Slipping Rib Syndrome
Search Strategy[edit | edit source]
Keywords: Slipping rib syndrome (+ Diagnosis / Therapy / Epidemiology / Rehabilitation / Examination / Symptoms / Characteristics / Clinical), clicking rib, painful rib syndrome, 12th rib syndrome, cyriax syndrome
Search engines: Pubmed Web of knowledge PEDro
Definition/Description
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The slipping rib syndrome was first reported in 1919 by Cyriax.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title It is a condition, often misdiagnosed or underdiagnosed and can consequently cause months and even years of unresolved pain in the lower chest or upper abdomen, above the costal margin. Other features of the syndrome are a tender spot on the costal margin and reproduction of the pain on pressing the tender spot.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title The intensity of pain is related to mechanical conditions, such as bearning loads or coughing.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The slipping rib syndrome, far more common than realized, is also known by other names like clicking ribCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, painful rib syndromeCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, displaces ribsCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, interchondral subluxationCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, slipping rib cartilage syndromeCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, nerve nipping at the intercostal marginCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, Cyriax's syndromeCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, traumatic intercostal neuritisCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title, rib-tip syndromeCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title and 12th rib syndrome.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
The condition will lead to a slipping rib under the superior adjacent rib. This because of the hypermobility of the anterior ends of the false rib costal cartilagesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title (the 8th to 10th ribs, which are not directly insert into the sternum)Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The syndrome can be diagnosed by a clinical test (the hooking maneuver) and is often related to trauma (which can be neglected or forgotten), constrained posture and previous abdominal surgery.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Clinically Relevant Anatomy
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Epidemiology/Etiology[edit | edit source]
Characteristics/Clinical Presentation[edit | edit source]
Differential Diagnosis[edit | edit source]
The differential diagnosis of slipping rib syndrome includes:1,10,12
• Cholecystitis
• Esophagitis
• Gastric ulcer
• Hepatosplenic abnormalities
• Stress fracture
• Inflammation of the chondral cartilage
• Pleuritic chest pain
• Pleuritis
• Pneumonia
• Radiculitis
• Herpes zoster
• Aortic aneurysm
• Tietze syndrome (syndrome typically affects one joint and is associated with swelling) [29]
• Costochondritis (may affect numerous costochondral joints with no swelling)[29]
• Abscesses
• Metastases
• Muscle tears
• Abdominal diseases
Diagnostic Procedures[edit | edit source]
The slipping rib syndrome can be diagnosed by sonography and physical examination. It is often overlooked because of the lack of available paraclinical procedures and because CT scans has almost replaced a thorough clinical examinations for patients with flank pain.1,12,16
• Sonography
Interchondral joints can be precisely depicted with sonography and sequential scanning allows an accurate count of them. On the other hand, high-resolution sonography of the thoracic wall shows accurately the luxation of the cartilaginous rib.
Sonography is also used to exclude other causes of thoracic pain such as rib fractures, Tietze syndrome, abscesses, metastases, muscle tears, pleuritis, and abdominal diseases.12,13
•Physical examination
The hooking maneuver, first described in 1977, is a relatively simple clinical test which can be used to diagnose the syndrome. For more information see examination.1,8
•Radiologic investigation
Generally radiologic imaging is not useful in the diagnosis of slipping rib syndrome, but it can be used to exclude the other conditions in the differential diagnosis.1
Outcome Measures[edit | edit source]
Examination[edit | edit source]
Medical Management[edit | edit source]
Physical Therapy Management[edit | edit source]
Key Research[edit | edit source]
Resources[edit | edit source]
Clinical Bottom Line[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
1. Udermann B.E., et al., Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report, J Athl Train, 2005 (LoE 3B)
2. Scott E.M., et al., Painful rib syndrome--a review of 76 cases, Gut, 1993 July (LoE 3A)
3. Heinz G.J., et al., Zavala DC, Slipping rib syndrome, JAMA1977; 237(8): 794-5 (LoE 5)
4. DeLisi N., et al., Slipping rib syndrome: ’there’s an easier way’, Geriatrics, 1995 (LoE 5)
5. Gregory P.L., BISWAS A.C., Batt M.E., Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002. (LoE 3A)
