Professional Papers _______________________________________________________
Conservative Management of Costovertebral SubluxationFranklin Schoenholtz, DC, DABCO Arcadia, California
ACA Journal of Chiropractic /July 1980
Copyright The Journal of the American Chiropractic AssociationCopyright Dr Franklin Schoenholtz 2009
The chiropractic profession has referred to this syndromeas costovertebral subluxation, posterior rib lesion andcostal sprain.The disturbance is based on a structural and physiologicalvariation in the relationship between the rib articulationand the thoracic vertebra.This article will discuss the diagnosis, examination andmanipulative procedures to successfully manage thissyndrome.
Pain in the thoracic spine is the most commonsymptom. The pain may be felt centrally with lateralradiation into the anterior chest wall. The patient willusually recall that the pain had a sudden onset followinga faulty movement. The pain may be sharp and stabbingand sometimes the intercostal nerves are involved caus-ing the symptoms to be those of an intercostal neuralgia.A common complaint is of continuous soreness atthe costovertebral angle which may become aggravated bycertain unguarded movements such as coughing or sneezing.Painful episodes may occur following exertion ormovements which stress the lesion, such as shaking a pillow-case out or attempting to open a window.The costovertebral sprain must be differentiated fromrib fractures, cardiac pathology, bone pathology and respira-tory syndromes.
The clinical signs obtained from palpation are invalu-able. Palpatory
ndings will often reveal a resistance in thearea of complaint.The clinical approach to the examination that theauthor uses is to perform three tests to establish and con
rmthe presence of a costovertebral sprain.
1. THE SPRING TEST
This test will provide the examiner with informationso that re
ex muscle guarding may be able to be evaluated.(Figure 1)The test is performed with the patient in a proneposition. The doctor is at the head of the table and leansforward so that the heel of each hand rests on the ribs and
Dr Franklin Schoenholtz is a diplomate of the American Board of Chiropractic Orthopedists. He maintains a private practice at 226-228East Foothill Blvd. Arcadia, California. He taught diversi
ed tech-nique and undergraduate orthopedics at the Los Angeles College of Chiropractic in Glendale, California, from 1964 to 1976. Presently,Dr Schoenholtz is the secretary-treasurer of the Board of Regents atLACC. He has written numerous articles on the manipulative man-agement of various musculoskeletal conditions. The most recent, “Conservative Management of Selected Shoulder Problems” appearedin the October, 1979 issue of the ACA Journal.
Costovertebral lesions area frequent occurrenceseen often in practice. Not much has been writtenon this clinical entity. The author has provided theclinician with speci
c diagnostic tests to assessabnormal joint movement of the costovertebralsubluxation. Two rib manipulations are presentedfor consideration. Many variations of these maneu-vers may be utilized to correct speci
c articularlesions. This clinical paper attempts to provide thebusy practitioner with a short, clear, concise andwell illustrated article on the successful manage-ment of this syndrome.The author wishes to thank Tuan Tran, PhD, for hiseditorial assistance in the preparation of this clini-cal paper.