Slipping Rib Syndrome: An Overlooked Cause of Chest and Abdominal Pain

Lum-Hee, N.; Abdulla, Aza

doi:10.1111/j.1742-1241.1997.tb11446.x

Int J Clinical Practice

1997

DOI: 10.1111/j.1742-1241.1997.tb11446.x

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Slipping Rib Syndrome: An Overlooked Cause of Chest and Abdominal Pain

N. Lum-Hee

Aza Abdulla

Abstract: SUMMARYSlipping rib syndrome is a poorly recognised cause of chest and abdominal pain. It occurs principally in the middle‐aged but may occur at any age. It is equally common in men and women and is frequently confused with other serious causes of chest and abdominal pain. Patients are often subjected to extensive and sometimes invasive needless investigation for unexplained symptoms. Greater awareness of this syndrome among clinicians could save both patient and doctor time and unnecessary concern. Two case r… Show more

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Cited by 19 publications

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Exercise-Related Transient Abdominal Pain (ETAP)

Morton

Callister

2014

Sports Med

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Exercise-related transient abdominal pain (ETAP), commonly referred to as ‘stitch’, is an ailment well known in many sporting activities. It is especially prevalent in activities that involve repetitive torso movement with the torso in an extended position, such as running and horse riding. Approximately 70 % of runners report experiencing the pain in the past year and in a single running event approximately one in five participants can be expected to suffer the condition. ETAP is a localized pain that is most common in the lateral aspects of the mid abdomen along the costal border, although it may occur in any region of the abdomen. It may also be related to shoulder tip pain, which is the referred site from tissue innervated by the phrenic nerve. ETAP tends to be sharp or stabbing when severe, and cramping, aching, or pulling when less intense. The condition is exacerbated by the postprandial state, with hypertonic beverages being particularly provocative. ETAP is most common in the young but is unrelated to sex or body type. Well trained athletes are not immune from the condition, although they may experience it less frequently. Several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum. Of these theories, irritation of the parietal peritoneum best explains the features of ETAP; however, further investigations are required. Strategies for managing the pain are largely anecdotal, especially given that its etiology remains to be fully elucidated. Commonly purported prevention strategies include avoiding large volumes of food and beverages for at least 2 hours prior to exercise, especially hypertonic compounds; improving posture, especially in the thoracic region; and supporting the abdominal organs by improving core strength or wearing a supportive broad belt. Techniques for gaining relief from the pain during an episode are equivocal. This article presents a contemporary understanding of ETAP, which historically has received little research attention but over the past 15 years has been more carefully studied.

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Exercise-Related Transient Abdominal Pain (ETAP)

Morton

Callister

2014

Sports Med

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Peripheral neuropathic mimics of visceral abdominal pain: Can physical examination limit diagnostic testing?

Frumkin

Delahanty

2018

The American Journal of Emergency Medicine

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Slipping Rib Syndrome: Solving the Mystery of the Shooting Pain

Fares

Dimassi

Baydoun

et al. 2019

The American Journal of the Medical Sciences

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Slipping Rib Syndrome: An Overlooked Cause of Chest and Abdominal Pain

Cited by 19 publications

References 8 publications

Exercise-Related Transient Abdominal Pain (ETAP)

Exercise-Related Transient Abdominal Pain (ETAP)

Peripheral neuropathic mimics of visceral abdominal pain: Can physical examination limit diagnostic testing?

Slipping Rib Syndrome: Solving the Mystery of the Shooting Pain

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