The Costovertebral Joints

The articulations between ribs and the spine are called costovertebral joints. These joints are compound, so they have more than one pair of articulating surfaces. It means that any motion of the rib requires simultaneous action in two spacially separated joints: in the joint of the rib's head (articulatio capitis costae) and in the costotransverse joint (articulatio costotransversaria).

The importance of ligaments surrounding these joints is generally underestimated. However, the data available now suggest the leading role of these ligaments in maintaining the stability of the thoracic spine^1,2, the involvement of these ligaments in developing scoliotic lesions^3,4, and their potential importance in the surgical correction of scoliosis⁵.

¹ Panjabi M & Goel D. Physiologic strains in the lumbar spinal ligaments. Spine 1982, 7(3):192–203.

² Jiang, H. et al. Quantitative morphology of the lateral ligaments of the spine. Spine 1994, 19(23):2676–2682.

³ Darwish H, et al. Radiate ligament shortening and idiopathic scoliosis. Saudi Med J 2012, 33(10):1093–9.

⁴ Schultz A, et al. A study of geometrical relationships in scoliotic spines. J Biomech 1972, 5(4):409–420.

⁵ Yao X. et al. A biomechanical study on the effects of rib head release on thoracic spinal motion. Eur Spine J 2012, 21(4)606–612 (2012).

The 1st and 8th costovertebral joints in situ — Costovertebral joints of the 1^st and 8^th rib. Anterolateral view.
The joint of the rib's head is located between the head of the rib and the costal facet of one or two vertebral bodies. On the other hand, the costotransverse joint is between the articular surface of the costal tubercle and the costal facet of the transverse process.

Articulatio Capitis Costae & Ligaments of the Heads of Ribs

The radiate ligament of the head of rib — 1^st, 10^th, 11^th, and 12^th ribs articulate with the single vertebrae, while all other ribs articulate with two neighboring vertebrae. The count of involved vertebrae is reflected in the shape of the head of the rib. If the rib head has a crest, it articulates with two vertebrae; if there is no crest, it articulates with one.
The main ligament stabilizing the joint is the radiate ligament of the head of rib (**lig. radiatum capitis costae**). Note that for ribs articulating with a single vertebra, the radiate ligament may be attached to the corresponding vertebral body and the vertebra above^*.

^*Standering S. Gray's Anatomy. 39ht ed. Elsevier Churchill Livingstone, 2005 p 955–961

The bands of the ligamentum capitis costae radiatum — The joints of the rib's head. An inferior oblique view to the thorax with the rib cage cut made lateral to the angulus costae
The *ligamentum radiatum capitis costae* usually consists of 3 bands – the upper band, attaching to the upper vertebra; the middle band, connecting the head of a rib with the intervertebral disc; and the lower band, attaching to the lower vertebra^*. Please note that the radiate ligament does not surround the head circumferentially. Dorsally the joint of the rib's head is sealed by the loose and irregular fibers of the articular capsule.
Click an image to see the deeper layer – the **lig. intraarticulare capitis costae**, which extends from the crest of the head of rib to the intervertebral disc.

^* Darwish H H, et al. Radiate ligament shortening and idiopathic scoliosis. Saudi Med J, 2012, 33(1):1093–9.

Articulatio Costotransversaria & The Lateral Costotransversal Ligament

The lateral costotransverse ligaments. The posterior aspect of thorax — Thorax & the costotransversal joints. Posterior aspect
The costotransverse joints (standard synovial joint with articular cartilages and articular gap) could be found in all ribs, except the floating one – the 11^th and 12^th. The **lateral costotransverse ligament** is the primary stabilizer of the costotransverse joint. The ligament is with the oblique course, running superiorly and laterally from the tip of the transverse process of the vertebra to the rough non-articular portion of the corresponding costal tubercle^*.

^* Ibrahim A F & Darwish H H. The costotransverse ligaments in human: A detailed anatomical study. Clin Anat 2005, 18(5):340–345.

The capsule of the costotransverse joint with the lateral costotransverse ligament — The left side costotransversal joints. Posterior aspect
Note the dense and compact lateral costotransverse ligaments, passing in oblique superolateral direction and the loose articular capsule, completely surrounding the costotransverse joint.

Other Ligaments Stabilizing the Costovertebral Joint

Some clarification is needed here. In this section, we are trying to present some evidence-based data that may not fully match the information provided in anatomy textbooks and atlases. The ligaments presented here are:

‣ the lateral costotransverse (see above)
‣ the costotransverse
‣ the superior costotransverse
‣ the inferior costotransverse, and
‣ the posterior costotransverse ligaments;

The last two are not mentioned in the actual list of Anatomical Terminology but are described in the dedicated scientific literature and depicted in many anatomy atlases with original illustrations^1–4.

¹ Bourgery J M, Jacob N H. Atlas of human anatomy and surgery. Vol.1, Plate 48. Taschen, 2015.

² Braus H. Anatomie des Menschen. Ein Lehrbuch für Studierende und Ärzte. Bewegungsapparat. Springer-Verlag Berlin Heidelberg, 1929

³ Spalteholz W, Spanner R. Atlas of human anatomy. 16th ed. Scheltema & Holkema, 1967

⁴ Pernkopf E. Atlas of topographical and applied human anatomy. Vol.2. Thorax, abdomen and extremities. W.B.Saunders Company, 1980

The costotransverse and superior costotransverse ligaments — The costotransverse ligaments
Oblique posterior view of thorax, demonstrating the thick fibers of the costotransverse ligament joining the transverse process of the thoracic vertebrae with the neck of the corresponding rib. The last two ribs may not have such a ligament^*.

The layers of the superior costotransverse ligaments. The posterior aspect of thorax — The two images above demonstrate the **superior costotransverse ligaments**
The superior costotransverse ligament connects the upper edge of the rib's neck with the lower surface of the transverse process of the vertebra above. The ligament consists of two layers – the fibers of the anterior layer are directed cranio-laterally, but those of the posterior layer – cranio-medially^1–3. The lateral edge of the ligament fuses with the internal intercostal membrane. The superior costotransverse ligament is rudimentary or absent on the first rib^2,4.
Some authors suggest that the superior costotransverse ligament is the sole true ligament providing the lateral stability of the thoracic spine³.

¹ Arthrology. In: Williams P, et al., eds. Gray's Anatomy of the Human Body. 37th ed. Chuchill Livinstone, 1989:481–7

² Ibrahim A & Darwish H. The costotransverse ligaments in human: a detailed anatomical study. Clin Anat 2005, 18(5):340–345.
³ Jiang, H. et al. Quantitative morphology of the lateral ligaments of the spine. Spine 1994, 19(23):2676–2682.

⁴ Bannister L, et al., eds. Gray's anatomy. 38th ed. Churchill Livingstone, 1995, p.542–546

The posterior costotransverse ligaments. Posterior and posterolateral aspect of the thorax — The posterior and postero-lateral view to the thoracic spine with the proximal parts of the ribs
Both illustrations above demonstrate the **posterior costotransverse ligaments** connecting the non-articular part of the tubercle of the rib with the inferior articular process and the base of the transverse process of the vertebra above. The ligaments are usually identified in the lower part of the thorax – between the 5^th and 10^th rib. They are believed to stabilize the costotransverse joint against the strong pull of muscles during forced expiration and with increased intra-abdominal pressure¹. The origin and insertion of this ligament differ from the superior costotransverse ligament. However, there are many misleading interpretations in anatomy atlases. In some sources, the posterior costotransverse ligaments are depicted but not labeled^2,3; in others – this ligament is referred as the superior costotransverse⁴.

¹ Ibrahim A & Darwish H. The costotransverse ligaments in human: a detailed anatomical study. Clin Anat 2005, 18(5):340–345.

² Spalteholz W, Spanner R. Atlas of Human Anatomy. 16th ed. Scheltema & Holkema, 1967, p.77

³ Putz R & Pabst R, eds. Sobbota Atlas of Human Anatomy. 14th ed. Vol.2, Urban & Fischer, 2006, Fig.787

⁴ Pernkopf E. Atlas of Topographical and Applied Human Anatomy. 2nd ed. Vol.2, W.B.Saunders Company, 1980, Fig.115

The costotransverse ligaments, including the inferior costotransverse ligament. Inferior oblique view to the posterior thoracic wall — The thoracic spine with the proximal parts of the ribs. Inferior oblique view
The **inferior costotransverse ligaments** are the short bands connecting the inferior border of the neck of a rib to the anterior surface of the corresponding transverse process of the upper six vertebrae. These ligaments prevent the excessive mobility of the upper six ribs that might occur during deep inspiration¹.
The last rib is attached to the costal process of L1 and L2 by the lumbocostal ligament².

First published: 30/Jun/2021
Last update: 25/05/2023