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Hansen AJ, Hayanga J, Toker A, Badhwar V. Costal margin reconstruction for slipping rib syndrome: Outcomes of more than 500 cases and advancements beyond earlier sutured repair technique. JTCVS OPEN 2024; 19:347-354. [PMID: 39015462 PMCID: PMC11247216 DOI: 10.1016/j.xjon.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 07/18/2024]
Abstract
Objectives To evaluate results of sutured repair for slipping rib syndrome (SRS), identify failure points, and discuss technique modifications to improve outcomes through costal margin reconstruction (CMR). Methods Patients undergoing repair of SRS between February 2019 and February 2024 at an academic referral institution were retrospectively analyzed. Pain scores, quality of life, pain medication use, and reoperations were evaluated pre- and postoperatively at 1 and 6 months. In patients failing sutured repair we identified specific failure points and devised a new CMR technique to overcome them. Subsequent CMR patients were followed at 1, 6, 12, 18, and 24 months using the same outcome measures. Results Four hundred forty-nine patients underwent repair. Two hundred forty-one patients underwent sutured repair with revision required in 66. Median time to revision was 14 months. CMR was developed and performed in 247 patients. In CMR patients, preoperative mean pain score of 7.5 out of 10 dropped postoperatively to 4.0, 2.5, 1.9, 1.3, and 0.9 at 1, 6, 12, 18, and 24 months, respectively (P < .001). Mean quality of life of 38% improved to 73%, 83%, 88%, 93%, and 95% at the same intervals (P < .001). Preoperatively, 29% of patients chronically used opioid medications. Opioid use dropped postoperatively to 11%, 4%, 4%, 0%, and 0% at the same intervals. Use of nonopioid medications followed a similar pattern. One CMR patient required full revision. Conclusions SRS is a debilitating, but correctable disorder. Improved pain and quality of life, reduction in chronic opioid use, and freedom from revision surgery suggest that CMR should be considered the standard operation for SRS.
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Affiliation(s)
- Adam J. Hansen
- Department of Thoracic Surgery, West Virginia University Heart and Vascular Institute, Bridgeport, WVa
| | - Jeremiah Hayanga
- Department of Thoracic Surgery, West Virginia University Heart and Vascular Institute, Bridgeport, WVa
| | - Alper Toker
- Department of Thoracic Surgery, West Virginia University Heart and Vascular Institute, Bridgeport, WVa
| | - Vinay Badhwar
- Department of Thoracic Surgery, West Virginia University Heart and Vascular Institute, Bridgeport, WVa
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Lai K, Eldredge RS, Nguyen M, Padilla BE, McMahon LE. Initial outcomes using cryoablation in surgical management of slipping rib syndrome. J Pediatr Surg 2023:S0022-3468(22)00835-1. [PMID: 36737261 DOI: 10.1016/j.jpedsurg.2022.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Minimally invasive repair of pectus excavatum (MIRPE) and cartilaginous rib excision (CRE) for slipping rib syndrome (SRS) are painful procedures. Intercostal nerve cryoablation (Cryo) controls pain and decreases opioid use in MIRPE. Herein, we describe our experience with cryoablation in CRE. METHODS A retrospective chart review was performed of all patients undergoing CRE between 2018 and 2022. Data on demographics, clinical characteristics, operative details, and hospital course were collected. RESULTS A total of 98 patients underwent CRE: 68 CRE without cryo, 22 CRE + Cryo, and 8 combined MIRPE + CRE + Cryo. Ninety percent of patients underwent bioabsorbable rib plating. Patients were predominantly female (79%, 73%, 50% respectively) with median ages 17.6, 16.9, and 14.2 years respectively. CRE + Cryo patients used significantly less opioids in hospital (0.6 OME/kg [0.1,1.2]) compared to CRE without cryo (1.0 OME/kg [0.6,2.1]), p < 0.05. The median length of stay (LOS) in CRE + Cryo was 1 day [1,2] compared to 2 days in CRE without cryo [1,2], p = 0.09. MIRPE + CRE + Cryo patients used 0.6 OME/kg [0.2,8.0] with a 2 day [1,5.5] LOS. Ninety-one percent of Cryo patients had cryoablation of T9 and/or T10 intercostal nerves, with no documented abdominal wall laxity at median follow-up of 16 days. Cryo was applied extra-thoracically in CRE + cryo without thoracoscopy or lung isolation, while MIRPE + CRE + Cryo used a combination extra-/intra-thoracic cryoablation in with thoracoscopy. CONCLUSION Intercostal nerve cryoablation reduces opioid use and LOS in patients undergoing cartilaginous rib excision for slipping rib syndrome. Cryotherapy to as low as T10 did not result in abdominal wall laxity and can be applied extra-thoracically without the need for thoracoscopy. Ongoing prospective studies are required to assess the long-term outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Krista Lai
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.
| | - R Scott Eldredge
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Melissa Nguyen
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Benjamin E Padilla
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Lisa E McMahon
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.
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MacGregor RM, Schulte LJ, Merritt TC, Keller MS, Aubuchon JD, Abarbanell AM. Slipping Rib Syndrome in Children: Natural History and Outcomes Following Costal Cartilage Excision. J Surg Res 2022; 280:204-208. [PMID: 35994982 DOI: 10.1016/j.jss.2022.06.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Slipping rib syndrome (SRS) or subluxation of the medial aspect of the lower rib costal cartilages is an underdiagnosed cause of debilitating pain in otherwise healthy children. Costal cartilage excision may provide definitive symptom relief. However, limited data exist on the natural history, difficulty in diagnosis, and patient-reported outcomes for SRS in children. METHODS We performed a single-institution descriptive study using chart review and a patient-focused survey for patients who underwent surgery for SRS from 2012 to 2020. Data regarding demographics, symptoms, diagnostic workup, and patient-reported outcomes were collected. RESULTS Surgical resection was performed in 13 children. The median age at symptom onset was 12.5 y [IQR 9.7, 13.9], with a preponderance of girls (10, 77%). Eight patients participated in competitive athletics at the time of symptom onset. Prior to diagnosis, patients were seen by a median 3 [IQR 2, 5] providers with a median of 4 [IQR 3, 6] non-diagnostic imaging exams performed. The children included in the study underwent surgery for left (8), bilateral (4), and right (1) SRS. Two were lost to follow-up. At median post-op follow-up of 3.5 mo [IQR 1.2, 9.6], 73% (8/11) had returned to full activity. One reported non-limiting persistent pain symptoms. CONCLUSIONS Lack of knowledge regarding SRS may result in delayed diagnosis, excessive testing, and limitation of physical activity. Operative treatment appears to provide durable relief and should be considered for children with SRS. The challenge remains to decrease the number of non-diagnostic exams and time to diagnosis.
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Affiliation(s)
| | | | - Taylor C Merritt
- Section of Pediatric Cardiothoracic Surgery, St. Louis, Missouri
| | | | - Jacob D Aubuchon
- Division of Pediatric Anesthesiology, Washington University School of Medicine, St. Louis, Missouri
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4
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Long-term outcomes and satisfaction rates after costal cartilage resection for slipping rib syndrome. J Pediatr Surg 2021; 56:2258-2262. [PMID: 33546899 DOI: 10.1016/j.jpedsurg.2021.01.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Slipping rib syndrome (SRS) is a challenging and underdiagnosed condition. We previously demonstrated the efficacy of costal cartilage resection for SRS and now report long-term follow-up of our updated cohort. METHODS Retrospective chart review with prospective telephone follow-up was performed for 30 previously analyzed patients and 22 new patients to elucidate risk factors for recurrence, discuss preoperative experience, current symptoms, postoperative course, and satisfaction. RESULTS From 2006-2020, 49 patients met inclusion criteria and underwent 67 operations. Eleven underwent re-operation for recurrence, with median time of 1.6 years [1.2, 2.6]. Median age of symptom onset was 13 years [11,14] while median age at diagnosis was 15.4 years [14, 16.7]. 29/49 (59%) patients were contacted, with median follow-up of 4.5 years [2.1, 5.7]. Twenty-one patients (72%) reported complete cure, 20 (69%) reported satisfaction 10/10, with 83% rating their satisfaction >7/10. Eleven patients (38%) were offered opioids for pain control prior to surgical evaluation. Patients with recurrence had residual or fused cartilage, hypermobile bony ribs, or both, at re-excision. CONCLUSIONS Costal cartilage resection is an effective treatment for SRS with high satisfaction rates and an appropriate consideration for patients who fail conservative management. LEVEL OF EVIDENCE Level IV; Case series with no comparison groups.
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Bain ART, Hunt I, Shah MA. The use of dynamic ultrasound in the diagnosis of slipping rib syndrome. SONOGRAPHY 2021. [DOI: 10.1002/sono.12250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Andrew R. T. Bain
- Radiology Department St George's University Hospitals Tooting London UK
| | - Ian Hunt
- Cardiothoracic Surgery St George's University Hospitals Tooting London UK
| | - Mohammad Ali Shah
- Radiology Department St George's University Hospitals Tooting London UK
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Obourn PJ, Benoit J, Brady G, Campbell E, Rizzone K. Sports Medicine-Related Breast and Chest Conditions-Update of Current Literature. Curr Sports Med Rep 2021; 20:140-149. [PMID: 33655995 DOI: 10.1249/jsr.0000000000000824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.
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Affiliation(s)
- Peter J Obourn
- Department of Orthopaedics, Division of Sports Medicine, University of Rochester Medical Center, Rochester, NY
| | - Janeeka Benoit
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
| | - Geena Brady
- Sports and Spine Rehabilitation, University of Rochester Medical Center, Rochester, NY
| | - Elisabeth Campbell
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
| | - Katherine Rizzone
- Department of Orthopaedics, Division of Sports Medicine, University of Rochester Medical Center, Rochester, NY
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Squillaro AI, Sanders K, Onwubiko C, Chang CJ, Kim S. Laparoscopic Treatment of Slipping Rib Syndrome in Pediatric Patients. J Laparoendosc Adv Surg Tech A 2020; 30:1253-1256. [DOI: 10.1089/lap.2020.0314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anthony I. Squillaro
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Katherine Sanders
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Chinwendu Onwubiko
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland, California, USA
| | - Cindy J. Chang
- Departments of Orthopedic Surgery and Family & Community Medicine, Primary Care Sports Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sunghoon Kim
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
- Division of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland, California, USA
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Hansen AJ, Toker A, Hayanga J, Buenaventura P, Spear C, Abbas G. Minimally Invasive Repair of Adult Slipped Rib Syndrome Without Costal Cartilage Excision. Ann Thorac Surg 2020; 110:1030-1035. [PMID: 32330472 DOI: 10.1016/j.athoracsur.2020.02.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/11/2020] [Accepted: 02/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Slipped rib syndrome (SRS) is a painful disorder caused when 1 or more of the 8th-10th false ribs become abnormally mobile. Established treatment modalities include analgesia, intercostal nerve injection, and costal cartilage excision. No definitive surgical correction of SRS without cartilage excision has been previously described. We aimed to determine whether a nonexcisional repair technique in affected adults could demonstrate significant relief from SRS using standardized outcome measures. METHODS We performed a retrospective review of cases of SRS treated at our institution in 2019. We obtained data by survey before and after sutured 10th rib fixation, using a self-reported rating scale from 0-10 at defined intervals. Surveyed outcome measures were compared pre- and postoperatively using the Wilcoxon signed rank sum test. The use of neural modulating, narcotic, and nonsteroidal antiinflammatory drug medications was also compared pre- and postoperatively using McNemar's test where applicable. RESULTS SRS was diagnosed using clinical examination alone in 42 adults and repaired in 29 patients. Median postoperative improvement in pain at 1 and 6 months was 75% (P < .001) and 80% (P < .001), respectively. Improvements in other outcome measures were similar. In patients who took pain medications preoperatively, narcotics were discontinued at 1 month by 100%, neural modulators by 86%, and nonsteroidal antiinflammatory drugs by 92% (all P values < .001). Pain medication use remained minimal at 6 months in 23 (79%) of patients completing follow-up. CONCLUSIONS Minimally invasive slipped rib repair in adults provides significant relief of SRS, offering a useful alternative to costal cartilage excision. It is well tolerated and effective.
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Affiliation(s)
- Adam J Hansen
- Division of Thoracic Surgery, West Virginia University College of Medicine, Heart and Vascular Institute, Morgantown, West Virginia.
| | - Alper Toker
- Division of Thoracic Surgery, West Virginia University College of Medicine, Heart and Vascular Institute, Morgantown, West Virginia
| | - Jeremiah Hayanga
- Division of Thoracic Surgery, West Virginia University College of Medicine, Heart and Vascular Institute, Morgantown, West Virginia
| | - Percival Buenaventura
- Division of Thoracic Surgery, West Virginia University College of Medicine, Heart and Vascular Institute, Morgantown, West Virginia
| | - Charlotte Spear
- Division of Thoracic Surgery, West Virginia University College of Medicine, Heart and Vascular Institute, Morgantown, West Virginia
| | - Ghulam Abbas
- Division of Thoracic Surgery, West Virginia University College of Medicine, Heart and Vascular Institute, Morgantown, West Virginia
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Abstract
OBJECTIVE (1) To investigate the clinical presentation, diagnosis, and treatment of slipping rib syndrome in athletes; (2) to investigate the hooking maneuver for diagnosis of slipping rib syndrome. DESIGN Retrospective chart review of 362 athletes with rib pain. SETTING Pediatric-based sports medicine clinic between January 1, 1999, and March 1, 2014. PATIENTS Costochondritis, Tietze, fractures, rib tip syndrome, and unclear diagnoses were excluded. Athletes were included who had a palpable rib subluxation, mechanical rib symptom, positive hooking maneuver, or resolution of pain after the resection of a slipping rib segment. MAIN OUTCOME MEASURES Slipping rib syndrome is associated with athletic performance. RESULTS Fifty-four athletes were diagnosed with slipping rib syndrome, of which 38 (70%) were females. Mean age at presentation was 19.1 years (range 4-40 years). Mean number of previous specialist consultations per athlete was 2.3 and mean time from symptom onset to diagnosis was 15.4 months. The hooking maneuver was attempted 21 times (38.9%). Unilateral symptoms presented in 49 athletes (90.7%). The most symptomatic rib was the 10th, affecting 24 athletes (44.4%), eighth and ninth were affected in 17 athletes (31.5%) each. Most, 39 (72.2%), reported insidious onset of symptoms. Running, rowing, lacrosse, and field hockey were frequently associated activities. Twelve athletes had psychiatric diagnoses (22.2%), 10 (19.2%) were hypermobile. Sixty-six total imaging studies were performed. The most successful treatment options included: osteopathic manipulative treatment (71.4%), surgical resection (70%), and diclofenac gel (60%). CONCLUSIONS Most athletes with slipping rib syndrome were active females with insidious onset of unilateral pain, a high prevalence of hypermobility and prolonged pain. The hooking maneuver was underused.
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Frumkin K, Delahanty LF. Peripheral neuropathic mimics of visceral abdominal pain: Can physical examination limit diagnostic testing? Am J Emerg Med 2018; 36:2279-2285. [PMID: 30170933 DOI: 10.1016/j.ajem.2018.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The emergency department evaluation of patients with abdominal pain is most appropriately directed at identifying acute inflammation, infection, obstruction, or surgical disease. Doing so commonly involves "routine" (and often extensive) diagnostic imaging and laboratory testing. Benign mimics of serious visceral abdominal pain that can be diagnosed by physical exam and confirmed with local anesthetic injections have been identified over the last century. These syndromes derive from painful irritation of the intercostal nerves by a mobile rib below, or from impingement of the cutaneous branches of those same intercostal nerves as they penetrate the abdominal wall. These peripheral neuropathic mimics of visceral abdominal pain continue to go unrecognized and underdiagnosed. METHODS Our purpose is to review the affirmative diagnosis of non-visceral abdominal pain by physical examination. RESULTS The consequences of failure to identify these conditions are considerable. In the search for a diagnosis that is literally at the provider's fingertips, patients frequently undergo months to years of fruitless and often invasive diagnostic tests, not uncommonly including unsuccessful surgeries. CONCLUSIONS With proper consideration of and appropriate testing for visceral etiologies, a carefully directed physical examination may yield an affirmative diagnosis in a percentage of these common emergency department patients.
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Affiliation(s)
- Kenneth Frumkin
- Emergency Medicine Department, Naval Medical Center, Portsmouth, VA, USA.
| | - Liam F Delahanty
- Emergency Medicine Department, Naval Medical Center, Portsmouth, VA, USA
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Kuehn R, Muncie C, Berch B. Recurrent Pain after Resection for Slipping Rib Syndrome: Report of a Difficult Case. Am Surg 2018. [DOI: 10.1177/000313481808400901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rachael Kuehn
- Division of Pediatric Surgery University of Mississippi Medical Center Jackson, Mississippi
| | - Colin Muncie
- Division of Pediatric Surgery University of Mississippi Medical Center Jackson, Mississippi
| | - Barry Berch
- Division of Pediatric Surgery University of Mississippi Medical Center Jackson, Mississippi
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Abstract
Slipping rib syndrome (SRS) is an under-diagnosed cause of intermittent, yet often debilitating lower rib and abdominal pain. SRS is caused by a hypermobility of the anterior false ribs that allows the 8th-10th ribs to slip or click as the cartilaginous rib tip abuts or slips under the rib above. Pain occurs from impingement of the intercostal nerve passing along the undersurface of the adjacent rib. Studies consistently find patients reporting months to years of typical pain symptoms, unnecessary tests and procedures prior to diagnosis. SRS is a clinical diagnosis, but dynamic ultrasound can be helpful for confirmation or diagnosis in difficult cases. Resection of the slipping rib cartilages is the mainstay of treatment, with good results for pain relief. Rib stabilization is an emerging option for recurrent symptoms.
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Affiliation(s)
- Lisa E McMahon
- Division of Pediatric Surgery, Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, Arizona 85016; Mayo Clinic School of Medicine Arizona, Phoenix, Arizona; University of Arizona School of Medicine, Phoenix, Arizona. United States.
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13
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Abstract
PURPOSE Classical slipping rib syndrome (SRS) can be subclassified based on anatomical location. We describe our experience with three patients suffering from symptomatic sternocostal slipping rib syndrome (SCSRS), a much less common variant of SRS. METHODS This was a retrospective review of patients with SRS from 1988 to 2016. Described is our experience. RESULTS Of 44 patients identified with SRS, three patients underwent operations for SCSRS variant. All three had significant pain and point tenderness at the sternocostal junction, and all experienced a popping sensation localized to this area. The mean age at onset was 14.3 years and mean time to diagnosis was 1.3 years. All patients experienced total resolution of symptoms following localized excision of the offending cartilage. CONCLUSIONS A high index of suspicion based on history and physical examination are key to the early diagnosis of SCSRS. Excision of the symptomatic cartilage is effective for treatment.
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Kerr H, Bowen B, Light D. Thoracoabdominal Injuries. CONTEMPORARY PEDIATRIC AND ADOLESCENT SPORTS MEDICINE 2018. [PMCID: PMC7123492 DOI: 10.1007/978-3-319-56188-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Trauma to the thorax and abdomen can occur during participation in sports. This chapter reviews some of the more common presentations of such injuries and how such injuries should be best managed. Thoracic injuries reviewed include internal injuries such as pneumothorax, pulmonary contusion, hemothorax, commotio cordis, and cardiac contusion. Chest wall injuries are also reviewed such as rib fractures, costochondritis, and slipping rib syndrome plus sternal and scapular fractures. Abdominal injuries reviewed are focused on internal organ trauma to the spleen and liver, kidney, pancreas, and bowel. There is attention to the effect of Epstein-Barr virus and infectious mononucleosis, seen very frequently in high school and collegiate athletes. Finally, groin pain and athletic pubalgia are described. In addition to anatomy and clinical presentation, imaging modalities that characterize such trauma are reviewed for each diagnosis. Prevention of thoracoabdominal injuries and return-to-play decisions are described at the chapter conclusion.
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Gasparri M, Gasparri M. Slipping Rib Syndrome and Other Causes of Chest Wall Pain. RIB FRACTURE MANAGEMENT 2018:105-116. [DOI: 10.1007/978-3-319-91644-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Gould JL, Rentea RM, Poola AS, Aguayo P, St Peter SD. The effectiveness of costal cartilage excision in children for slipping rib syndrome. J Pediatr Surg 2016; 51:2030-2032. [PMID: 27697317 DOI: 10.1016/j.jpedsurg.2016.09.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/12/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Slipping rib syndrome (SRS) is an elusive diagnosis. Previous reports have been single cases or small series. We previously reported a small multicenter review with encouraging early results. We now describe our matured experience. METHODS This is a follow-up study of patients with SRS from 2006 to 2015. Included are 5 previously analyzed patients and 25 new patients. Patients were called to review current symptoms, course, and satisfaction. RESULTS From 2006 to 2015, 30 patients underwent 38 operations. Eight underwent re-operation. All had reproducible pain localized to the costal margin, 60% had a popping sensation, and 23% were bilateral. 86% were female. Median age of symptom onset was 14 (IQR 13.75-15) years, while median age at diagnosis was 16 (IQR 15-17). Contact was possible with 18/30 patients, and mean follow up time was 1.3years. 72% of those felt they were cured, and 44% rated satisfaction a 10/10 (mean 7.84). Of those not cured, all reported significant improvement. CONCLUSIONS Costal cartilage excision is an effective treatment for SRS and should be considered early in the workup of costal margin pain in a normally active population. Case Series with no Comparison Group - Level IV.
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Affiliation(s)
- Joanna L Gould
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Ashwini S Poola
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
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Knezevic NN, Rana MV, Czarnocki P, Anantamongkol U. Reprogramming of in situ spinal cord stimulator for covering newly developed postthoracotomy pain. J Clin Anesth 2015; 27:411-5. [PMID: 25980625 DOI: 10.1016/j.jclinane.2015.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 12/17/2014] [Accepted: 04/16/2015] [Indexed: 11/27/2022]
Abstract
The objective of this case report is to describe the use of in situ spinal cord stimulator (SCS) for postthoracotomy pain syndrome (PTPS). We report a 39-year-old woman with complex regional pain syndrome type I of the left lower extremity. The patient's pain was relieved by a SCS for 1 month before the patient developed slipping rib syndrome at her T12 rib from an unrelated trauma. After failed conservative treatments and undergoing a thoracotomy procedure, the patient developed PTPS. Conservative management with medications and intercostal nerve blocks provided short-term relief. An already implanted single Octrode with Eon Mini generator (St Jude Neuromodulator, Plano, TX) at the T7 level was reprogrammed in attempt to recruit peripheral fibers to target the patient's additional areas of chest discomfort. This adjustment improved the pain at the left lateral rib area as well as her left leg. The patient was followed for 1 year, and her quality of life improved since her initial presenting symptoms. The use of the SCS in this patient provided significant lasting pain relief for both complex regional pain syndrome and PTPS. We believe that the use of SCS should be considered as a treatment option for patients with PTPS to avoid side effects associated with medications and to provide long-term pain relief.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, 60657, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, 60612, USA
| | - Maunak V Rana
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, 60657, USA; Department of Anesthesiology, University of Illinois, Chicago, IL, 60612, USA.
| | - Philip Czarnocki
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, 60657, USA
| | - Utchariya Anantamongkol
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, 60657, USA
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Kingsley RA. A little-known cause of chest pain in a 14-year-old athlete. J Pediatr Health Care 2014; 28:555-8. [PMID: 24929845 DOI: 10.1016/j.pedhc.2014.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/16/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
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Ayloo A, Cvengros T, Marella S. Evaluation and Treatment of Musculoskeletal Chest Pain. Prim Care 2013; 40:863-87, viii. [DOI: 10.1016/j.pop.2013.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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