Rib Joint Play | Costotransversal Joint Assessment & Treatment

Joint play assessment is part of the clinical expertise of manual practitioners to gain information on the reactivity of a joint and of course articular problems such as capsular limitations or dispositions.

Two studies from Heiderscheidt et al. (2008) and Beynon et al. (2018) found only slight agreement for assessing mobility or stiffness in the thoracic spine and costovertebral junctions. For this reason, the clinical value of costovertebral joint play assessment is weak.

To conduct this joint play assessment, the patient lies in prone position with their head turned towards the side to be examined and the arm of that side hanging off of the edge of the treatment bench so that the scapula protracts and makes room for your hands to be placed on the costovertebral junctions.
You are going to stand on the opposite side of the ribs to be examined.

For Ribs 2 to 7,  The hypothenar aspect of your fixating hand is placed on the heterolateral transverse process of the segment to be examined as well as the segment above.
Using a cross grip, place the hypothenar aspect of your working hand on the angulus costae so that your forearm points into ventral, lateral and caudal direction.
While your patient exhales, examine for joint play including end-feel of the costotransversal joint.

If you find limited joint play, you can use the same technique as a mobilization. Here, you can make use of the Maitland grades of mobilization to dose your technique. Click on the video in the top right corner to learn more about this concept.

For Ribs 8 to 12, the patient is in the same position as before. However now, the fixating and working hands are switched to direct our pressure in a different direction.
Again, the hypothenar aspect of your fixating hand is placed on the heterolateral transverse process of the segment to be examined as well as the segment above.
The other hand’s hypothenar aspect is placed on the angulus costae so that the forearm points into ventral, lateral and cranial direction.

Other orthopedic tests to assess the costotransversal joints:

• First Rib Assessment
• Cervical Rotation Lateral Flexion 

Beynon, A. M., Hebert, J. J., & Walker, B. F. (2018). The interrater reliability of static palpation of the thoracic spine for eliciting tenderness and stiffness to test for a manipulable lesion. Chiropractic & manual therapies, 26(1), 1-10.

Heiderscheit, B., & Boissonnault, W. (2008). Reliability of joint mobility and pain assessment of the thoracic spine and rib cage in asymptomatic individuals. Journal of Manual & Manipulative Therapy, 16(4), 210-216.