Twelfth rib syndrome: a differential diagnosis of loin pain.

Botulinum Toxin Treatment for Slipping Rib Syndrome

“…A variety of names have been given to pain syndromes involving the lower ribs, including rib-tip, 9 slipping rib, 13 twelfth rib, 12,14 Cyriax syndrome, 15 and clicking rib syndrome. 10 SRS is a very challenging diagnosis because it is actually a pure clinical finding and a diagnosis of exclusion.…”

“…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.…”

“…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.…”

Twelfth rib syndrome- an often missed differential diagnosis of hypogastric and lumbar pain: case series

“…6 These injections produce noticeable pain relief in many but unfortunately not always and hence women in some studies had to go through rib resection also. 7 In our case series no woman had to go under rib resection till now. Side effects of LA and steroid include numbness or tingling in the concerned area with discomfort for few days until the steroid starts working.…”

The painful rib syndrome

“…The ventral ramus is larger than that of the other intercostal nerves, and gives a communicating branch to the first lumbar nerve. [8]…”