Slipping Rib Syndrome in a Female Adult with Longstanding Intractable Upper Abdominal Pain

Abstract

Slipping rib syndrome is a rare cause of abdominal or lower chest pain that can remain undiagnosed for many years. Awareness among health care personnel of this rare but significant disorder is necessary for early recognition. Prompt treatment can avoid unnecessary testing, radiographic exposure, and years of debilitating pain. A 52-year-old female was evaluated for a 3-year history of recurrent abdominal and lower chest pain. Pain was sharp, primarily located in the lower chest and subcostal region left more than right, waxing and waning, nonradiating, and aggravates with specific movements. She underwent frequent physical therapies, treated with multiple muscle relaxants and analgesics with minimal improvement. Imaging modalities including CT scan, MRI, and X-rays performed on multiple occasions failed to signify any underlying abnormality. Complete physical examination was unremarkable except for positive hooking maneuver. Dynamic flow ultrasound of lower chest was performed which showed slipping of the lowest rib over the next lowest rib bilaterally left worse than right, findings consistent with slipping rib syndrome. Slipping rib syndrome is caused by hypermobility of the floating ribs (8 to 12) which are not connected to the sternum but attached to each other with ligaments. Diagnosis is mostly clinical, and radiographic tests are rarely necessary. Hooking maneuver is a simple clinical test to reproduce pain and can aid in the diagnosis. Reassurance and avoiding postures that worsen pain are usually helpful. In refractory cases, nerve block and surgical intervention may be required.

Slipping rib syndrome in an adolescent wrestler

“…Lastly, those with severe pain or refractory cases to conservative management can undergo surgical resection of the anterior rib and costal cartilage (figure 5). 6 The outcomes of both conservative and surgical management have been shown to be favourable 8…”

Abdominal pain related to pathology of peripheral nervous system

“…Врач может воспроизвести симптомы, оттягивая вверх передний край X ребра больного (прием «крючка»). Для исключения других патологических процессов (перелома ребра, плеврита, синдрома Титце, метастатического поражения ребер и патологии органов брюшной полости), помимо тщательного физикального исследования, необходимо, как минимум, выполнить рентгенографию органов грудной клетки [23,24,25]. В качестве диагностического мероприятия проводится местная анестезия.…”

Cyriax syndrome: a misdiagnosed condition of the chest wall

“…1 Hypochondrial or basithoracic pain mimicking an abdominal emergency has rarely been reported. 2 Diagnosis of CS is based mainly on physical examination. Dynamic ultrasound performed during movement may show the slipping ribs.…”