Slipping Rib Syndrome as Persistent Abdominal and Chest Pain

Abstract

Slipping rib syndrome is an overlooked cause of persistent abdominal or chest pain. The etiology of this syndrome is not well understood, but the characteristic pain is from hypermobility of the false ribs. Although it is a diagnosis of exclusion, misdiagnosis may lead to an excessive workup. A simple clinical examination via the hooking maneuver is the most significant feature of its diagnosis. We describe the case of a 41-year-old woman with slipping rib syndrome.

Cyriax syndrome: a misdiagnosed condition of the chest wall

“…Resection of the slipping ribs and cartilages is performed. 3 The most frequently dislocated cartilages are those of the 8th-10th ribs, as in our case. The detached and hypermobile cartilages are identified and removed.…”

“…The prevalence of CS is approximately 1%–5% in general practice. 3 However, it may be underestimated, given that CS is not well known. It often evolves for several months before the diagnosis is made.…”

Slipping rib syndrome in an adolescent wrestler

“…Despite its awareness and publications in the literature today, it remains underdiagnosed or misdiagnosed by many medical professionals. The prevalence is believed to be 1% to 5%, however, this could be an underestimation 2…”

“…Slipping rib syndrome is an uncommon, but recognised, cause of recurrent lower chest or upper abdominal pain. Other names in the literature for this syndrome include rib tip syndrome, slipping rib cartilage syndrome, twelfth rib syndrome, clicking rib syndrome, painful rib syndrome, gliding ribs, displaced ribs, intercostal subluxation, traumatic intercostal neuritis, cyriax syndrome and nerve ripping 2…”

“…Fifth, patients with slipping rib syndrome can present differently, making it difficult to pinpoint a classic presentation. Lastly, and most importantly, diagnostic testing is not commonly used to support the clinical findings 2. Although dynamic ultrasound allows for visualisation of the ribs slipping against each other, it is not often used and may not be readily available 6…”