From the Guidelines
Slipped rib syndrome, also known as intercostal neuralgia or Tietze's syndrome, should be treated with conservative measures, including rest, ice or heat application, and over-the-counter pain medications, as surgical stabilization of rib fractures is not a recommended treatment for this condition. The provided evidence [ 1 ] discusses the treatment of rib fractures, which is not directly related to slipped rib syndrome.
Diagnosis and Treatment
The diagnosis of slipped rib syndrome is typically based on clinical presentation, including pain in the lower rib area, tenderness to palpation, and abnormal rib movement. Treatment focuses on relieving pain and stabilizing the affected area. Conservative measures such as:
- Rest and avoidance of activities that exacerbate symptoms
- Ice or heat application to reduce pain and inflammation
- Over-the-counter pain medications like ibuprofen (400-800mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily)
- Physical therapy focusing on core strengthening exercises to stabilize the area
- Intercostal nerve blocks with lidocaine 1-2% for temporary pain relief in severe cases
Prognosis and Management
Most patients with slipped rib syndrome improve within 3-6 months with conservative treatment [ 1 ]. It is essential to prioritize morbidity, mortality, and quality of life when managing this condition. Patients should avoid activities that worsen symptoms and consider using a supportive abdominal binder during recovery to limit rib movement and reduce pain during daily activities. In rare cases where conservative treatment fails, surgical intervention to remove the affected cartilage may be considered, but this is not a primary recommendation based on the provided evidence.
From the Research
Diagnosis of Slipped Rib Syndrome
- The diagnosis of slipped rib syndrome is mainly clinical, relying on knowledge of the condition and its symptoms 2, 3, 4, 5, 6.
- A physical examination technique called the "Hooking Maneuver" can be used to reproduce pain and aid in diagnosis 3, 4, 5, 6.
- Dynamic ultrasound can also be used to identify abnormalities in the rib and cartilage anatomy, as well as soft tissue swelling 5.
- Definitive diagnosis can be made with pain relief on nerve block, visualization of altered anatomy during surgery, and relief after surgical correction 6.
Treatment of Slipped Rib Syndrome
- Conservative techniques such as manipulation, localized anesthetic, and steroid or anesthetic nerve block can be used to manage the condition 2.
- Reassurance and avoiding postures that worsen pain are usually helpful 3.
- In refractory cases, nerve block and surgical intervention may be required 3, 6.
- Surgical techniques, including excision of the rib, can be used to treat the condition 2, 6.
- Other treatment options, such as botulinum toxin injections and prolotherapy, have also been attempted 2, 5.
- Initial treatment includes rest, ice, and NSAIDs, as well as screening for co-morbid conditions, and local symptomatic relief 6.
- Injection therapy with local anesthetics and steroids can provide a diagnosis as well as symptomatic relief 6.