Costosternal Anatomy

Anatomy of the thoracic wall.

The costosternal anatomy is unique in the body, and quite diffent to the other bones and joints. This is because of its important function of protection of the vital organs, whilst still enabling breathing. The ribs make up an important part of the thoracic wall.

The ribcage is formed by three sets of bones:

The STERNUM, or breastbone, in front,
which connects via twelve pairs of RIBS to
twelve THORACIC VERTEBRAE posteriorly.

The joints between the breastbone and the ribs are made up of special so-called COSTAL CARTILAGE which may sometimes become very painful in the Tietze's syndrome.

Muscles

From the chiropractic perspective, costosternal anatomy is concerned with bones, muscles, joints and nerves.

The spaces between the ribs are filled by the INTERCOSTAL MUSCLES. These muscles extends from the sternum to the angle of the rib, posteriorly. They are very important in breathing.

The PECTORALIS MAJOR muscle is very evident on the anterior thoracic wall, has two origins, one of which is the sternocostal cartilages and the sternum bone.

The PECTORALIS MINOR muscle is located at a deeper level than the pectoralis major muscle. It originates from the third, fourth and fifth ribs and is inserted in the coracoid process of the scapula.

The SERRATUS ANTERIOR muscle covers most of the lateral thoracic wall and originates from the first nine ribs. Its fibers converge posteriorly to be inserted into the medial margin of the scapula, thus contributing towards forming the medial wall of the axilla.

The diminutive SUBCLAVIUS muscle originates from the first rib, close to the chondrocostal junction, to be inserted in the collarbone. Its function is to stabilize the clavicle in movements of the shoulder.

Costo-sternal joints

These costosternal anatomy joints, when subluxated, are a common cause of chest pain. Chiropractic treatment involves stretching the doctor's hands right around the ribcage, from the sternum to the spine, an providing gentle thrusts to release the fixations.

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Costo Vertebral Joints

The rib forms three synovial articulations with the spine (see below):

One with the transverse process, the so called COSTO-TRANSVERSE JOINT, and
Two with the vertebral bodies above and below the rib, the so called COSTO-VERTEBRAL JOINTS.

This arrangement restrains the motion of the ribs allowing them to work in a parallel fashion during breathing. If a typical rib had only one joint posteriorly the resultant swivel action would allow a rib to out of sinc with respect to the neighboring ribs making for a very inefficient respiratory mechanism.

These joints may be sprained, often after a violent sneeze, causing severe sharp pain with every breath. The condition responds extremely well to a gentle chiropractic adjustment.

For information about chiropractic treatment of rib pain, click here.

The Breast

The breast obviously lies just adjacent to the costo-sternal joints, and covers some of the muscles.

A breast condition may mimic the costo-sternal syndrome, and sometimes a breast examination may be indicated.

During the treatment of the costo-chondral syndrome, the doctor's hands will approximate the breast tissue as they firmly hold the rib during the in or out phase of breathing. He should release his grip, and slightly remove his hands during the inactive phase of breathing, to ensure that there is no embarrassment.

Should you feel awkward then it may be necessary to ask a friend or family member to accompany you, or ask if the secretary may be present. It is best to talk frankly about this.

Nerves

The NERVE bundles from the spine, are threaded between the muscle layers, and are responsible for the innervation of the intercostal muscules.

As can be seen the costosternal anatomy is unusual in both function and structure, making it vulnerable to various pain syndromes. Other conditions may mimic a rib problem. For example, a hiatus hernia.

To return from COSTOSTERNAL ANATOMY to CHEST PAIN follow this link:

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