Is slipping rib syndrome, also known as traumatic intercostal neuritis or costal cartilage syndrome, a legitimate medical condition?

From the Guidelines

Slipping rib syndrome is a recognized medical condition that causes musculoskeletal chest pain due to one or more ribs subluxing from the joint. This condition is acknowledged in the medical community, as seen in the 2017 American College of Cardiology/American Heart Association task force report 1, which lists "musculoskeletal chest pain due to slipping rib syndrome" as a condition characterized by musculoskeletal chest pain associated with one or more ribs subluxing from the joint. The diagnosis and detection of slipping rib syndrome can be facilitated by dynamic imaging capabilities, such as ultrasound, which has been shown to detect the condition in 89% of cases and rule it out in 100% of cases 1. Key characteristics of slipping rib syndrome include:

• Sharp, intermittent pain in the lower chest or upper abdomen
• Pain triggered by movement, deep breathing, or pressure on the affected area
• Typically affects ribs 8,9, and 10, which are not directly attached to the sternum
• Diagnosis often involves a physical examination, including the "hooking maneuver"
• Treatment generally includes rest, anti-inflammatory medications, and physical therapy to strengthen surrounding muscles.

From the Research

Definition and Causes of Slipping Rib Syndrome

• Slipping rib syndrome is a rare cause of chest pain that could be perceived as local or diffuse pain, stemming from irritation of intercostal nerves 2.
• It is caused by slipping of the costal cartilage and the resulting displacement of a false rib and pinning underneath the adjacent superior rib and nerve irritation 2.
• The syndrome is often associated with trauma and high intensity athletic activity as risk factors 2.

Clinical Presentation and Diagnosis

• Patients usually present with severe intermittent abdominal pain that is exacerbated by various physical movements 3.
• The pain can be localized, radiating or diffuse visceral, and is often alleviated by positions that offload the impinged nerve 2.
• Diagnosis is initially clinical and can be confirmed with nerve blocks and surgical visualization 2.
• The "Hooking Maneuver" is a physical examination technique that can aid in diagnosis 3, 4.
• Dynamic ultrasound can also identify abnormalities in the rib and cartilage anatomy, as well as soft tissue swelling 4.

Treatment and Management

• Initial treatment includes rest, ice and NSAIDs, as well as screening for co-morbid conditions, as well as local symptomatic relief 2.
• Injection therapy with local anesthetics and steroids can provide a diagnosis as well as symptomatic relief 2.
• Surgical correction remains the definitive treatment, and advanced surgical options have paved way for cure for previously hard to treat patients 2.
• Other treatment options include reassurance, nonsteroidal anti-inflammatory drugs, physical therapy, intercostal nerve injections, osteopathic manipulative treatment, and botulinum toxin injections 4.
• Ultrasound-guided intercostal cryoneurolysis is a minimally-invasive procedure that may provide long-term analgesia in patients with slipping rib syndrome 5.