1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
Nummela MT, Pyhältö TT, Bensch FV, Heinänen MT, Koskinen SK. Costal cartilage fractures in blunt polytrauma patients - a prospective clinical and radiological follow-up study. Emerg Radiol 2022; 29:845-854. [PMID: 35661281 PMCID: PMC9458556 DOI: 10.1007/s10140-022-02066-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
Abstract
Purpose To assess the healing of costal cartilage fractures (CCFX) in patients with blunt polytrauma with follow-up imaging and clinical examination. Effect on physical performance and quality of life (QoL) was also evaluated. Methods The study group comprised twenty-one patients with diagnosed CCFX in trauma CT. All the patients underwent MRI, ultrasound, ultra-low-dose CT examinations, and clinical status control. The patients completed QoL questionnaires. Two radiologists evaluated the images regarding fracture union, dislocation, calcifications, and persistent edema at fracture site. An attending trauma surgeon clinically examined the patients, with emphasis on focal tenderness and ribcage mobility. Trauma registry data were accessed to evaluate injury severity and outcome. Results The patients were imaged at an average of 34.1 months (median 36, range 15.8–57.7) after the initial trauma. In 15 patients (71.4%), CCFX were considered stable on imaging. Cartilage calcifications were seen on healed fracture sites in all the patients. The fracture dislocation had increased in 5 patients (23.8%), and 1 patient (4.8%) showed signs of a non-stable union. Four patients (19.0%) reported persistent symptoms from CCFX. Conclusion Non-union in CCFX is uncommon but may lead to decreased stability and discomfort. Both clinical and radiological examinations play an important part in the post-traumatic evaluation of CCFX. CT and MRI visualize the healing process, while dynamic ultrasound may reveal instability. No significant difference in QoL was detected between patients with radiologically healed and non-healed CCFX. Post-traumatic disability was mostly due to other non-thoracic injuries. Supplementary Information The online version contains supplementary material available at 10.1007/s10140-022-02066-w.
Collapse
Affiliation(s)
- Mari T Nummela
- Department of Radiology, Töölö Hospital, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, PL 266, 00029 HUS, Helsinki, Finland.
| | - Tuomo T Pyhältö
- Department of Orthopaedics and Traumatology, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Frank V Bensch
- Department of Radiology, Töölö Hospital, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, PL 266, 00029 HUS, Helsinki, Finland
| | - Mikko T Heinänen
- Department of Orthopaedics and Traumatology, Töölö Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Seppo K Koskinen
- Department of Clinical Science, Intervention, and Technology, Division for Radiology, Karolinska Institute, Stockholm, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| |
Collapse
|
3
|
Patel N, John JK, Pakeerappa P, Aiyer R, Zador LN. Slipping rib syndrome: case report of an iatrogenic result following video-assisted thoracic surgery and chest tube placement. Pain Manag 2021; 11:555-559. [PMID: 33980032 DOI: 10.2217/pmt-2020-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this case report is to shed light on slipping rib syndrome (SRS), a painful and overlooked condition. A 62-year old man reported intermittent, self-resolving sharp rib pain that began after a video-assisted thoracic surgery and chest tube placement 4 years prior to presentation. The patient's pain was associated with a rigid protrusion in the right upper quadrant, and home use of acetaminophen provided no relief. After physical examination, multiple imaging and lab tests, the patient was diagnosed with SRS and was referred to physical therapy and thoracic surgery for further evaluation. SRS is an under-recognized cause of upper abdominal and lower thoracic pain that should be considered if a patient's history includes previous trauma or abdominal surgery.
Collapse
Affiliation(s)
- Nimesh Patel
- Anesthesiology, Henry Ford Health Systems, Detroit, MI 48202, USA
| | - Jessin K John
- Anesthesiology, Henry Ford Health Systems, Detroit, MI 48202, USA
| | - Praveen Pakeerappa
- Interventional Pain Medicine, Henry Ford Health Systems, Detroit, MI 48202, USA
| | - Rohit Aiyer
- Interventional Pain Medicine & Pain Psychiatry, Henry Ford Health Systems, Detroit, MI 48202, USA
| | - Lara N Zador
- Anesthesiology & Pain Medicine, Henry Ford Health Systems, Detroit, MI 48202, USA
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Vijay CS, Chen CB. Recurrent Rib Pain in a 13-year-old Girl. Pediatr Rev 2020; 41:S64-S66. [PMID: 33004586 DOI: 10.1542/pir.2018-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Charles B Chen
- Department of Pediatrics, West Virginia University, Morgantown, WV
| |
Collapse
|
6
|
Dynamic ultrasound in the evaluation of patients with suspected slipping rib syndrome. Skeletal Radiol 2019; 48:741-751. [PMID: 30612161 DOI: 10.1007/s00256-018-3133-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/03/2018] [Accepted: 12/09/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Slipping rib syndrome (SRS) affects adolescents and young adults. Dynamic ultrasound plays a potential and likely significant role; however, limited data exist describing the protocol and techniques available. It is our intent to describe the development of a reproducible protocol for imaging in patients with SRS. MATERIALS AND METHODS Retrospective review of suspected SRS patients from March 2017 to April 2018. A total of 46 patients were evaluated. Focused history and imaging was performed at the site of pain. Images of the ribs were obtained in the parasagittal plane at rest and with dynamic maneuvers. Dynamic maneuvers included Valsalva, crunch, rib push maneuver, and any provocative movement that elicited pain. Imaging was compared with records from the pediatric surgeon specializing in slipping ribs. Statistical analysis was performed. RESULTS Thirty-six of the 46 patients had a diagnosis of SRS, and had an average age of 17 years. Thirty-one patients were female, 15 were male. Thirty-one out of 46 (67%) were athletes. Average BMI was 22.6. Dynamic ultrasound correctly detected SRS in 89% of patients (32 out of 36) and correctly detected the absence in 100% (10 out of 10). Push maneuver had the highest sensitivity (87%; 0.70, 0.96) followed by morphology (68%; 0.51, 0.81) and crunch maneuver (54%; 0.37, 0.71). Valsalva was the least sensitive (13%; 0.04, 0.29). CONCLUSION Dynamic ultrasound of the ribs, particularly with crunch and push maneuvers, is an effective and reproducible tool for diagnosing SRS. Valsalva plays a limited role. In addition to diagnosing SRS, ultrasound can give the surgeon morphological data and information on additional ribs at risk, thereby assisting in surgical planning.
Collapse
|
7
|
Slipping Rib Syndrome: Solving the Mystery of the Shooting Pain. Am J Med Sci 2019; 357:168-173. [DOI: 10.1016/j.amjms.2018.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022]
|
8
|
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.
Collapse
|
9
|
Slipping Rib Syndrome in a Female Adult with Longstanding Intractable Upper Abdominal Pain. Case Rep Med 2018; 2018:7484560. [PMID: 30057619 PMCID: PMC6051074 DOI: 10.1155/2018/7484560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/12/2018] [Accepted: 04/29/2018] [Indexed: 11/17/2022] Open
Abstract
Slipping rib syndrome is a rare cause of abdominal or lower chest pain that can remain undiagnosed for many years. Awareness among health care personnel of this rare but significant disorder is necessary for early recognition. Prompt treatment can avoid unnecessary testing, radiographic exposure, and years of debilitating pain. A 52-year-old female was evaluated for a 3-year history of recurrent abdominal and lower chest pain. Pain was sharp, primarily located in the lower chest and subcostal region left more than right, waxing and waning, nonradiating, and aggravates with specific movements. She underwent frequent physical therapies, treated with multiple muscle relaxants and analgesics with minimal improvement. Imaging modalities including CT scan, MRI, and X-rays performed on multiple occasions failed to signify any underlying abnormality. Complete physical examination was unremarkable except for positive hooking maneuver. Dynamic flow ultrasound of lower chest was performed which showed slipping of the lowest rib over the next lowest rib bilaterally left worse than right, findings consistent with slipping rib syndrome. Slipping rib syndrome is caused by hypermobility of the floating ribs (8 to 12) which are not connected to the sternum but attached to each other with ligaments. Diagnosis is mostly clinical, and radiographic tests are rarely necessary. Hooking maneuver is a simple clinical test to reproduce pain and can aid in the diagnosis. Reassurance and avoiding postures that worsen pain are usually helpful. In refractory cases, nerve block and surgical intervention may be required.
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
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.
Collapse
|
12
|
Nummela MT, Bensch FV, Pyhältö TT, Koskinen SK. Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma. Radiology 2017; 286:696-704. [PMID: 29095676 DOI: 10.1148/radiol.2017162429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ2 and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P < .0001). Hepatic injuries were more common in patients with chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion CC fractures are common in high-energy blunt chest trauma and often occur with multiple consecutive rib fractures. Aortic and hepatic injuries were more common in patients with CC fractures than in patients without CC fractures. © RSNA, 2017.
Collapse
Affiliation(s)
- Mari T Nummela
- From the Department of Radiology, HUS Medical Imaging (M.T.N., F.V.B.), and Department of Orthopedics and Traumatology (T.T.P.), Töölö Hospital, Helsinki University Hospital, PL 266, 00029 Helsinki, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (S.K.K.); and Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden (S.K.K.)
| | - Frank V Bensch
- From the Department of Radiology, HUS Medical Imaging (M.T.N., F.V.B.), and Department of Orthopedics and Traumatology (T.T.P.), Töölö Hospital, Helsinki University Hospital, PL 266, 00029 Helsinki, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (S.K.K.); and Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden (S.K.K.)
| | - Tuomo T Pyhältö
- From the Department of Radiology, HUS Medical Imaging (M.T.N., F.V.B.), and Department of Orthopedics and Traumatology (T.T.P.), Töölö Hospital, Helsinki University Hospital, PL 266, 00029 Helsinki, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (S.K.K.); and Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden (S.K.K.)
| | - Seppo K Koskinen
- From the Department of Radiology, HUS Medical Imaging (M.T.N., F.V.B.), and Department of Orthopedics and Traumatology (T.T.P.), Töölö Hospital, Helsinki University Hospital, PL 266, 00029 Helsinki, Finland; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden (S.K.K.); and Department of Radiology, Karolinska University Hospital Huddinge, Stockholm, Sweden (S.K.K.)
| |
Collapse
|
13
|
van Delft EAK, van Pul KM, Bloemers FW. The slipping rib syndrome: A case report. Int J Surg Case Rep 2016; 23:23-4. [PMID: 27082995 PMCID: PMC4855817 DOI: 10.1016/j.ijscr.2016.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 11/30/2022] Open
Abstract
The slipping rib syndrome is a condition hard to recognize. By performing a hooking maneuver the diagnosis slipping rib syndrome can be made. When pain medication is not sufficient, resection of the rib can be performed. Knowledge of the syndrome can prevent unnecessary comprehensive treatment.
We present a case report and review of literature about slipping rib syndrome, a syndrome rarely recognized and often un or misdiagnosed. In literature there is no clear consensus about the diagnosis and treatment. We present a case of a 47 year old man who was diagnosed with slipping rib syndrome after a cycling incident 8 years ago. Also, we developed a flow chart according the diagnostic and therapeutic steps in the treatment of slipping rib syndrome. Central massage Knowledge and treatment of the slipping rib syndrome can prevent chronic complaints and unnecessary comprehensive treatment.
Collapse
Affiliation(s)
| | - K M van Pul
- VU University medical Center, Amsterdam, The Netherlands
| | - F W Bloemers
- VU University medical Center, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Bolaños-Vergaray JJ, de la Gala García F, Obaya Rebollar JC, Bové Alvarez M. Slipping Rib Syndrome as Persistent Abdominal and Chest Pain. ACTA ACUST UNITED AC 2015; 5:167-8. [DOI: 10.1213/xaa.0000000000000243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
15
|
|
16
|
Affiliation(s)
- Nelson L Turcios
- Pediatric Pulmonology, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA.
| |
Collapse
|
17
|
Kaczynski J, Dillon M, Hilton J. Superior subluxation of an anterior end of the first rib in a trauma patient. BMJ Case Rep 2012; 2012:bcr.02.2012.5796. [PMID: 22669858 DOI: 10.1136/bcr.02.2012.5796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a young man with a superior subluxation of an anterior end of the first rib following a road traffic accident. To the best of our knowledge, no similar case has so far been described in the literature. The patient presented with headache, backache and pain in the right anterior chest wall. After initial assessment, a chest radiograph was performed and it showed no abnormalities. A CT of the chest revealed an isolated hypermobile first rib at the anterior end owing to superior subluxation. The patient was treated conservatively.
Collapse
Affiliation(s)
- Jakub Kaczynski
- General Surgery Department, ABM University Health Board, Morriston Hospital, Swansea, UK.
| | | | | |
Collapse
|
18
|
Abstract
The application of manual techniques to pediatric athletic injuries has been considered alternative medicine. There are many injuries that are associated with loss of normal motion. Altered biomechanics can be readily identified and treated using manual methods. These include articular or thrust techniques, muscle energy, strain-counterstrain, and myofascial treatments, among others. Although there are few high-quality studies available, most available literature reports effectiveness of manual techniques in combination with therapeutic exercise for common pediatric motion restrictions.
Collapse
Affiliation(s)
- Delmas J Bolin
- Department of Sports Medicine, Family Medicine, The Via College of Osteopathic Medicine, Blacksburg, VA 24060, USA.
| |
Collapse
|