Costovertebral joints

The costovertebral joints (CRJs) include two groups of synovial joints that connect the proximal ends of the ribs to their corresponding thoracic vertebrae, thus forming the rib cage posteriorly.

The connection of the ribs to the vertebrae occurs in two places:

• Head (rib head joint). The two convex faces of the rib head articulate with the costal fossae of the bodies of two adjacent vertebrae, forming a synovial joint, which is strengthened by the ligament of the rib head, the radiate ligament of the rib head and the intercapital ligament.
• Tubercle of the rib (costotransverse joint). This articulation is formed by the articular surface of the tubercle of the rib and the transverse costal fossa of the transverse process of the vertebra. This articulation is strengthened by the costotransverse ligaments.

Clinically Relevant Anatomy

Thus, the costovertebral joint consists of the rib head joint and the costotransverse joint.

Head of rib joint (HRJ)

The SGR has two faces (each face is a separate synovial joint), separated by a ridge:

• The lower edge of the head articulates with the upper costal fossa of its own vertebra.
• The upper edge of the head articulates with the lower costal fossa of the overlying vertebra.
• The first rib articulates only with the first thoracic vertebra, and the three lower ribs articulate only with the bodies of their own vertebrae.

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Ligaments of the rib head joint:

• Intra-articular ligament (rib head ligament) - connects the crest of the rib head to the intervertebral disc.
• The radiate ligament of the rib head is formed by three parts that connect the rib head to the vertebral bodies. The upper part extends to the body of the overlying vertebra, and the lower part to the body of the underlying vertebra. The central part approaches the anterior longitudinal ligament and fuses with the intervertebral disc to join the same ligament on the opposite side. At the articulations of the first rib and the articulations of the last three ribs there are only two parts of this ligament, since they are connected only to their own vertebra.

Costotransverse joint

There are two sides of the rib tubercle - medial and lateral.

• The medial face, lined with hyaline cartilage, forms a flat synovial joint with the apex of the transverse process of the vertebra, which is reinforced by a capsule.
• The lateral facet is attached to the transverse process by three ligaments: Lateral costotransverse ligament - attaches the lateral facet to the tip of the transverse process of the vertebral body.
• The costotransverse ligament attaches the posterior portion of the neck of the rib to the anterior portion of the transverse process of the vertebra.
• The superior costotransverse ligament attaches the neck of the rib to the inferior surface of the transverse process of the overlying vertebra.

The two lower ribs are attached only by means of the SGR and ligaments and do not form synovial articulations with the transverse processes of the vertebrae.

Sternocostal joints

rice.
235. Ligaments and joints of the ribs and sternum: front view. Frontal cut, the anterior sections of the ribs and sternum are partially removed on the left.) The anterior ends of the ribs end in costal cartilages.

The bony part of the ribs is connected to the costal cartilages through costochondral joints, articulationes costochondrales (Fig. 235), and the periosteum of the rib continues into the perichondrium of the corresponding costal cartilage, and the connection between them becomes saturated with lime with age. The costal cartilage of the first rib fuses with the sternum.

The costal cartilages of the II-VII ribs articulate with the costal notches of the sternum, forming the sternocostal joints, articulationes sternocostales (Fig. 236; see Fig. 235). The cavity of these joints is a narrow, vertically located gap, which in the cavity of the joint of the second costal cartilage has an intra-articular sternocostal ligament, lig. sternocostale intraarticulare. It goes from the costal cartilage of the second rib to the junction of the manubrium and the body of the sternum.

Rice. 236. Ligaments and joints of the ribs, vertebrae and sternum; view from above. (Connection of the V pair of ribs with the V thoracic vertebra and the corresponding segment of the sternum.)

In the cavities of other sternocostal joints, this ligament is weakly expressed or absent.

The articular capsules of these joints, formed by the perichondrium of the costal cartilages, are strengthened by the radiate sternocostal ligaments, ligg.

sternocostalia radiata, of which the anterior ones are more powerful than the posterior ones. These ligaments run radially from the end of the costal cartilage to the anterior and posterior surfaces of the sternum, forming crosses and interlaces with the ligaments of the same name on the opposite side, as well as with the overlying and underlying ligaments. As a result, a strong fibrous layer is formed covering the sternum - the sternum membrane, membrana sterni.

The bundles of fibers that run from the anterior surface of the VI-VII costal cartilages obliquely downwards and medially to the xiphoid process form the costoxiphoid ligaments, ligg.

Rice. 234. Ligaments and joints of ribs and vertebrae; back view.

In addition, the outer and inner intercostal membranes are located in the intercostal spaces (see Fig. 234, 235).

The external intercostal membrane, membrana intercostalis externa, lies on the anterior surface of the chest in the region of the costal cartilages. Its constituent bundles start from the lower edge of the cartilage and, moving obliquely downward and anteriorly, end at the upper edge of the underlying cartilage.

The internal intercostal membrane, membrana intercostalis interna, is located in the posterior sections of the intercostal spaces. Its bundles start from the upper edge of the rib and, moving obliquely upward and anteriorly, are attached to the lower edge of the overlying rib.

In the areas where the membranes are located, intercostal muscles are absent. Both membranes strengthen the intercostal spaces.

The costal cartilages from the 5th to the 9th ribs are connected to each other through dense fibrous tissue and intercartilaginous joints, articulationes interchondrales.

The tenth rib is connected by fibrous tissue to the cartilage of the IX rib, and the cartilages of the XI and XII ribs end freely between the abdominal muscles.

Available moves

Movement at these joints is called a "pump handle" or "bucket handle" motion, and is limited to a small degree of sliding and rotation of the rib head.

• The purpose of these movements is to ensure that the ribs move up and out during inhalation.
• The end result is an increase in the lateral diameter of the thorax and subsequent expansion of the lung parenchyma.

The costovertebral complex is an essential component of the biomechanics of thoracic movements. The costovertebral ligaments enable movement of the costovertebral joints and spinal motion segments of the thoracic region.

• Attach, stabilize and allow some freedom of movement of the ribs at the rib head joints. Their presence helps to perform the load-bearing, protective, postural and supporting functions that the chest provides with its stabilizing properties.
• Allow and limit movement of the ribs at the costotransverse joints to ensure maximum expansion of the thoracic cavity for respiratory function. Their effect on both the costovertebral and intervertebral complexes allows for lateroflexion and axial rotation.

Connections in the chest

The cartilaginous parts of the upper seven pairs of ribs are connected to the sternum; the resulting sternocostal joints (articulationes stemocostales) (Fig. 16, 19) are reinforced by the radiate sternocostal ligaments (connecting the costal cartilage to the surface of the sternum). The cartilages of the VIII, IX and X ribs, connecting with the cartilage of the overlying rib, form intercartilaginous joints (Fig. 16).

As you inhale and exhale, the sternum and the anterior ends of the ribs attached to it move up and down. This movement corresponds to the rotational movements of the posterior ends of the ribs. The axis of rotation runs along the neck of the rib, and the rotation itself occurs at the junction of the rib and the vertebra.

The connection of the ribs to the vertebrae is ensured through combined cylindrical joints. Such joints consist of a costotransverse joint (articulatio costotransversaria) (Fig. 18, 19), otherwise called the joint of the costal tubercle, and a joint of the rib head (articulatio capitis costae) (Fig. 19). Despite the fact that anatomically these joints are not one whole, the movements in them occur synchronously, and therefore the costotransverse joint and the joint of the rib head can be considered as a single joint. The XI and XII ribs do not have a costotransverse joint.

The costotransverse joint is formed by the articular surface of the tubercle of the rib and the costal fossa of the transverse process of the vertebra. The costotransverse joint is strengthened by strong ligaments: the upper (lig. costotransversarium superius) and lateral (lig. costotransversarium laterale) costotransverse ligaments (Fig. 17), as well as the costotransverse ligament (lig. costotransversarium), which occupies the entire space between the transverse the vertebral process and the rib neck (Fig. 18).

The rib head joint is formed by the head of the rib and the costal semi-fossae of adjacent vertebrae (the heads of the I, II and XII ribs enter the hollow fossae of the corresponding vertebrae). From the inside, the joint is reinforced by the intraarticular ligament of the rib head (lig. capitis costae intraarticulare), and from the outside by the radiate ligament of the rib head (lig. capitis costae radiatum). The I, II and XII ribs have no intra-articular ligaments of the rib head.

Muscles that carry out the movement of the RPS

The main muscles affecting the RPS are the respiratory muscles:

• Diaphragm.
• Intercostal muscles.

However, all muscles that attach to the ribs and are classified as accessory muscles of respiration can cause movement in these joints. These include the following muscles:

• Sternocleidomastoid muscle.
• Scalene muscles.
• Serratus anterior muscle.
• Pectoral muscles.
• Latissimus dorsi muscle.
• Serratus posterior superior muscle.

Innervation of costovertebral joints

Both types of RPS are innervated by the posterior rami of the C8-Th11 spinal nerves.

• The innervation is segmental in nature.
• Each joint receives fibers from the spinal nerve at its level and from the nerve located at a higher level.

Clinical significance

Costovertebral joint dysfunctions are problems affecting or involving the rib head joints or costotransverse joints and ligaments.

Important consideration:

• Often overlooked, this can be a cause of pain/functional impairment in the thoracic spine.
• This problem can occur due to injury, degenerative changes, tumors, deformities, or muscle spasms.
• Diagnosis is usually made based on clinical examination and treatment, which may include local administration of medications, mobilization techniques, and exercise selection.

Links[edit]

This article incorporates public domain text from page 203 of the 20th edition

"Grey's Anatomy"
(1918).

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