From the Guidelines
Slipping rib syndrome should be treated with conservative measures, including rest, avoiding activities that worsen symptoms, and over-the-counter pain medications like ibuprofen or acetaminophen to manage pain and inflammation, as this approach has been shown to be effective in managing the condition. The condition is characterized by musculoskeletal chest pain associated with one or more ribs subluxing from the joint, as defined in the 2017 AHA/ACC key data elements and definitions for ambulatory electronic health records in pediatric and congenital cardiology 1. Treatment options for slipping rib syndrome include:
- Conservative measures such as rest and avoiding activities that worsen symptoms
- Over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) to manage pain and inflammation
- Ice packs applied for 15-20 minutes several times daily to reduce inflammation
- Heat therapy to help relax muscles
- Physical therapy focusing on core strengthening exercises to stabilize the area and prevent recurrence For severe cases that don't respond to conservative treatment, intercostal nerve blocks with local anesthetics may provide temporary relief, while in persistent cases, surgical intervention to stabilize or remove the affected cartilage might be necessary. The condition often results from trauma, repetitive strain, or congenital weakness of the costal cartilage, and proper diagnosis typically requires a physical examination where the doctor can reproduce the pain by hooking their fingers under the rib cage and pulling forward (the hooking maneuver), as imaging studies often appear normal.
From the Research
Definition and Diagnosis of Slipping Rib Syndrome
- Slipping rib syndrome (SRS) is an often underdiagnosed cause of lower chest wall and abdominal pain, characterized by the increased mobility of the anterior ends of the costal cartilages of the false ribs 2, 3.
- The diagnosis of SRS is established by physical examination with or without dynamic ultrasound, and can be confirmed by a physical examination technique termed the "Hooking Maneuver" 4, 3.
- Dynamic ultrasound can identify abnormalities in the rib and cartilage anatomy, as well as soft tissue swelling, and is a useful diagnostic tool for SRS 4, 5.
Treatment Options for Slipping Rib Syndrome
- Treatment options for SRS include conservative therapy, intercostal nerve block, and surgical operation, and the management and care plan of each patient must be individualized as per the presenting symptoms and medical history 3.
- Surgical techniques for SRS have been described, including cartilage rib excision (CRE), minimally invasive rib fixation, and costal cartilage excision with vertical rib plating, which have been shown to be successful and safe alternative techniques 2, 5.
- Other treatment options, such as prolotherapy, botulinum toxin injections, and ultrasound-guided intercostal cryoneurolysis, have also been attempted, and may provide long-term analgesia in patients with SRS 4, 6.
Challenges and Future Directions in the Treatment of Slipping Rib Syndrome
- SRS is a poorly understood condition, leading to a significant delay in diagnosis and therapeutic management, and recurrence of pain following resection is a common problem 4, 5.
- Further research is needed to develop effective and safe treatment options for SRS, and to improve our understanding of the condition and its prognosis 2, 5.