Surgical treatment of the ‘slipping rib syndrome’

Abstract

This review seeks to draw attention to the existence of the 'slipping rib syndrome' as a not uncommon clinical entity. It is characterized by trunk pain in a radicular distribution, often related to certain movements or activity, but not associated with other visceral symptoms. The diagnosis is a clinical one, with surgical excision of the affected rib and costal cartilage a successful simple treatment for relieving those patients of a severe and persistent pain syndrome.

Botulinum Toxin Treatment for Slipping Rib Syndrome

“…8 In some cases surgical excision of the involved rib is required. 5,[7][8][9][10][11][12] In SRS, pain is thought to involve the impingement of an intercostal nerve between costal cartilages, secondary to the subluxation of an interchondral cartilage. The contraction of abdominal wall muscle (particularly the rectus muscle which inserts at the costal margin) as in the Valsalva maneuvre, respiratory movements, twisting or turning of the chest, or external influences such as palpation by the examiner, allows the loosened rib cartilage to subluxate superiorly, causing nerve impingement and pain.…”

“…2,4 It is a conflict between 2 adjacent ribs; the etiology is unknown, it seems due to increased mobility of the affected rib that has a tendency to slip under the superior adjacent rib causing nerve impingement and pain. 5 It usually involves one of the ribs from 8th to 10th, but also the 11th and 12th have been described. Ribs from 8th to 10th, also called "false ribs," are not connected to sternum, but are connected to each other through a fibrous band therefore they tend to be more mobile and susceptible to trauma.…”

“…The management is controversial as well, with uncertain outcomes, 6 if medical treatment fails surgical excision of the rib is required. 5,[7][8][9][10][11][12] Considering muscular contraction responsible for rib dislocation, we thought to weaken muscular activity with injections of incobutulinum toxin A into muscles inserting on the ribcage (quadratus lumborum muscle, muscle transversus abdomini, abdominal external oblique muscle, and recto abdomini). Up-to-date botulinum toxin has never been proposed for treatment of SRS.…”

Slipping rib syndrome. An aggressive but effective treatment

“…Por ello se plantean soluciones agresivas pero eficaces, como la extirpación de los cartí-lagos costales dolorosos, conservando su pericondrio 2,10 . Esta intervención no está exenta de riesgos desde la producción de un neumotórax, deformidades torácicas residuales, recidiva del dolor o repercusión estética.…”

Slipping rib syndrome

“…3 It can last from several hours to weeks at a time. 5 Long-term pain may be accompanied by nausea, anorexia, and bloating, 1 which can lead to diagnostic confusion with conditions having a visceral cause. The differential diagnosis of slipping Jib syndrome includes gallbladder disease, hiatus hernia, peptic ulcer, gastrtc cancer, spinal root lesions, pancreatitis, pancreatic carcinoma, renal calculi, 4 pleurtsy, coronary thrombosis, and Tietze's syndrome.…”