Syndrome of costal-vertebral articulation
Last reviewed: 23.04.2024
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The costal-vertebral joint is the true joint that can be affected by osteoarthritis, rheumatoid arthritis, psoriatic arthritis, Reiter's syndrome, and especially ankylosing spondylitis. The joint is often injured in the case of damage such as "acceleration-inhibition" and blunt injuries of the chest, with severe injuries, a subluxation or dislocation of the joint may occur.
Overloads can lead to acute inflammation of the costal-vertebral joint, which can be very debilitating. Also, the joint can be affected by a tumor from the primary focus, for example, with a lung tumor, and with metastatic disease. Pain resulting from the vertebral-rib joint can simulate pain of pulmonary or cardiac origin.
Symptoms of the vertebral-articular joint
In a physical examination, patients try to fix the affected joint or joints and avoid flexion, extension and lateral inclinations of the spine; Also they can try to reduce the scapula, trying to alleviate the pain. The vertebral-rib joint can be painful on palpation, hot and swollen with acute inflammation. Patients may complain of a click sensation when moving in this joint. Since ankylosing spondylitis often affects both the vertebral-rib and sacroiliac joint, many patients may develop a crooked posture, which should alert clinicians to the possibility of this disease as a cause of pain in the vertebral-rib joint.
Examination
X-ray and X-ray review are shown to all patients with pain supposedly coming from the vertebral-articular joint to exclude the hidden pathology of the bone, including the tumor. In the presence of trauma, radionuclide studies of the bone can be useful for detecting hidden fractures of the ribs or sternum. Laboratory studies on collagen and other joint diseases, including ankylosing spondylitis, are indicated for patients with pain in the vertebral-articular joint, especially if the remaining joints are intact. Due to the frequent lesion of the vertebral-rib joint with ankylosing spondylitis, the HLA B-27 test should be taken into account. Additional clinical studies, such as a general blood test, determination of the level of prostate-specific antigen, ESR and antinuclear antibodies, can also be performed. MRI is indicated for suspected joint instability or swelling, or for further clarification of the cause of the pain.
Differential diagnosis
As it was said before, the pain in the syndrome of the vertebral-joint joint is often mistaken for a pulmonary or cardiac joint, which leads to a visit to the emergency room and an unnecessary pulmonary or cardiac benefit. If there is a trauma, the spinal-joint syndrome may exist simultaneously with broken ribs or a fracture of the spine or sternum, which can be missed during a review of radiography, which may require radionuclide scanning of the bone for more accurate identification.
Neuropathic pain of the chest wall can be confused or exist simultaneously with the syndrome of the vertebral-rib joint. Examples of such neuropathic pain are diabetic neuropathy and acute Herpes zoster, affecting the breast nerves. Possible diseases of mediastinal structures, which are difficult to diagnose. Pathological processes that lead to inflammation of the pleura, such as pulmonary thrombus, infection, Bornholm's disease, can also complicate diagnosis and treatment.
Complications and Diagnostic Errors
Since many pathological processes can imitate pain from the vertebral-articular joint, the physician should exclude lung, heart and spinal cord and mediastinum diseases. The absence of this can lead to serious consequences.
The main complication of injection equipment is pneumothorax, in case the needle is too laterally or deeply enters the pleural cavity. Infection, quite rare. Can occur with a violation of asepsis. It is also possible to injure the structures of the mediastinum. The number of these complications can be significantly reduced by strictly observing the correct location of the needle.
Patients with pain arising from the vertebral-joint joint can be sure that they suffer from pneumonia or myocardial infarction. It is necessary to convince them.
[Treatment of the vertebral-rib joint
Initial treatment of pain and function disorders in the vertebral-joint syndrome is an NSAID (for example, diclofenac or lornoxicam). Local heat and cold application can be effective. The use of an elastic rib bandage can provide a reduction in pain and protect the spinal joint from additional trauma. For patients who do not respond to this treatment, the next step is the injection of local anesthetics and steroids into the vertebral-costal joint. Light exercises are shown a few days after the injection of steroids. Excessive exercise should be avoided, as they aggravate the symptoms. Simultaneously with injections, simple analgesics and NSAIDs can be used.