A Study of the Slipping-Rib-Cartilage Syndrome

Abstract

THE purpose of this paper is to call attention to an abnormal mobility and deformity of the anterior ends of the lower costal cartilages that cause painful symptoms, and to report cases observed over a period of twenty-seven years, emphasizing particularly persistent cases relieved by a simple operative procedure.It should be understood that this particular syndrome has reference to the anterior ends of the rib cartilages and with the interchondral articulations, and is in no way concerned with the osteochondral junction of the anterior ends of the ribs, and that, barring anomalies, mistakes in numbering the ribs and exceptions, it has to do with the eighth, ninth and tenth rib cartilages only. This symptom complex was first reported by Cyriax,1 of London. He specifically mentions 3 cases, all treated expectantly. In 1922, DaviesColley,2 of London, under the original title, "Slipping Rib," reported 2 cases of displacement of the anterior end of the rib cartilage, which he had operated on by resection of the loosened cartilage with "complete relief of symptoms." From this time until 1924, 8 other cases by five authors3-7 were reported in the British Medical Journal. In 1931, Bisgard,8 of Chicago, referred to DaviesColley's2 article and other published cases, and reported 1 case, which he had operated on with cure.In the same year, Darby,9 of Vancouver, Washington, referred to Bisgard's publication and described a typical case of slipping rib cartilage that was also operated on by resection of the cartilage and followed by relief of pain.This makes a total of 15 cases reported from 1919 to 1931, 8 of which were operated on by resection of the cartilage, with complete relief of symptoms. Davies-Colley noted:It is probably not a rare condition and is a trivial enough complaint in itself but it gives rise to most irksome symptoms. ... In its [the pain's] position at the costal margin it resembles that due to so many deeper lesions of the abdomen and thorax, that I think it is quite likely that many cases occur in which such an apparently unimportant cause as a movable rib cartilage is unsuspected and the diagnosis missed.Slipping rib cartilage is apparently of fairly common occurrence, and often produces irksome, incapacitating symptoms. It is diagnosed by physical examination, and cured by a simple operative procedure. As stated by Davies-Colley, "it is curious that it should receive no recognition in modern textbooks of surgery," and by Bisgard, "it has received but little attention in medical literature."Because of failure to recognize this symptom syndrome, needless laparotomies have been performed, and prolonged suffering and incapacity Figure 1. Sternocostal and Interchondral Articulations: Anterior view.11 (Repi-oduced by permission of the publisher.)from an easily curable condition are often permitted. Moreover, there does not appear to be any clear conception of the development of this deformity. These facts justify an attempt to secure a better understanding and more general recognition of this entity.

Painful Rib Syndrome

“…In an attempt to explain the cause of what they called "rib tip syndrome" from an anatomical position, McBeath (1975) performed autopsies on 10 individuals who did not have clinical histories of rib pain. Their conclusions supported the earlier finding of Holmes (1941), that there was a close relationship between the thin, fibrous bands of cartilage and posterior location of the intercostal nerve which could explain the origin of the pain. Inflammation of the synovial membranes was suggested as a possible cause of PRS (Holmes, 1941).…”

“…Nursing literature does not include any information about this condition. Some names frequently given to PRS are slipping rib (Davies-Colley, 1922), slipping rib cartilage syndrome (Holmes, 1941), and clicking rib (Mynors, 1973). Hypermobility of the eighth, ninth, and 10th ribs occurs which causes increased susceptibility to trauma and microtraurna, often without client awareness.…”

The painful rib syndrome

“…This may cause a variety of somatic and visceral complaints. [12345] Although the diagnosis may be made based on history and physical examination, lack of recognition of this disorder frequently leads to extensive diagnostic evaluations before definitive therapy. We depict the case study of three patients with painful rib syndrome who presented within a year's time.…”

“…Cases have been reported in children as young as 12 years through individuals in their mid-80s, with the syndrome affecting females slightly more than males. [456] Bilateral cases have been reported but the condition is almost always unilateral, with pain localized to the tip of the 10 th , 11 th , or 12 th rib, which might be exacerbated by movement. [7]…”

Slipping Rib Syndrome

“…16 The literature has many examples of needless laparoto¬ mies performed to diagnose what seemed to be visceral pain. [1][2][3][4][5] The pur¬ pose of this report is to emphasize the existence of a common chest wall syn¬ drome that can be diagnosed by a simple "hooking maneuver" on physi¬ cal examination. The syndrome should be considered in the differ¬ ential diagnosis of abdominal and chest pain.…”