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Slipping rib syndrome — an intricate clinical entity?


Cardiology Care


Dr Naveen Mudalagiri FRCP MD BSC MBBS PGCERT Consultant Cardiologist Highest rated 5 star cardiologist TOPDOCTORS.UK


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T: 020 3916 5159 E: cardiologycare@outlook.com www. cardiologycare.uk


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Slipping rib syndrome (SRS) is also known as Cyriax syndrome, rib-tip syndrome, painful rib syndrome, clicking rib and interchondral subluxation. It’s associated with hypermobility — where the aff ected rib slips under the superior adjacent rib. During this movement, the intercostal nerve is trapped, triggering the symptoms. While still relatively unfamiliar to most healthcare providers, recent publications demonstrate that SRS accounts for approximately 5% of all musculoskeletal chest pain in primary care. Aff ecting both men and women of all ages, it’s associated with chronic lower rib and upper abdominal pain, impacting daily activities and quality of life. It can be the result of a previous blunt rib cage injury but oſt en can be congenital anomaly or of unknown origin. Its main clinical characteristics include a persistent discomfort, sharp pain in the lower ribs on one or both sides along with a burning sensation and possible radiating symptoms to the anterior ribs or the back. Unfortunately, given the vagueness


of symptoms, variety of location distribution and lack of radiologic evidence, patients will sometimes


visit physicians for years before establishing a correct diagnosis. In the meantime numerous investigations are carried out including chest X-rays, CT and MRI scans, gastroscopy etc — in most cases, reported as normal. An initial diagnosis can be


made with clinical examination and confi rmed with a dynamic ultrasound. Conservative treatment options include rest, analgesia, anti-infl ammatory medication and avoidance of strenuous exercising. Injection of local anaesthetic with steroids can be a diagnostic and symptomatic relief option. If more conservative measures fail, surgery for the stabilisation of the rib can provide, in selected patients, a defi nitive solution.


For more information


Mr Nikolaos Panagiotopoulos is a consultant thoracic surgeon with an interest in minimally invasive and robotic assisted thoracic surgery. He’s practising in central London. Face-to-face and virtual appointments. E: nick@chestsurgeon.co.uk T: 07501 789354 W: chestsurgeon.co.uk


MR NIKOLAOS PANAGIOTOPOULOS


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