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Slipping Rib Syndrome (SRS), alternatively known as Cyriax Syndrome (OR Slipped Rib, Displaced Ribs, and Interchondral Subluxation) is a highly debilitating and underdiagnosed disoder (Bong & Healey, 2022; Madeka et al., 2023). SRS occurs when the cartilage securing ribs 8, 9, and/or 10 breaks, leading to subluxation (partial dislocation) of the rib(s), contributing to abnormal hypermobility and movement (McMahon et al., 2018). This condition may cause the exposed tips of these ribs to slip under (or, less commonly, over) the ribs above. Moreover, pain occurs due to the impingement of the intercostal neves (McMahon et al., 2018). Even a clicking or popping noise can co-occur with discomfort, pain, and irritation of the intercostal nerves. Furthermore, the10th rib is typically the most affected and on the left side, and SRS predominantly affects females, though it is considered rare overall. Indeed, more research is needed to familiarize providers with this condition. It often takes years for patients to receive a diagnosis.

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Information Videos

Dr. Lisa McMahon: https://www.youtube.com/watch?v=5Ub72X_lMX0&t=51s

Dr. Adam Hansen: https://www.youtube.com/watch?v=K83Dj1hLlQA&t=2499s

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Symptoms 

Primarily manifest in the abdomen and back, with pain ranging from minor inconvenience to significantly impacting one's quality of life. Some indications can include that you have this is that it is debilitating. Mine became significantly worse after having pelvic floor botox and laparoscopy co2 for endometriosis. Certain postures or movements involving the ribcage and surrounding abdominal muscles can worsen symptoms, such as stretching, reaching, coughing, sneezing, lifting, bending, sitting, walking, and breathing.

Symptoms can be bilateral, but unilateral is also possible

Some indications you could have SRS:

  • Pain with breathing

  • Thoracic pain

  • Shoulder blade pain

  • Abdomen pain, in the middle or in the flank (often sharp, and mistaken for a kidney or urinary tract infection)

  • Hip pain around the iliac crest

  • Lower back pain

  • Slipping feeling

  • Popping, clicking in ribs

  • Intercostal neuralgia

  • Costochondritis

  • Spine feels like it's ripping apart

  • Worsens around menstrual cycle

  • Difficult wearing a brassiere

  • Comorbidity of Ehlers-Danlos syndrome, especially hEDs

  • Increased gas, decreased satiety or appetite

  • Intermittent tingling on affected side

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Diagnostic tests

  • Dynamic ultrasound - In 32/36 patients, dynamic ultrasound correctly detected SRS and identifed negative cases (van Tassel et al., 2019)

  • Physical evaluation - Hansen method - Click on this video here

  • While the hooking method has been represented as a physical evaluation, it is not viable. 1) Contribute to worsening pain symptoms and is limited in utility. Instead, Hansen et al. proposes 1) a palpable separation of at least 1 cm at the anterior insertion of the 10th rib into the costal arch, (2) the 10th rib is unusually mobile on palpation, and (3) palpation at the separation point reproduces the patient’s pain.

Treatments include nerve blocks, nerve blocks, physical therapy, and surgical operations.

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SRS can be triggered by sudden chest wall trauma or can develop gradually without an identifiable cause (idiopathic). It is commonly mistaken for costochondritis and Tietze Syndrome, which are distinct conditions involving the chest wall. In addition, providers have also mistaken it as gastroinestinal disorders, and endometriosis

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References

 

Bong, J., & Healey, D. (2022). Slipping rib syndrome. Journal of medical imaging and radiation oncology, 66(3), 409–410. https://doi.org/10.1111/1754-9485.13247 

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Fares, M. Y., Dimassi, Z., Baydoun, H., & Musharrafieh, U. (2019). Slipping Rib Syndrome: Solving the Mystery of the Shooting Pain. The American journal of the medical sciences, 357(2), 168–173. https://doi.org/10.1016/j.amjms.2018.10.007

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Gress, K., Charipova, K., Kassem, H., Berger, A. A., Cornett, E. M., Hasoon, J., Schwartz, R., Kaye, A. D., Viswanath, O., & Urits, I. (2020). A Comprehensive Review of Slipping Rib Syndrome: Treatment and Management. Psychopharmacology bulletin, 50(4 Suppl 1), 189–196.

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Madeka, I., Alaparthi, S., Moreta, M., Peterson, S., Mojica, J. J., Roedl, J., & Okusanya, O. (2023). A Review of Slipping Rib Syndrome: Diagnostic and Treatment Updates to a Rare and Challenging Problem. Journal of clinical medicine, 12(24), 7671. https://doi.org/10.3390/jcm12247671

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McMahon L. E. (2018). Slipping Rib Syndrome: A review of evaluation, diagnosis and treatment. Seminars in pediatric surgery, 27(3), 183–188. https://doi.org/10.1053/j.sempedsurg.2018.05.009

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Van Tassel, D., McMahon, L. E., Riemann, M., Wong, K., & Barnes, C. E. (2019). Dynamic ultrasound in the evaluation of patients with suspected slipping rib syndrome. Skeletal radiology, 48(5), 741–751. https://doi.org/10.1007/s00256-018-3133-z

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Slipping Rib Syndrome

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