Midline anterior fusion of several vertebral bodies, bilateral fusion of some costovertebral joints
and both sacroiliac joints, and ossification of costal cartilage suggest the individual possibly suffered from ankylosing spondylitis.
Restrictions on palpation were noted in the cervical, upper thoracic and left upper costovertebral joints. Deep palpation of the anterior and middle scalenes, as well as, left cervical rotation and cervical extension recreated the pain along the medial border of the scapula.
Manipulation of the thoracic facet and costovertebral joints is often met with temporary relief only and should tip the practitioner to a different primary cause of the intrathoracic pain.
TB abscesses of the chest wall are usually seen at the margins of the sternum and along the rib shafts, and can also involve the costochondral junctions, costovertebral joints
and the vertebrae (7).
The associated loss of flexibility of the spine and costovertebral joints
also impairs the respiratory mechanics.
This edition has reworked chapters on the heart and lungs and contains 20 new dissections, such as for the ligaments of the vertebral column and the costovertebral joints
, the arteries of the celiac trunk, the branches of the abdominal aorta, the iliac vessels, the female recto-uterine pouch, and the male perineal neurovascular structures.
Secondary findings included a dental focus in the right maxilla and pronounced degenerative changes in the entire vertebral column; the degeneration was most pronounced in the costovertebral joints
and in the facet joints of the lumbar spine.
Osteublastosis can occur in the costovertebral joints
, the costochrondal joints, the costosternal joints and the sternoclavicularjoints.
Palpation of her thoracic spine revealed tenderness with restricted joint movement from T5-T7, as well as the left 6 and 7 costovertebral joints. The left intercostal space between rib 6 and 7 and the paraspinal musculature (rhomboids major, spinalis thoracis, longissimus thoracis, iliocostalis thoracis, multifidus thoracis) from T4 to the iliac crest were tender to palpation with increased myofascial tension, especially on the left.
The diagnosis of costovertebral dysfunction was revisited and the next two treatments were delivered by her primary chiropractor who focused the manipulation to the hypomobile costovertebral joints. The manipulative technique was modified to a supine, single spinous supine thoracic manipulation utilising a soft thenar contact inferior to the restricted spinal segments of T5-T7 about the area of the costovertebral joints of the 6th and 7th ribs as described Byfield.
Cervical Kemp's test on the right caused pain at C7-T1 and along the right first and second costovertebral joints
. Right Adson's test reproduced the numbness in her right hand and her radial pulse was significantly decreased.
Seated motion palpation (6) of the thoracic spine revealed local pain and restriction with lateral spinous process challenge from T3-T9, as well as local pain and restriction in the costovertebral joints
bilaterally at T3-T4 and T6-T7 (worse on the right with posterior to anterior challenge).