Costotransverse Joint Injection

A costotransverse joint injection places local anaesthetic (sometimes with a steroid) into one of the small joints in the mid-back where a rib joins the transverse process of a thoracic vertebra. These costotransverse joints can become worn or irritated and act as a source of localised thoracic (mid-back) pain that can spread around the ribcage. The injection is used mainly to test whether a particular joint is responsible for a person's symptoms, and it can also provide relief.

The principle is the same as other diagnostic joint injections: if numbing a specific costotransverse joint temporarily relieves the pain, that joint is likely a source; if it does not, the pain probably comes from elsewhere. Because these joints are small and lie deep against the ribcage, imaging guidance — usually X-ray screening, sometimes CT — is used to place the needle accurately, often with a little contrast to confirm position. Any steroid included works to settle inflammation in and around the joint over the following days.

You lie face down while the skin over the mid-back is cleaned and numbed, and imaging guides the needle to the joint. You may feel pressure or a brief ache, and the procedure takes only a few minutes. As with other diagnostic injections, the useful information comes afterwards, so you will be asked to monitor and record how your pain behaves over the following hours and days. After-care advice is given, and you may need someone to accompany you home.

Mid-back pain can be difficult to localise, and the costotransverse joints are an under-recognised potential source. By testing one joint directly, the injection can help separate a joint that is genuinely generating pain from other causes in the region. Confirming the source in this way can guide focused treatment, and the result is always interpreted by the specialist together with symptoms, examination and imaging.

• —Faculty of Pain Medicine, Royal College of Anaesthetists — Standards
• —Royal College of Radiologists — iRefer: Making the Best Use of Clinical Radiology
• —British Association of Spine Surgeons (BASS)

This information is for general patient education and is not a substitute for an individual consultation. Always seek personalised advice from a qualified spinal specialist.