Costovertebral Block 

Introduction
Your ribs are joined to your spine by the costovertebral joints in your upper back.  A variety of conditions can cause pain in this area.  A costovertebral block is a procedure that is used both to diagnose and treat the source of pain and inflammation.  A “block” uses a medication mixture that contains a local anesthetic and anti-inflammatory medication, such as a steroid medication.  Although the results are not permanent, the long-lasting pain relief affords people the opportunity to participate in physical rehabilitation and enjoy their favorite activities again.

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Anatomy
The thoracic spine is located in your chest area.  Twelve bones (vertebrae) make up the thoracic spine.  The ribs are joined on each side of the vertebrae by the costovertebral joints.  The costovertebral joints allow your ribs to move when you breathe.  A disc between each bone allows movement and acts as a shock absorber.

The opening in the center of each bone forms the spinal canal.  Your spinal cord is located within the protective spinal canal.  The spinal cord extends from the brain and is a major part of your nervous system.  The spinal cord does not fill the entire space in the spinal canal.  Spinal nerves extending from the spinal cord travel out of the thoracic spine to exchange nerve signals with your brain about specific parts of your body.  The nerves at the thoracic level travel to the chest, middle back, and arms below the elbows to the fingers, sending information about sensation and movement.  Thoracic level nerves supply your internal organs and the muscles that move the ribs when you breathe.

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Causes
A costovertebral block is used to relieve pain at a costovertebral joint.  Several conditions may result in pain at the costovertebral joint, including injury, structural weakness, rib dysfunction syndromes, and rarely, a ruptured (herniated) disc.

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Symptoms
Conditions affecting the costovertebral joint can cause aching pain in the upper back or pain that spreads to the arms or throughout the ribs to the chest.  You may experience muscle spasms in your upper back.

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Diagnosis
Your doctor will examine you and conduct tests to determine the cause of your thoracic back pain.  Imaging tests, lab tests, and nerve studies may be used to provide your doctor with more information.  A costovertebral block is used to diagnose the source of pain.  As a diagnostic tool, anesthetic medication is placed in a suspected joint.  If the medication relieves the pain, then the joint has successfully been identified as the source of the problem. Costovertebral blocks are also used as a treatment by providing  anti-inflammatory steroid medication for long-term pain relief.

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Treatment
Costovertebral blocks are short outpatient procedures.  Before you receive the costovertebral block, you will put on a gown and be positioned lying face down.  Your upper back area will be sterilized and numbed with an anesthetic.  You may receive relaxation medicine before the procedure begins.

Your doctor will use a live X-ray image (fluoroscopy) to carefully insert and guide the needle to the costovertebral joint.  A contrast dye is used to confirm the needle placement.  Next, the medication solution is delivered to the costovertebral joint, and the needle is removed.

You will be monitored for several minutes before you can return home.  It is common to experience an initial slight increase in pain, followed by pain relief after several days.  Most people are able to resume regular daily activities the day after the procedure.  Although costovertebral blocks do not offer permanent pain relief, they can provide long-term pain relief to allow you to participate in physical therapy.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.