Introduction
The ribs are connected to the spine through costovertebral joints located in the upper back. Pain in this area can result from a variety of conditions. A costovertebral block is a medical procedure used to both diagnose and treat this pain and inflammation. The block involves the use of a local anesthetic and an anti-inflammatory medication, such as a steroid. While the effects aren’t permanent, this treatment provides lasting relief, giving patients the opportunity to engage in physical rehabilitation and return to their regular activities.
Anatomy
The thoracic spine, situated in the chest area, consists of 12 vertebrae. Each rib is connected to these vertebrae through costovertebral joints, which facilitate rib movement during breathing. Between each vertebra is a disc that provides mobility and absorbs shock. The center of each vertebra has an opening forming the spinal canal, which houses the spinal cord. Extending from the brain, the spinal cord is a critical component of the nervous system. Thoracic nerves branching from the spinal cord transmit signals between the brain and specific areas of the body, including the chest, mid-back, and arms. These nerves are also responsible for controlling the muscles involved in breathing and certain internal organs.
Causes
A costovertebral block is used to alleviate pain stemming from the costovertebral joints. Pain in these joints may be caused by various conditions, such as injuries, structural weaknesses, rib dysfunction syndromes, or, in rare cases, a herniated disc.
Symptoms
Issues affecting the costovertebral joints often cause aching pain in the upper back, which may radiate to the arms or ribs and spread to the chest. Some individuals may also experience muscle spasms in the upper back.
Diagnosis
Your physician will perform a thorough examination, utilizing various tests to determine the cause of thoracic back pain. These may include imaging tests, lab work, and nerve studies. A costovertebral block can also serve as a diagnostic tool. When anesthetic medication is injected into the suspected joint, pain relief indicates that the joint is the source of the problem. This block also serves as a treatment by delivering anti-inflammatory steroids for longer-lasting pain relief.
Treatment
A costovertebral block is a brief outpatient procedure. Before it begins, you will change into a gown and lie face down. Your upper back will be sterilized, and a local anesthetic will be applied to numb the area. You may also receive a mild sedative to help you relax. Using a live X-ray (fluoroscopy), the doctor will carefully guide a needle into the costovertebral joint. After confirming proper needle placement with a contrast dye, the doctor will inject the medication mixture into the joint before removing the needle.
You will be observed for a short time before being allowed to go home. While some initial pain may occur, relief usually follows within a few days. Most patients can resume normal activities the day after the procedure. Although costovertebral blocks don't provide permanent pain relief, they can offer long-term relief, allowing individuals to participate in physical therapy and improve their overall function.
