This article reviews selected manual procedures used in the treatment of costovertebral dysfunctions and other associated rib and functional lesions. Approach: A qualitative review of the literature in three health care databases relating to costovertebral joints and ribs was performed. Summary: The ribs may be a source of chest wall or upper back pain. Rib dysfunction may also result in shoulder, arm, or neck pain. An understanding of the structures and conditions causing thoracic pain will aid the clinician in appropriate management and treatment interventions. Selected manual procedures for the treatment of costovertebral joint and rib pain syndromes are presented.