Slipping Rib Syndrome: Difference between revisions
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== Introduction == | == Introduction == | ||
[[File:Slipping Rib Syndrome Example.svg.png|thumb|400x400px]] | [[File:Slipping Rib Syndrome Example.svg.png|thumb|400x400px]] | ||
Slipping rib syndrome (SRS) is characterized by pain in the lower chest or upper abdominal region caused by intercostal nerve impingement as a result of abnormal movement of false ribs (8-12) related to unstable costal cartilaginous attachments<ref name=":7">Healthline [https://www.healthline.com/health/slipping-rib-syndrome#symptoms Slipping Rib Syndrome] Available from:https://www.healthline.com/health/slipping-rib-syndrome#symptoms (last accessed 6.5.2020)</ref><ref>Tsobgny Panka, Chrislain, and Patrick Yvan Tchebegna. [http://www.scielo.org.za/pdf/sajsm/v32n1/18.pdf “Cyriax Syndrome in a Young Male Professional Soccer Player: A Case Report.”] ''South African Journal of Sports Medicine'', vol. 32, no. 1, 3 July 2020, pp. 1–2, www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1015-51632020000100018, 10.17159/2078-516x/2020/v32i1a8300. Accessed 31 Jan. 2022.</ref><ref>Holmes, John F. [https://www.sciencedirect.com/science/article/abs/pii/S000296104190034X “Slipping Rib Cartilage.”] ''The American Journal of Surgery'', vol. 54, no. 1, Oct. 1941, pp. 326–338, www.sciencedirect.com/science/article/abs/pii/S000296104190034X, 10.1016/s0002-9610(41)90034-x. Accessed 31 Jan. 2022.</ref> | Slipping rib syndrome (SRS) is characterized by pain in the lower chest or upper abdominal region caused by intercostal nerve impingement as a result of abnormal movement of false ribs (8-12) related to unstable costal cartilaginous attachments<ref name=":7">Healthline [https://www.healthline.com/health/slipping-rib-syndrome#symptoms Slipping Rib Syndrome] Available from:https://www.healthline.com/health/slipping-rib-syndrome#symptoms (last accessed 6.5.2020)</ref><ref name=":0">Tsobgny Panka, Chrislain, and Patrick Yvan Tchebegna. [http://www.scielo.org.za/pdf/sajsm/v32n1/18.pdf “Cyriax Syndrome in a Young Male Professional Soccer Player: A Case Report.”] ''South African Journal of Sports Medicine'', vol. 32, no. 1, 3 July 2020, pp. 1–2, www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1015-51632020000100018, 10.17159/2078-516x/2020/v32i1a8300. Accessed 31 Jan. 2022.</ref><ref>Holmes, John F. [https://www.sciencedirect.com/science/article/abs/pii/S000296104190034X “Slipping Rib Cartilage.”] ''The American Journal of Surgery'', vol. 54, no. 1, Oct. 1941, pp. 326–338, www.sciencedirect.com/science/article/abs/pii/S000296104190034X, 10.1016/s0002-9610(41)90034-x. Accessed 31 Jan. 2022.</ref> | ||
Slipping rib syndrome goes by many names, including: | Slipping rib syndrome goes by many names, including: | ||
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* Twelfth rib syndrome | * Twelfth rib syndrome | ||
* Cyriax syndrome | * Cyriax syndrome | ||
* Interchondral subluxation, among others.<ref name=":7" /><ref>McMahon, Lisa E. [https://pubmed.ncbi.nlm.nih.gov/30078490/ “Slipping Rib Syndrome: A Review of Evaluation, Diagnosis and Treatment.”] ''Seminars in Pediatric Surgery'', vol. 27, no. 3, June 2018, pp. 183–188, pubmed.ncbi.nlm.nih.gov/30078490/, 10.1053/j.sempedsurg.2018.05.009. Accessed 31 Jan. 2022.</ref> | * Interchondral subluxation, among others.<ref name=":7" /><ref name=":30">McMahon, Lisa E. [https://pubmed.ncbi.nlm.nih.gov/30078490/ “Slipping Rib Syndrome: A Review of Evaluation, Diagnosis and Treatment.”] ''Seminars in Pediatric Surgery'', vol. 27, no. 3, June 2018, pp. 183–188, pubmed.ncbi.nlm.nih.gov/30078490/, 10.1053/j.sempedsurg.2018.05.009. Accessed 31 Jan. 2022.</ref> | ||
== Epidemiology == | == Epidemiology == | ||
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* Higher prevalence among women than men by a ratio of 3:1 <ref>Yu, Hyun Jeong, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4942647/ “Nineth Rib Syndrome after 10th Rib Resection.”] ''The Korean Journal of Pain'', vol. 29, no. 3, 31 July 2016, pp. 185–188, www.ncbi.nlm.nih.gov/pmc/articles/PMC4942647/, 10.3344/kjp.2016.29.3.185. Accessed 31 Jan. 2022.</ref><ref name=":8">Romano, Rosalia, et al. [https://academic.oup.com/icvts/article/34/2/331/6374795 “A New Sign of the Slipping Rib Syndrome?”] ''Interactive CardioVascular and Thoracic Surgery'', vol. 34, no. 2, 24 Sept. 2021, pp. 331–332, academic.oup.com/icvts/article/34/2/331/6374795, 10.1093/icvts/ivab252. Accessed 31 Jan. 2022.</ref> | * Higher prevalence among women than men by a ratio of 3:1 <ref>Yu, Hyun Jeong, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4942647/ “Nineth Rib Syndrome after 10th Rib Resection.”] ''The Korean Journal of Pain'', vol. 29, no. 3, 31 July 2016, pp. 185–188, www.ncbi.nlm.nih.gov/pmc/articles/PMC4942647/, 10.3344/kjp.2016.29.3.185. Accessed 31 Jan. 2022.</ref><ref name=":8">Romano, Rosalia, et al. [https://academic.oup.com/icvts/article/34/2/331/6374795 “A New Sign of the Slipping Rib Syndrome?”] ''Interactive CardioVascular and Thoracic Surgery'', vol. 34, no. 2, 24 Sept. 2021, pp. 331–332, academic.oup.com/icvts/article/34/2/331/6374795, 10.1093/icvts/ivab252. Accessed 31 Jan. 2022.</ref> | ||
* May occur at any age, more common in middle-aged women, and is a relatively uncommon, but recognized cause of recurrent lower chest and/or upper abdomen pain in adolescents. <ref name=":14">GE, Porter. “[https://pubmed.ncbi.nlm.nih.gov/4058991/ Slipping Rib Syndrome: An Infrequently Recognized Entity in Children: A Report of Three Cases and Review of the Literature.”] ''Pediatrics'', vol. 76, no. 5, 2012, pubmed.ncbi.nlm.nih.gov/4058991/. Accessed 31 Jan. 2022.</ref><ref>Lum-Hee N. et al.; [https://pubmed.ncbi.nlm.nih.gov/9287271/ Slipping rib syndrome: an overlooked cause of chest and abdominal pain]; Int. J. Clin. Pract., 51 (4) (1997), pp. 252–253 (LoE 4)</ref><ref>Turcios N.L. et al.; [https://journals.sagepub.com/doi/10.1177/0009922812469290?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Slipping rib syndrome in an adolescent: an elusive diagnosis]; Clin. Pediatr., 52 (9) (2012), pp. 879–881 (LoE 2B)</ref> | * May occur at any age, more common in middle-aged women, and is a relatively uncommon, but recognized cause of recurrent lower chest and/or upper abdomen pain in adolescents. <ref name=":14">GE, Porter. “[https://pubmed.ncbi.nlm.nih.gov/4058991/ Slipping Rib Syndrome: An Infrequently Recognized Entity in Children: A Report of Three Cases and Review of the Literature.”] ''Pediatrics'', vol. 76, no. 5, 2012, pubmed.ncbi.nlm.nih.gov/4058991/. Accessed 31 Jan. 2022.</ref><ref>Lum-Hee N. et al.; [https://pubmed.ncbi.nlm.nih.gov/9287271/ Slipping rib syndrome: an overlooked cause of chest and abdominal pain]; Int. J. Clin. Pract., 51 (4) (1997), pp. 252–253 (LoE 4)</ref><ref>Turcios N.L. et al.; [https://journals.sagepub.com/doi/10.1177/0009922812469290?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Slipping rib syndrome in an adolescent: an elusive diagnosis]; Clin. Pediatr., 52 (9) (2012), pp. 879–881 (LoE 2B)</ref> | ||
* It’s been reported in people as young as | * It’s been reported in people as young as 7 years and as old as 86, but it mostly affects middle-aged people.<ref name=":7" /><ref name=":30" /> | ||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
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* Congenital anomaly of the chest wall<ref name=":8" /> | * Congenital anomaly of the chest wall<ref name=":8" /> | ||
* The destruction of the fibrous articulation of the rib or their cartilage portion<ref name=":8" /> | * The destruction of the fibrous articulation of the rib or their cartilage portion<ref name=":8" /> | ||
* Hypermobility of the costal cartilages of the false ribs<ref name=":4" /> | * Hypermobility of the costal cartilages of the false ribs<ref name=":30" /><ref name=":4" /> | ||
== Risk Factors <ref name=":30" /> == | |||
* overuse | |||
* direct trauma that causes the pain. | |||
* Sudden extension or flexion, repeated one-sided weight bearing or exercise such as throwing a ball, vigorous swimming, or swinging a bat. | |||
== Clinical Presentation == | == Clinical Presentation == | ||
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=== Signs and Symptoms === | === Signs and Symptoms === | ||
Following signs and symptoms can be observed:<ref name=":8" /><ref name=":14" /><ref name=":5" /><ref name=":22" /><ref name=":6" /><ref name=":11">Cranfield K.A.W. et al.; [https://pubmed.ncbi.nlm.nih.gov/9114637/ The twelfth rib syndrome];Journal of Pain and Symptom Management, 1997. (LoE 3B)</ref><ref name=":18">Mooney D.P. et al.; [https://pubmed.ncbi.nlm.nih.gov/9247238/ Slipping rib syndrome in childhood; J. Pediatr.] Surg., 32 (7) (1997), pp. 1081–1082 (LoE 3B) </ref><ref name=":19">Arroyo JF, Vine R, Reynaud C, Michel JP. [https://pubmed.ncbi.nlm.nih.gov/7883201/ Slipping rib syndrome: don’t be fooled.] Geriatrics. 1995;50:46–49. (LoE 3A)</ref><ref name=":20">Copeland GP, Machin DG, Shennan JM. [https://pubmed.ncbi.nlm.nih.gov/6733425/ Surgical treatment of the ‘‘slipping rib syndrome.’’] Br J Surg. 1984;71:522–523. (LoE 1A)</ref><ref name=":1">Saltzman D.A. et al. [https://pubmed.ncbi.nlm.nih.gov/11696155/ The slipping rib syndrome in children. Pediatric Anesthesia]. Volume 11, Issue 6, November 2001, Pages 740–743 (LoE 4) </ref><ref name=":26">Machin D.G. et al.; [https://pubmed.ncbi.nlm.nih.gov/6411237/ Twelfth rib syndrome: a differential diagnosis of loin pain;] British Medical Journal, 1983 (LoE 4) </ref><ref name=":15">Van Delft E.A.K. et al.; [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855817/ The Slipping Rib Syndrome: A case report;] International Journal of Surgery Case Reports, 2016. (LoE 4)</ref><ref name=":3">Mynors J.M. et al.; [https://pubmed.ncbi.nlm.nih.gov/4121886/ Clicking rib]; Lancet, 1 (1973), p. 674 (LoE 1B)</ref><ref name=":21">Bass J. et al.; [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2537485/ Slipping Rib Syndrome]; Journal of the National Medical Association, 1979;71(9):863-865. (LoE 4) </ref><ref name=":27">Cyriax E, et al., On various conditions that may simulate the referred pains of visceral disease and a consideration of these from the point of view of cause and effect, Practitioner, 1919</ref><ref>Germanovich A;Ferrante FM. [https://pubmed.ncbi.nlm.nih.gov/27008303/ “Multi-Modal Treatment Approach to Painful Rib Syndrome: Case Series and Review of the Literature.”] ''Pain Physician'', vol. 19, no. 3, 2016, pubmed.ncbi.nlm.nih.gov/27008303/. Accessed 31 Jan. 2022.</ref><ref>Kumar, Rajender, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748696/ “The Painful Rib Syndrome.”] ''Indian Journal of Anaesthesia'', vol. 57, no. 3, 2013, p. 311, www.ncbi.nlm.nih.gov/pmc/articles/PMC3748696/, 10.4103/0019-5049.115585. Accessed 31 Jan. 2022.</ref><ref>Arya, Sangeeeta, et al. [https://www.ijrcog.org/index.php/ijrcog/article/view/839 “Twelfth Rib Syndrome- an Often Missed Differential Diagnosis of Hypogastric and Lumbar Pain: Case Series.”] ''International Journal of Reproduction, Contraception, Obstetrics and Gynecology'', vol. 3, no. 1, 2014, pp. 263–265, www.ijrcog.org/index.php/ijrcog/article/view/839. Accessed 31 Jan. 2022.</ref><ref>Mazzella, Antonio, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995823/ “Costal Cartilage Resection for the Treatment of Slipping Rib Syndrome (Cyriax Syndrome) in Adults.”] ''Journal of Thoracic Disease'', vol. 12, no. 1, Jan. 2020, pp. 10–16, www.ncbi.nlm.nih.gov/pmc/articles/PMC6995823/, 10.21037/jtd.2019.07.83. Accessed 31 Jan. 2022.</ref><ref name=":28">Kamal, YasserAli. [https://www.e-fjs.org/article.asp?issn=1682-606X;year=2019;volume=52;issue=6;spage=229;epage=231;aulast=Kamal;type=0#:~:text=Slipping%20rib%20syndrome%3A%20A%20neglected,Kamal%20YA%20%2D%20Formos%20J%20Surg&text=Slipping%20rib%20syndrome%20(SRS)%20is,with%20chronic%20right%20hypochondrial%20pain. “Slipping Rib Syndrome: A Neglected Cause of Hypochondrial Pain.”] ''Formosan Journal of Surgery'', vol. 52, no. 6, 2019, p. 229, Accessed 31 Jan. 2022.</ref><ref>Migliore, Marcello, et al. [https://d1wqtxts1xzle7.cloudfront.net/40268087/Flank_pain_caused_by_slipping_rib_syndro20151122-796-fisq0g.pdf?1448218051=&response-content-disposition=inline%3B+filename%3DFlank_pain_caused_by_slipping_rib_syndro.pdf&Expires=1643663794&Signature=OBm-MHoUIGTMiUSXIz8M6E2vemV~EVEQOtHmjVgaTtVir5zB54VZhV~UltzsCK5MzwL8k09AK7v-Ht5k4Bp3cis-ZvZKFFlys-GQXxRSIIeq18yze7EQ7k5H2IXgsobR-b2~YQ~6BQmsfJ8jQgOLD2cS32CrhW3Ng7mWnRa2gWwUeJH-IuVeNgq~-QOOA-RxA287cpGL9lFGXyWlfeHhZSUXXjTV6yZ3FQSoPWHlOBSsHTYDfT3jh66~UjUhtEw97wdmKUF-17BKkOeG0qjq0XC-zoEyQWz9CQ1GLOq08NTWuEgRdegqGlsar9kGDyWhw3bN673L7tjpXUeQtg4wLw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA “Flank Pain Caused by Slipping Rib Syndrome.”] ''The Lancet'', vol. 383, no. 9919, Mar. 2014, p. 844, Accessed 31 Jan. 2022.</ref><ref name=":29">Turcios, Nelson L. [https://pubmed.ncbi.nlm.nih.gov/27245407/#:~:text=Slipping%20rib%20syndrome%20remains%20rarely,and%20avoid%20chronic%20debilitating%20pain. “Slipping Rib Syndrome: An Elusive Diagnosis.”] ''Paediatric Respiratory Reviews'', vol. 22, Mar. 2017, pp. 44–46, Accessed 31 Jan. 2022.</ref> | Following signs and symptoms can be observed:<ref name=":30" /><ref name=":8" /><ref name=":14" /><ref name=":5" /><ref name=":22" /><ref name=":6" /><ref name=":11">Cranfield K.A.W. et al.; [https://pubmed.ncbi.nlm.nih.gov/9114637/ The twelfth rib syndrome];Journal of Pain and Symptom Management, 1997. (LoE 3B)</ref><ref name=":18">Mooney D.P. et al.; [https://pubmed.ncbi.nlm.nih.gov/9247238/ Slipping rib syndrome in childhood; J. Pediatr.] Surg., 32 (7) (1997), pp. 1081–1082 (LoE 3B) </ref><ref name=":19">Arroyo JF, Vine R, Reynaud C, Michel JP. [https://pubmed.ncbi.nlm.nih.gov/7883201/ Slipping rib syndrome: don’t be fooled.] Geriatrics. 1995;50:46–49. (LoE 3A)</ref><ref name=":20">Copeland GP, Machin DG, Shennan JM. [https://pubmed.ncbi.nlm.nih.gov/6733425/ Surgical treatment of the ‘‘slipping rib syndrome.’’] Br J Surg. 1984;71:522–523. (LoE 1A)</ref><ref name=":1">Saltzman D.A. et al. [https://pubmed.ncbi.nlm.nih.gov/11696155/ The slipping rib syndrome in children. Pediatric Anesthesia]. Volume 11, Issue 6, November 2001, Pages 740–743 (LoE 4) </ref><ref name=":26">Machin D.G. et al.; [https://pubmed.ncbi.nlm.nih.gov/6411237/ Twelfth rib syndrome: a differential diagnosis of loin pain;] British Medical Journal, 1983 (LoE 4) </ref><ref name=":15">Van Delft E.A.K. et al.; [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855817/ The Slipping Rib Syndrome: A case report;] International Journal of Surgery Case Reports, 2016. (LoE 4)</ref><ref name=":3">Mynors J.M. et al.; [https://pubmed.ncbi.nlm.nih.gov/4121886/ Clicking rib]; Lancet, 1 (1973), p. 674 (LoE 1B)</ref><ref name=":21">Bass J. et al.; [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2537485/ Slipping Rib Syndrome]; Journal of the National Medical Association, 1979;71(9):863-865. (LoE 4) </ref><ref name=":27">Cyriax E, et al., On various conditions that may simulate the referred pains of visceral disease and a consideration of these from the point of view of cause and effect, Practitioner, 1919</ref><ref>Germanovich A;Ferrante FM. [https://pubmed.ncbi.nlm.nih.gov/27008303/ “Multi-Modal Treatment Approach to Painful Rib Syndrome: Case Series and Review of the Literature.”] ''Pain Physician'', vol. 19, no. 3, 2016, pubmed.ncbi.nlm.nih.gov/27008303/. Accessed 31 Jan. 2022.</ref><ref>Kumar, Rajender, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748696/ “The Painful Rib Syndrome.”] ''Indian Journal of Anaesthesia'', vol. 57, no. 3, 2013, p. 311, www.ncbi.nlm.nih.gov/pmc/articles/PMC3748696/, 10.4103/0019-5049.115585. Accessed 31 Jan. 2022.</ref><ref>Arya, Sangeeeta, et al. [https://www.ijrcog.org/index.php/ijrcog/article/view/839 “Twelfth Rib Syndrome- an Often Missed Differential Diagnosis of Hypogastric and Lumbar Pain: Case Series.”] ''International Journal of Reproduction, Contraception, Obstetrics and Gynecology'', vol. 3, no. 1, 2014, pp. 263–265, www.ijrcog.org/index.php/ijrcog/article/view/839. Accessed 31 Jan. 2022.</ref><ref>Mazzella, Antonio, et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995823/ “Costal Cartilage Resection for the Treatment of Slipping Rib Syndrome (Cyriax Syndrome) in Adults.”] ''Journal of Thoracic Disease'', vol. 12, no. 1, Jan. 2020, pp. 10–16, www.ncbi.nlm.nih.gov/pmc/articles/PMC6995823/, 10.21037/jtd.2019.07.83. Accessed 31 Jan. 2022.</ref><ref name=":28">Kamal, YasserAli. [https://www.e-fjs.org/article.asp?issn=1682-606X;year=2019;volume=52;issue=6;spage=229;epage=231;aulast=Kamal;type=0#:~:text=Slipping%20rib%20syndrome%3A%20A%20neglected,Kamal%20YA%20%2D%20Formos%20J%20Surg&text=Slipping%20rib%20syndrome%20(SRS)%20is,with%20chronic%20right%20hypochondrial%20pain. “Slipping Rib Syndrome: A Neglected Cause of Hypochondrial Pain.”] ''Formosan Journal of Surgery'', vol. 52, no. 6, 2019, p. 229, Accessed 31 Jan. 2022.</ref><ref>Migliore, Marcello, et al. [https://d1wqtxts1xzle7.cloudfront.net/40268087/Flank_pain_caused_by_slipping_rib_syndro20151122-796-fisq0g.pdf?1448218051=&response-content-disposition=inline%3B+filename%3DFlank_pain_caused_by_slipping_rib_syndro.pdf&Expires=1643663794&Signature=OBm-MHoUIGTMiUSXIz8M6E2vemV~EVEQOtHmjVgaTtVir5zB54VZhV~UltzsCK5MzwL8k09AK7v-Ht5k4Bp3cis-ZvZKFFlys-GQXxRSIIeq18yze7EQ7k5H2IXgsobR-b2~YQ~6BQmsfJ8jQgOLD2cS32CrhW3Ng7mWnRa2gWwUeJH-IuVeNgq~-QOOA-RxA287cpGL9lFGXyWlfeHhZSUXXjTV6yZ3FQSoPWHlOBSsHTYDfT3jh66~UjUhtEw97wdmKUF-17BKkOeG0qjq0XC-zoEyQWz9CQ1GLOq08NTWuEgRdegqGlsar9kGDyWhw3bN673L7tjpXUeQtg4wLw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA “Flank Pain Caused by Slipping Rib Syndrome.”] ''The Lancet'', vol. 383, no. 9919, Mar. 2014, p. 844, Accessed 31 Jan. 2022.</ref><ref name=":29">Turcios, Nelson L. [https://pubmed.ncbi.nlm.nih.gov/27245407/#:~:text=Slipping%20rib%20syndrome%20remains%20rarely,and%20avoid%20chronic%20debilitating%20pain. “Slipping Rib Syndrome: An Elusive Diagnosis.”] ''Paediatric Respiratory Reviews'', vol. 22, Mar. 2017, pp. 44–46, Accessed 31 Jan. 2022.</ref> | ||
* Upper abdominal and lower anterior chest wall pain. | * Upper abdominal and lower anterior chest wall pain. | ||
* Flank pain | * Flank pain | ||
* Tenderness over the affected costal margins | * Tenderness over the affected costal margins | ||
* Clicking, popping or slipping sensation can also be present. | |||
* Pain was preceded by certain activities such as sitting, leaning forward, and interestingly she found that using a swing machine was especially likely to produce discomfort. | * Pain was preceded by certain activities such as sitting, leaning forward, and interestingly she found that using a swing machine was especially likely to produce discomfort. | ||
* [[Pain Assessment|Pain]] associated with slipping rib syndrome has distinct characteristics which can be used in identifying the syndrome: | * [[Pain Assessment|Pain]] associated with slipping rib syndrome has distinct characteristics which can be used in identifying the syndrome: | ||
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The physiotherapist looks for an association between certain movements or postures and pain intensity (signs and symptoms), determines if the patient has experienced recent trauma (not always present), constrained posture, or previous abdominal surgery and reproduces the symptoms (eg, pain, clicking) <ref name=":5" /><ref name=":13">Meuwly J. et al.; Slipping Rib Syndrome A Place for Sonography in the Diagnosis of a Frequently Overlooked Cause of Abdominal or Low Thoracic Pain; Journal of ultrasound in medicine, 2002. (LoE 4)</ref> | The physiotherapist looks for an association between certain movements or postures and pain intensity (signs and symptoms), determines if the patient has experienced recent trauma (not always present), constrained posture, or previous abdominal surgery and reproduces the symptoms (eg, pain, clicking) <ref name=":5" /><ref name=":13">Meuwly J. et al.; Slipping Rib Syndrome A Place for Sonography in the Diagnosis of a Frequently Overlooked Cause of Abdominal or Low Thoracic Pain; Journal of ultrasound in medicine, 2002. (LoE 4)</ref> | ||
*Classically, the pain occurs in the upper abdomen or lower chest, in the abdominal wall and above the anterior costal margin. | *Classically, the pain occurs in the upper abdomen or lower chest, in the abdominal wall and above the anterior costal margin. | ||
* At that place the involved costal cartilage moves more freely than normal and the examiner can typically feel tenderness<ref name=":16" /><ref name=":13" />. A painful click is sometimes felt over the tip of the involved costal cartilage with certain movements. | * At that place the involved costal cartilage moves more freely than normal and the examiner can typically feel tenderness<ref name=":16">Adel G. et al.; Musculoskeletal chest wall pain; Can Med Assoc J, 1985 (LoE 5)</ref><ref name=":13" />. | ||
* A painful click is sometimes felt over the tip of the involved costal cartilage with certain movements. | |||
*[https://www.youtube.com/watch?v=j38Sfn_1syU <sup></sup>][https://www.youtube.com/watch?v=SC29GbWbN-M <sup></sup>]Palpation - At physical examination, the most common finding in a case of slipping rib syndrome is the tenderness above the costal margin. The physiotherapist can reproduce chest pain by palpation <ref name=":6" /><ref name=":17" /><ref name=":23">Ronga A. et al.; Development and validation of a clinical prediction rule for chest wall syndrome in primary care; BiomedCentral, 2012. (LoE 2B)</ref><ref name=":1" />.[https://www.youtube.com/watch?v=j38Sfn_1syU <sup></sup>][https://www.youtube.com/watch?v=SC29GbWbN-M <sup></sup>] | *[https://www.youtube.com/watch?v=j38Sfn_1syU <sup></sup>][https://www.youtube.com/watch?v=SC29GbWbN-M <sup></sup>]Palpation - At physical examination, the most common finding in a case of slipping rib syndrome is the tenderness above the costal margin. The physiotherapist can reproduce chest pain by palpation <ref name=":6" /><ref name=":17" /><ref name=":23">Ronga A. et al.; Development and validation of a clinical prediction rule for chest wall syndrome in primary care; BiomedCentral, 2012. (LoE 2B)</ref><ref name=":1" />.[https://www.youtube.com/watch?v=j38Sfn_1syU <sup></sup>][https://www.youtube.com/watch?v=SC29GbWbN-M <sup></sup>] | ||
* The Hooking manoeuvre - positive test | * The Hooking manoeuvre - positive test | ||
== Diagnostic Procedures == | |||
Diagnosing SRS is the main challenge, which is based on the careful patient history, physical examination, and knowledge of its existence. <ref name=":10" /> <ref>Hansen, Adam J., et al. [https://pubmed.ncbi.nlm.nih.gov/32330472/ “Minimally Invasive Repair of Adult Slipped Rib Syndrome without Costal Cartilage Excision.”] ''The Annals of Thoracic Surgery'', vol. 110, no. 3, Sept. 2020, pp. 1030–1035, pubmed.ncbi.nlm.nih.gov/32330472/, 10.1016/j.athoracsur.2020.02.081. Accessed 31 Jan. 2022.</ref> However, following procedures can be use for diagnosis:<ref name=":30" /><ref name=":10" /><ref name=":22" /> | |||
* Hooking maneuvre. | |||
* Intercostal nerve blocks can be performed after positive hooking manoeuvre, to confirm the diagnosis. | |||
* Dynamic ultrasound of the ribs can be performed with valsalva, coughing, twisting, crunch and push manoeuvres to diagnose SRS. | |||
== Outcome Measures == | |||
* The physiotherapist can reproduce chest pain by palpation of the ribs and chest wall <ref name=":5" />. | |||
* Hooking manoeuvre - Reproduce the symptoms. This is a relatively simple clinical test where the clinician places his or her fingers under the lower costal margin and pulls the hand in an anterior direction. Pain or clicking indicates a positive test <ref name=":5" /><ref name=":21" /><ref name=":16" /><ref name=":17" /> | |||
*[[Patient Specific Functional Scale|Patient-specific functional scale]] ( PSFS)<ref name=":24">Richard B. Westrick et al.; EVALUATION AND TREATMENT OF MUSCULOSKELETAL CHEST WALL PAIN IN A MILITARY ATHLETE; Int J Sports Phys Ther. 2012 June; 7(3): 323–332 (LoE 4) </ref>. | |||
* The Global rating of change (GROC) - To measure the patient’s subjective rate of improvement, the GROC has been stated to be reliable <ref>Proulx A. M. et al.; Costochondritis: Diagnosis and treatment; American Family Physician; 80(6), 617–620. doi:10.1016/S0015-1882(09)70196; 2009 (LoE 5)</ref>. | |||
== Differential Diagnosis == | == Differential Diagnosis == | ||
Line 101: | Line 122: | ||
* [[Pancreatitis]] | * [[Pancreatitis]] | ||
== | * | ||
== Management == | |||
In some cases, slipping rib syndrome resolves on its own without treatment if not, the choice of treatment depends on the severity of patient’s symptoms. There are different approaches in Conservative and non-conservative management that can be taken into account when treating SRS.<ref name=":7" /> | |||
* | === Conservative Management === | ||
* | Conservative management includes the following:<ref name=":30" />[[File:Dane-wetton-t1NEMSm1rgI-unsplash.jpg|right|frameless]] | ||
* Rest. | |||
* Avoiding strenuous activities. | |||
* Applying heat or ice to the affected area. | |||
* Oral medications like NSAIDS. | |||
* Topical analgesics. | |||
* Physical Therapy. | |||
* Nerve blocks. | |||
==== Activities to Avoid ==== | |||
Reassurance of the benign nature of the disease combined with explanation and advice concerning postural avoidance <ref name=":25">Gregory P.L. et al.; Musculoskeletal problems of the chest wall in athletes; Sports Med. 2002 (LoE 3A)</ref> | |||
==== Oral Medications ==== | |||
* Acetaminophen (Tylenol) | |||
* Nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve) | |||
==== Physical Therapy Management ==== | |||
[[File:30 3.jpg|right|230x230px]] | |||
* Manual therapy: manipulation of the costovertebral joint and electric stimulation can help manage the pain, but probably no long term relief <ref name=":5" />. | |||
[[File:Picture 1- rib mwm.png|right|230x230px]] | |||
* Taping of ribs can possibly provide some temporary relief. To decide on the location and direction of taping, apply a manual superior compression force through the postero-lateral aspect of the rib cage. Now ask the patient to take in a deep breath or rotate. If the patient notes a significant improvement in symptoms, then apply the tape at that level <ref name=":12">Bahram J. et al.; Ribs don’t sublux, ribs don’t “go out” … so what’s going on?; Advanced Physical Therapy Education Institute, 2015 (LoE: 4)</ref><sup>.</sup> | |||
[[File:30 2.jpg|right|230x230px]] | |||
* Rib mobilization with movement (MWM) as proposed by Brian Mulligan. The range of motion and pain level are evaluated. A cranial glide is applied over the lateral as3pect of the rib above the painful region. While sustaining this rib elevation (unloading), the patient is asked to rotate again while ROM and pain are once again evaluated. If there is no change, the technique is repeated on a rib above or below. If MWM on a rib at a specific level is found to reduce or eliminate the pain, it is repeated 10 times <ref name=":12" />. | |||
* The | |||
* | * A home program of self MWM may be provided. Instruction: “lift the rib up with the web space of one hand and actively rotate towards the painful direction, repeat as often as necessary”. The goal is to move the irritated costovertebral joint without pain as often as possible to reduce both the protective muscle spasm and the local inflammation <ref name=":12" /> | ||
== | ==== Intercostal Nerve Blocks ==== | ||
If the pain continues despite taking a painkiller: | If the pain continues despite taking a painkiller: | ||
* A corticosteroid injection to help reduce the swelling | * A corticosteroid injection to help reduce the swelling | ||
* An intercostal nerve block (an injection of an anesthetic in the intercostal nerve) to relieve pain | * An intercostal nerve block (an injection of an anesthetic in the intercostal nerve) to relieve pain | ||
The blocks may also provide temporary relief and in some cases may provide complete symptom relief. 11,28 In other cases the rebound pain is severe. It is recommended to block the entire nerve of the painful rib, as well as the one above and below it. The most common block is with Bupivicaine with or without corticosteroid. '''(A Review of Slipping Rib Syndrome: Evaluation, Diagnosis and treatment)''' | |||
== | === Non-conservative Management === | ||
If the condition persists or causes severe pain, surgery may be recommended. Following surgical procedures can be done <ref name=":7" /><ref name=":0" /><ref name=":10" /><ref name=":22" /><ref name=":28" /><ref>Hansen, Adam J., et al. [https://pubmed.ncbi.nlm.nih.gov/32330472/ “Minimally Invasive Repair of Adult Slipped Rib Syndrome without Costal Cartilage Excision.”] ''The Annals of Thoracic Surgery'', vol. 110, no. 3, Sept. 2020, pp. 1030–1035, pubmed.ncbi.nlm.nih.gov/32330472/, 10.1016/j.athoracsur.2020.02.081. Accessed 4 Feb. 2022.</ref><ref>McMahon, Lisa E., et al. [https://www.sciencedirect.com/science/article/abs/pii/S0022346820307119 “Vertical Rib Plating for the Treatment of Slipping Rib Syndrome.”] ''Journal of Pediatric Surgery'', vol. 56, no. 10, Oct. 2021, pp. 1852–1856, Accessed 4 Feb. 2022.</ref> | |||
* partial rib resection (Diagnosing and treating Slipping Rib Syndrome: An unusual case of undiagnosed pain for 5 years) | |||
* Minimally Invasive Repair of Adult Slipped Rib Syndrome Without Costal Cartilage Excision . | |||
* Vertical rib plating with bioabsorbable plates significantly decreased the rate of recurrence in our early experience. | |||
* | |||
* | |||
{{#ev:youtube|cvPIKZ5IsJw|300}}<ref>[https://www.youtube.com/watch?v=cvPIKZ5IsJw|Thoracic Rib MWM]. [Accessed 16 May 2020] </ref> | {{#ev:youtube|cvPIKZ5IsJw|300}}<ref>[https://www.youtube.com/watch?v=cvPIKZ5IsJw|Thoracic Rib MWM]. [Accessed 16 May 2020] </ref> | ||
== Clinical Bottom Line == | == Clinical Bottom Line == |
Revision as of 07:21, 7 February 2022
Original Editor - User:Jeroen Verwichte
Top Contributors - Tessa de Jongh, Laura Van Der Perren, Areeba Raja, Ine Wittevrongel, Kim Jackson, Gwen Wyns, Jeroen Verwichte, Lucinda hampton, Evan Thomas, Anouk Van den Bossche, Joao Costa, Claire Knott and Khloud Shreif
Introduction[edit | edit source]
Slipping rib syndrome (SRS) is characterized by pain in the lower chest or upper abdominal region caused by intercostal nerve impingement as a result of abnormal movement of false ribs (8-12) related to unstable costal cartilaginous attachments[1][2][3]
Slipping rib syndrome goes by many names, including:
- Clicking rib
- Displaced ribs
- Rib tip syndrome
- Nerve nipping
- Painful rib syndrome
- Slipping-rib-cartilage syndrome
- Gliding ribs
- Traumatic intercostal neuritis
- Twelfth rib syndrome
- Cyriax syndrome
- Interchondral subluxation, among others.[1][4]
Epidemiology[edit | edit source]
- It is considered to be a rare syndrome and accounts for approximately five percent of all musculoskeletal chest pain in primary care. [1][5]
- Higher prevalence among women than men by a ratio of 3:1 [6][7]
- May occur at any age, more common in middle-aged women, and is a relatively uncommon, but recognized cause of recurrent lower chest and/or upper abdomen pain in adolescents. [8][9][10]
- It’s been reported in people as young as 7 years and as old as 86, but it mostly affects middle-aged people.[1][4]
Clinically Relevant Anatomy[edit | edit source]
The slipping rib syndrome is a condition affecting the false ribs. There are 3 types of ribs:
- Ribs which are attached to the sternum by costosternal joints and ligaments (true ribs - 1-7th)
- Ribs which are connected to each other through a weaker cartilaginous or fibrous band (false ribs – 8-10th)
- Ribs which aren’t attached to the sternum or to each other (floating ribs – 11-12th)
The condition arises from hypermobility of the anterior ends of the false rib costal cartilages, which often leads to slipping of the affected rib under the superior adjacent rib. This slippage or movement can lead to an irritation of the intercostal nerve, strain of the intercostal muscles, sprain of the lower costal cartilage, or general inflammation in the affected area. Because of their weak connection, there is increased mobility and greater susceptibility to trauma [11][12]. Anterior rib hypermobility is also likely to cause problems in the posterior thoracic area, because it’s a closed system [11].
Pathophysiology[edit | edit source]
Subluxation of the rib tips caused by disrupted articulation causes ends of ribs to curl up inside and impinge on the intercostal nerves. The impingement causes the pain as the result of repeated irritation of the intercostal nerves.[5][7][13] [14][15]
Etiology[edit | edit source]
It can be caused by:
- Congenital anomaly of the chest wall[7]
- The destruction of the fibrous articulation of the rib or their cartilage portion[7]
- Hypermobility of the costal cartilages of the false ribs[4][5]
Risk Factors [4][edit | edit source]
- overuse
- direct trauma that causes the pain.
- Sudden extension or flexion, repeated one-sided weight bearing or exercise such as throwing a ball, vigorous swimming, or swinging a bat.
Clinical Presentation[edit | edit source]
Slipping rib syndrome is presented through the following characteristics [11][16][17][13]
- Intense pain in the lower chest or upper abdomen above the costal margin, mostly at the height of the 8th, 9th and 10th ribs (false ribs).
- A tender spot on the costal margin
- Reproduction of the pain by pressing the tender spot or by external influences
- Signs and symptoms are usually unilateral, however there are also cases where patients reported bilateral pain.
Signs and Symptoms[edit | edit source]
Following signs and symptoms can be observed:[4][7][8][11][15][16][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]
- Upper abdominal and lower anterior chest wall pain.
- Flank pain
- Tenderness over the affected costal margins
- Clicking, popping or slipping sensation can also be present.
- Pain was preceded by certain activities such as sitting, leaning forward, and interestingly she found that using a swing machine was especially likely to produce discomfort.
- Pain associated with slipping rib syndrome has distinct characteristics which can be used in identifying the syndrome:
- Intermittent sharp stabbing pain followed by a constant monotonous pain that may last from several hours to many weeks.
- Range of severity of pain varies from being a minor nuisance, moderately severe to interfering with activities of daily living.
- May also be reported to radiate from the costochondral area to the chest or to the same level in the back .
- Exacerbated by certain postures and movements: lying or turning in bed, rising from a chair, driving, stretching, reaching, lifting, bending, twisting the trunk, coughing, walking, or bearing loads.
- May affect sporting activities involving trunk movements and deep breathing, but in particular running, horseback riding, arm abduction, or swimming. Pain may be severe enough to make patients stop playing sports.
- Visceral innervation converges at the same spinal cord levels as slipping ribs and intercostal nerves and this close association of the intercostal nerves and the sympathetic system may also cause a variety of somatic and visceral complaints, such as biliary or renal colic.
Physical Examination[edit | edit source]
The physiotherapist looks for an association between certain movements or postures and pain intensity (signs and symptoms), determines if the patient has experienced recent trauma (not always present), constrained posture, or previous abdominal surgery and reproduces the symptoms (eg, pain, clicking) [11][35]
- Classically, the pain occurs in the upper abdomen or lower chest, in the abdominal wall and above the anterior costal margin.
- At that place the involved costal cartilage moves more freely than normal and the examiner can typically feel tenderness[36][35].
- A painful click is sometimes felt over the tip of the involved costal cartilage with certain movements.
- Palpation - At physical examination, the most common finding in a case of slipping rib syndrome is the tenderness above the costal margin. The physiotherapist can reproduce chest pain by palpation [16][17][37][22].
- The Hooking manoeuvre - positive test
Diagnostic Procedures[edit | edit source]
Diagnosing SRS is the main challenge, which is based on the careful patient history, physical examination, and knowledge of its existence. [14] [38] However, following procedures can be use for diagnosis:[4][14][15]
- Hooking maneuvre.
- Intercostal nerve blocks can be performed after positive hooking manoeuvre, to confirm the diagnosis.
- Dynamic ultrasound of the ribs can be performed with valsalva, coughing, twisting, crunch and push manoeuvres to diagnose SRS.
Outcome Measures[edit | edit source]
- The physiotherapist can reproduce chest pain by palpation of the ribs and chest wall [11].
- Hooking manoeuvre - Reproduce the symptoms. This is a relatively simple clinical test where the clinician places his or her fingers under the lower costal margin and pulls the hand in an anterior direction. Pain or clicking indicates a positive test [11][26][36][17]
- Patient-specific functional scale ( PSFS)[39].
- The Global rating of change (GROC) - To measure the patient’s subjective rate of improvement, the GROC has been stated to be reliable [40].
Differential Diagnosis[edit | edit source]
The differential diagnosis of slipping rib syndrome includes a variety of conditions[1][14][15][32][34]
- Cholecystitis
- Esophagitis
- Gastric ulcers
- Stress fractures
- Muscle tears
- Pleuritic chest pain
- Inflammation of the chondral cartilage
- Bronchitis
- Asthma
- Costochondritis, or Tietze syndrome
- Appendicitis
- Heart conditions
- Bone metastases
- Hepatosplenic issues
- Peptic ulcer
- Renal colic
- Pancreatitis
Management[edit | edit source]
In some cases, slipping rib syndrome resolves on its own without treatment if not, the choice of treatment depends on the severity of patient’s symptoms. There are different approaches in Conservative and non-conservative management that can be taken into account when treating SRS.[1]
Conservative Management[edit | edit source]
Conservative management includes the following:[4]
- Rest.
- Avoiding strenuous activities.
- Applying heat or ice to the affected area.
- Oral medications like NSAIDS.
- Topical analgesics.
- Physical Therapy.
- Nerve blocks.
Activities to Avoid[edit | edit source]
Reassurance of the benign nature of the disease combined with explanation and advice concerning postural avoidance [41]
Oral Medications[edit | edit source]
- Acetaminophen (Tylenol)
- Nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin IB) or naproxen (Aleve)
Physical Therapy Management[edit | edit source]
- Manual therapy: manipulation of the costovertebral joint and electric stimulation can help manage the pain, but probably no long term relief [11].
- Taping of ribs can possibly provide some temporary relief. To decide on the location and direction of taping, apply a manual superior compression force through the postero-lateral aspect of the rib cage. Now ask the patient to take in a deep breath or rotate. If the patient notes a significant improvement in symptoms, then apply the tape at that level [42].
- Rib mobilization with movement (MWM) as proposed by Brian Mulligan. The range of motion and pain level are evaluated. A cranial glide is applied over the lateral as3pect of the rib above the painful region. While sustaining this rib elevation (unloading), the patient is asked to rotate again while ROM and pain are once again evaluated. If there is no change, the technique is repeated on a rib above or below. If MWM on a rib at a specific level is found to reduce or eliminate the pain, it is repeated 10 times [42].
- A home program of self MWM may be provided. Instruction: “lift the rib up with the web space of one hand and actively rotate towards the painful direction, repeat as often as necessary”. The goal is to move the irritated costovertebral joint without pain as often as possible to reduce both the protective muscle spasm and the local inflammation [42]
Intercostal Nerve Blocks[edit | edit source]
If the pain continues despite taking a painkiller:
- A corticosteroid injection to help reduce the swelling
- An intercostal nerve block (an injection of an anesthetic in the intercostal nerve) to relieve pain
The blocks may also provide temporary relief and in some cases may provide complete symptom relief. 11,28 In other cases the rebound pain is severe. It is recommended to block the entire nerve of the painful rib, as well as the one above and below it. The most common block is with Bupivicaine with or without corticosteroid. (A Review of Slipping Rib Syndrome: Evaluation, Diagnosis and treatment)
Non-conservative Management[edit | edit source]
If the condition persists or causes severe pain, surgery may be recommended. Following surgical procedures can be done [1][2][14][15][32][43][44]
- partial rib resection (Diagnosing and treating Slipping Rib Syndrome: An unusual case of undiagnosed pain for 5 years)
- Minimally Invasive Repair of Adult Slipped Rib Syndrome Without Costal Cartilage Excision .
- Vertical rib plating with bioabsorbable plates significantly decreased the rate of recurrence in our early experience.
Clinical Bottom Line[edit | edit source]
- The Slipping rib syndrome is an often under diagnosed disease for which sometimes comprehensive diagnostic evaluation is performed.
- Knowledge of the slipping rib syndrome can lead to quick and simple diagnosis and prevent months or years of chronic complaints.
- The impingement can cause severe constant pain and a slipping sensation provoked by several movements.
- It can also lead to an irritation of the intercostal nerve or problems to structures in that area.
- Knowledge of the syndrome is important; it can lead to quick and simple diagnosis.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Healthline Slipping Rib Syndrome Available from:https://www.healthline.com/health/slipping-rib-syndrome#symptoms (last accessed 6.5.2020)
- ↑ 2.0 2.1 Tsobgny Panka, Chrislain, and Patrick Yvan Tchebegna. “Cyriax Syndrome in a Young Male Professional Soccer Player: A Case Report.” South African Journal of Sports Medicine, vol. 32, no. 1, 3 July 2020, pp. 1–2, www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1015-51632020000100018, 10.17159/2078-516x/2020/v32i1a8300. Accessed 31 Jan. 2022.
- ↑ Holmes, John F. “Slipping Rib Cartilage.” The American Journal of Surgery, vol. 54, no. 1, Oct. 1941, pp. 326–338, www.sciencedirect.com/science/article/abs/pii/S000296104190034X, 10.1016/s0002-9610(41)90034-x. Accessed 31 Jan. 2022.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 McMahon, Lisa E. “Slipping Rib Syndrome: A Review of Evaluation, Diagnosis and Treatment.” Seminars in Pediatric Surgery, vol. 27, no. 3, June 2018, pp. 183–188, pubmed.ncbi.nlm.nih.gov/30078490/, 10.1053/j.sempedsurg.2018.05.009. Accessed 31 Jan. 2022.
- ↑ 5.0 5.1 5.2 Gress, Kyle, et al. “A Comprehensive Review of Slipping Rib Syndrome: Treatment and Management.” Psychopharmacology Bulletin, vol. 50, no. 4 Suppl 1, 2020, pp. 189–196, www.ncbi.nlm.nih.gov/pmc/articles/PMC7901126/. Accessed 31 Jan. 2022.
- ↑ Yu, Hyun Jeong, et al. “Nineth Rib Syndrome after 10th Rib Resection.” The Korean Journal of Pain, vol. 29, no. 3, 31 July 2016, pp. 185–188, www.ncbi.nlm.nih.gov/pmc/articles/PMC4942647/, 10.3344/kjp.2016.29.3.185. Accessed 31 Jan. 2022.
- ↑ 7.0 7.1 7.2 7.3 7.4 Romano, Rosalia, et al. “A New Sign of the Slipping Rib Syndrome?” Interactive CardioVascular and Thoracic Surgery, vol. 34, no. 2, 24 Sept. 2021, pp. 331–332, academic.oup.com/icvts/article/34/2/331/6374795, 10.1093/icvts/ivab252. Accessed 31 Jan. 2022.
- ↑ 8.0 8.1 GE, Porter. “Slipping Rib Syndrome: An Infrequently Recognized Entity in Children: A Report of Three Cases and Review of the Literature.” Pediatrics, vol. 76, no. 5, 2012, pubmed.ncbi.nlm.nih.gov/4058991/. Accessed 31 Jan. 2022.
- ↑ Lum-Hee N. et al.; Slipping rib syndrome: an overlooked cause of chest and abdominal pain; Int. J. Clin. Pract., 51 (4) (1997), pp. 252–253 (LoE 4)
- ↑ Turcios N.L. et al.; Slipping rib syndrome in an adolescent: an elusive diagnosis; Clin. Pediatr., 52 (9) (2012), pp. 879–881 (LoE 2B)
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 Udermann B.E. et al.; Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report; J Athl Train, 2005 (LoE 3B)
- ↑ McBeath A.A. et al.; The rib-tip syndrome; J. Bone Joint Surg. Am., 57 (1975), pp. 795–797 (LoE 3A)
- ↑ 13.0 13.1 Sanghani, Ravi, et al. “A CAse RepoRt of Slipping Rib SyndRome: An UnCommon and UndeRdiAgnosed CAUse of AbdominAl PAin.” J. ANESTH, vol. 24, no. 2, p. 2017, Accessed 31 Jan. 2022.
- ↑ 14.0 14.1 14.2 14.3 14.4 Hussain, Azar. “Diagnosing and Treating Slipping Rib Syndrome: An Unusual Case of Undiagnosed Pain for 5 Years.” Journal of Pulmonary Medicine, vol. 4, no. 6, 2018, pp. 15–17, Accessed 31 Jan. 2022.
- ↑ 15.0 15.1 15.2 15.3 15.4 Fu, Roxana, et al. “Costal Cartilage Excision for the Treatment of Pediatric Slipping Rib Syndrome.” Journal of Pediatric Surgery, vol. 47, no. 10, Oct. 2012, pp. 1825–1827, Accessed 31 Jan. 2022.
- ↑ 16.0 16.1 16.2 Scott E.M. et al.; Painful rib syndrome: a review of 76 cases; Gut 1993 July (LoE 3A)
- ↑ 17.0 17.1 17.2 Keoghane S.R. et al.; Twelfth rib syndrome: a forgotten cause of flank pain; BJUI International, 2008 (LoE 5)
- ↑ Cranfield K.A.W. et al.; The twelfth rib syndrome;Journal of Pain and Symptom Management, 1997. (LoE 3B)
- ↑ Mooney D.P. et al.; Slipping rib syndrome in childhood; J. Pediatr. Surg., 32 (7) (1997), pp. 1081–1082 (LoE 3B)
- ↑ Arroyo JF, Vine R, Reynaud C, Michel JP. Slipping rib syndrome: don’t be fooled. Geriatrics. 1995;50:46–49. (LoE 3A)
- ↑ Copeland GP, Machin DG, Shennan JM. Surgical treatment of the ‘‘slipping rib syndrome.’’ Br J Surg. 1984;71:522–523. (LoE 1A)
- ↑ 22.0 22.1 Saltzman D.A. et al. The slipping rib syndrome in children. Pediatric Anesthesia. Volume 11, Issue 6, November 2001, Pages 740–743 (LoE 4)
- ↑ Machin D.G. et al.; Twelfth rib syndrome: a differential diagnosis of loin pain; British Medical Journal, 1983 (LoE 4)
- ↑ Van Delft E.A.K. et al.; The Slipping Rib Syndrome: A case report; International Journal of Surgery Case Reports, 2016. (LoE 4)
- ↑ Mynors J.M. et al.; Clicking rib; Lancet, 1 (1973), p. 674 (LoE 1B)
- ↑ 26.0 26.1 Bass J. et al.; Slipping Rib Syndrome; Journal of the National Medical Association, 1979;71(9):863-865. (LoE 4)
- ↑ Cyriax E, et al., On various conditions that may simulate the referred pains of visceral disease and a consideration of these from the point of view of cause and effect, Practitioner, 1919
- ↑ Germanovich A;Ferrante FM. “Multi-Modal Treatment Approach to Painful Rib Syndrome: Case Series and Review of the Literature.” Pain Physician, vol. 19, no. 3, 2016, pubmed.ncbi.nlm.nih.gov/27008303/. Accessed 31 Jan. 2022.
- ↑ Kumar, Rajender, et al. “The Painful Rib Syndrome.” Indian Journal of Anaesthesia, vol. 57, no. 3, 2013, p. 311, www.ncbi.nlm.nih.gov/pmc/articles/PMC3748696/, 10.4103/0019-5049.115585. Accessed 31 Jan. 2022.
- ↑ Arya, Sangeeeta, et al. “Twelfth Rib Syndrome- an Often Missed Differential Diagnosis of Hypogastric and Lumbar Pain: Case Series.” International Journal of Reproduction, Contraception, Obstetrics and Gynecology, vol. 3, no. 1, 2014, pp. 263–265, www.ijrcog.org/index.php/ijrcog/article/view/839. Accessed 31 Jan. 2022.
- ↑ Mazzella, Antonio, et al. “Costal Cartilage Resection for the Treatment of Slipping Rib Syndrome (Cyriax Syndrome) in Adults.” Journal of Thoracic Disease, vol. 12, no. 1, Jan. 2020, pp. 10–16, www.ncbi.nlm.nih.gov/pmc/articles/PMC6995823/, 10.21037/jtd.2019.07.83. Accessed 31 Jan. 2022.
- ↑ 32.0 32.1 32.2 Kamal, YasserAli. “Slipping Rib Syndrome: A Neglected Cause of Hypochondrial Pain.” Formosan Journal of Surgery, vol. 52, no. 6, 2019, p. 229, Accessed 31 Jan. 2022.
- ↑ Migliore, Marcello, et al. “Flank Pain Caused by Slipping Rib Syndrome.” The Lancet, vol. 383, no. 9919, Mar. 2014, p. 844, Accessed 31 Jan. 2022.
- ↑ 34.0 34.1 Turcios, Nelson L. “Slipping Rib Syndrome: An Elusive Diagnosis.” Paediatric Respiratory Reviews, vol. 22, Mar. 2017, pp. 44–46, Accessed 31 Jan. 2022.
- ↑ 35.0 35.1 Meuwly J. et al.; Slipping Rib Syndrome A Place for Sonography in the Diagnosis of a Frequently Overlooked Cause of Abdominal or Low Thoracic Pain; Journal of ultrasound in medicine, 2002. (LoE 4)
- ↑ 36.0 36.1 Adel G. et al.; Musculoskeletal chest wall pain; Can Med Assoc J, 1985 (LoE 5)
- ↑ Ronga A. et al.; Development and validation of a clinical prediction rule for chest wall syndrome in primary care; BiomedCentral, 2012. (LoE 2B)
- ↑ Hansen, Adam J., et al. “Minimally Invasive Repair of Adult Slipped Rib Syndrome without Costal Cartilage Excision.” The Annals of Thoracic Surgery, vol. 110, no. 3, Sept. 2020, pp. 1030–1035, pubmed.ncbi.nlm.nih.gov/32330472/, 10.1016/j.athoracsur.2020.02.081. Accessed 31 Jan. 2022.
- ↑ Richard B. Westrick et al.; EVALUATION AND TREATMENT OF MUSCULOSKELETAL CHEST WALL PAIN IN A MILITARY ATHLETE; Int J Sports Phys Ther. 2012 June; 7(3): 323–332 (LoE 4)
- ↑ Proulx A. M. et al.; Costochondritis: Diagnosis and treatment; American Family Physician; 80(6), 617–620. doi:10.1016/S0015-1882(09)70196; 2009 (LoE 5)
- ↑ Gregory P.L. et al.; Musculoskeletal problems of the chest wall in athletes; Sports Med. 2002 (LoE 3A)
- ↑ 42.0 42.1 42.2 Bahram J. et al.; Ribs don’t sublux, ribs don’t “go out” … so what’s going on?; Advanced Physical Therapy Education Institute, 2015 (LoE: 4)
- ↑ Hansen, Adam J., et al. “Minimally Invasive Repair of Adult Slipped Rib Syndrome without Costal Cartilage Excision.” The Annals of Thoracic Surgery, vol. 110, no. 3, Sept. 2020, pp. 1030–1035, pubmed.ncbi.nlm.nih.gov/32330472/, 10.1016/j.athoracsur.2020.02.081. Accessed 4 Feb. 2022.
- ↑ McMahon, Lisa E., et al. “Vertical Rib Plating for the Treatment of Slipping Rib Syndrome.” Journal of Pediatric Surgery, vol. 56, no. 10, Oct. 2021, pp. 1852–1856, Accessed 4 Feb. 2022.
- ↑ Rib MWM. [Accessed 16 May 2020]