swimming (butterfly strokes), rock climbing, yoga, singing, carrying of heavy weights and whiplash injury may be predisposed to costochondritis and tietze syndrome. Persons with biomechanical deficits, including a forward head posture, upper cross syndrome, hypokyphosis, scoliosis, or dysfunctional respiration may also be predisposed to thoracic and rib dysfunctions.  Undiagnosed rib dysfunction or costochondritis often cause unnecessary worry about more sinister diseases like cancer, heart attacks, strokes etc, and procrastination or failure to diagnose and treat a threatening origin have serious consequences.

Generally, chiropractic and manual therapy can alleviate and treat the above dysfunctions without need for imaging scans in the initial stages of pain. Radiographs may be necessary in cases of significant trauma, suspicion of fracture or instability, those ages over 50, or cases with lack of improvement with conservative care, or neuromotor deficits. The presence of red flags, including unexplained weight loss, history of cancer, corticosteroid use, osteoporosis, fever, or drug/alcohol abuse, also warrant further investigation.

Chiropractic adjustments and manual therapy are mainstay treatments for Costovertebral Joint Dysfunction, Costotransverse Disorders, Costochondritis and Tietze Syndrome. If you are experiencing rib pain, search ‘costochondritis chiropractor’, call our office, or visit our website for more information.


Your Trusted Chiropractor

 Dr. Nicholas Lim, D.C., ANutr, B.Sc. (Hons)

[Dr. of Chiropractic & Nutritionist &

Honorary Treasurer of The Chiropractic Association of Singapore]

WhatsApp :+65 9355 8828

Telephone : +65 6970 8152

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