Advancements have been made in the diagnosis of slipping rib syndrome by dynamic ultrasound. Defects in the costal cartilage of ribs 8 to 10 result in increased movement of the ribs, impinging soft tissue and intercostal nerves. “Slipping rib syndrome is pain created at the lower, anterior border of the rib cage when performing upper-extremity activities, coughing, laughing, or leaning over. Cassidy M Foley Davelaar wrote in the Current Sports Medicine Reports. Especially when the patient recreated movements that would cause them distress. What the doctors found was that ultrasound could accurately diagnose slipping rib syndrome. The doctors looked at 14 cases with the average age of the patient being 35 and mostly male. Here are two recent studies which try to convey the problems of diagnosis and the hunt for clues to help doctors properly diagnose the problem.Ī July 2021 paper in the journal Back and Musculoskeletal Rehabilitation ( 1) recorded doctors’ use of ultrasound to help assess the patient’s cause of pain focused on slipping rib syndrome. Doctors recognize that slipping rib syndrome is often unrecognized at the time of patient diagnosis and therefore an overlooked cause of chronic pain in the abdominal and/or chest pain area.ĭoctors also recognize that misdiagnosis or simply missing slipping rib syndrome as the cause of pain, the misdiagnosis may lead to excessive imaging, laboratory, and other complicated workups. Likewise, costovertebral ligament sprains refer to pain from the back of the rib segment to the sternum where the rib attaches. Sternocostal and costochondral ligaments refer to pain from the front of the chest to the mid-back. The loose ribs can also pinch intercostal nerves, sending excruciating pains around the chest into the back. Without muscles to hold the ribs in place, loose ligaments allow slipping of the rib which causes further stretching of the ligament, manifesting itself by producing severe pain. In this case, a rib was slipping out of place because the ligaments that hold the ribs to the sternum, the sternocostal ligaments, were weak. Chronic pain should be assumed to be originating from weakened soft tissue.
They can be associated factors involved in the problem, but they are normally not the cause. If heart and lung tests prove normal, yet the patient claims to still be experiencing pain, the patient is often given a psychiatric diagnosis.ĭepression, anxiety, and other mental illness challenges are not the etiological bases for most chronic pain. It is much more likely that chronic chest pain is due to weakened soft tissue, such as a ligament or tendon. The patient’s pain was caused by slipping rib syndrome.Īn extremely important point illustrated by this case is that even if an x-ray, blood sample, or EKG do not reveal a cause, they do not eliminate the presence of a physical condition as the source of chest pain. Had she ever been examined in this fashion? She said she had not. Pressure to the left fourth thoracic rib attachment onto the sternum and the patient’s severe crushing chest pain immediately returned. In this patient’s case, the diagnosis was made very quickly. She needed one more diagnostic test, physical examination with palpitation of the chest area to determine if the pain was being caused by problems related to Slipping Rib Syndrome. Upon her visit to us here at Caring Medical, she explained that she was not currently having severe chest pain but did feel a dull ache in her chest. Everyone began to wonder if she suffered from problems of mental illness and catastrophizing thoughts. After EKGs, blood tests, x-rays, and a stay in the intensive care unit, the cause of her pain were still unknown. The obvious concerns were with a cardiac event. She had been rushed to the hospital for the fourth time in less than a year complaining of severe chest pain. Ross Hauser, MD A Caring Medical case history
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