Innervation of the human costovertebral joint: Implications for clinical back pain syndromes

摘要: Abstract Background: The diagnosis of pain in the upper back, shoulder, chest, and arm is often made with considerable confusion may be accompanied by needless expense suffering patient. Despite paucity evidence concerning tissues mechanisms responsible for interscapular atypical chest or “pseudo-angina,” practitioners manual therapy maintain that manipulation costovertebral elements associated soft helpful treatment these painful conditions. Objective: We have examined complex humans respect to presence immune-like reactivity neurofilament protein neuropeptide substance P calcitonin gene-related peptide, markers reveal axons peripheral tissues. Design: Human complexes obtained at autopsy were processed standard histologic examination immunocytochemical methods detect neurofilaments, P, peptide. Main Outcome Measures: Outcomes descriptive did not require statistical methods. Results: All joints contained innervation within anterior capsule synovial In 4 separate cases, large intraarticular inclusions “meniscoids” found contain small bundles P. Axon identified serial section monoclonal antibodies neurofilaments as well urea-silver nitrate staining. Conclusions: joint has been considered a candidate producing back and/or psuedo-angina ameliorated spinal manipulation. This study demonstrated requisite production similar manner other column. (J Manipulative Physiol Ther 2000;23:395–403)